You are caring for a 66 yr old man with a hx of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. The CT scane is negative for hemorrhage. The pt is receiving oxygen via nasal cannula at 2 L/min, and an IV has been established. His BP is 180/Which drug do you anticipate giving to this pt?(a) Aspirin(b) Glucose (D50)(c) Nicardipine(d) rTPA
  • (d) Hold aspirin for at least 24 hrs if rtPA is administered
  • (a) Aspirin
  • Check the patient's pulse.
  • (d) Epinephrine 1 mg IV/IO
STEMI intervention is most important in reducing patients in hospital and 30 day mortality?
  • reperfusion therapy
  • Determine whether pulses are present.
  • (b) Simultaenously
  • At least 2 inches
A patient has been rususcitated from cardiac arrest. During post-ROSC treatment, pt becomes unresponsive, with ventricular fibrillation. Which action is indicated next?(a) Give an immediate unsynchronized high-energy shock (defibrillation dose)(b) Give lidocaine 1 to 1.6 mg/kg IV(c) Perform synchronized cardioversion(d) Repeat amiodarone 300 mg IV
  • (a) Give an immediate unsynchronized high-energy shock (defibrillation dose)
  • Lidocaine, epinephrine, vasopressin
  • Atropine 0.5mg
  • (c) 150 mg IV push
A patient with sinus bradycardia and a heart rate of 42 has diaphoresis and blood pressure of 80/What is the initial dose of atropine?
  • Give an immediate unsynchronized high-energy shock (defibrillation dose)
  • (b) Epinephrine 1 mg IV/IO
  • Start chest compressions at a rate of at least 100/min.
  • 0.5 mg
What do you do next If the patient is unconscious when you first arrive on scene?
  • Continue CPR while charging the defibrillator.
  • 2 inches
  • Potential oxygen toxicity
  • Initiate BLS
What is the recommended assisted ventilation rate for patients in respiratory arrest with a perfusing rhythm?
  • 1 breath every 5-6 seconds
  • 1 to 2 Liters
  • 10 to 12 breaths per minute
  • Suction during withdrawal but for no longer than 10 seconds.
A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks to you for instructions. What is your next action?(a) Check the carotid pulse(b) Give amiodarone 300 mg IV(c) Give atropine 1 mg IV(d) Resume high-quality chest compressions
  • seek expert consultation
  • Give an immediate unsynchronized high-energy shock (defibrillation dose)
  • (d) Resume high-quality chest compressions
  • Simple airway manuevers and assisted ventilations.
During your assessment, your patient suddenly loses consciousness. After calling for help and determining that the patient is not breathing, you are unsure whether the patient has a pulse. What is your next action?
  • Epinephrine 1 mg
  • Epinephrine 2 to 10 mcg/min
  • (b) Start high-quality CPR
  • Begin chest compressions.
What is the minimum systolic blood pressure one should attempt to achieve with fluid, inotropic, or vasopressor administration in a hypotensive post-cardiac arrest patient who achieves ROSC?
  • 120to200J
  • 90mm Hg
  • 35-40mm Hg
  • Determine whether pulses are present.
Why should chest compressions recoil?
  • To ensure adequate coronary perfusion pressure
  • After the second CPR session
  • Prolonged interruptions in chest compressions.
  • Neurologic function- Alert- Pain- Voice- Unresponsive
After verifying the absence of a pulse, you initiate CPR with adequate bag-mask ventilation. The patient's lead II ECG appears below. What is your next action?
  • Intermittent non-conducted P waves without progressive prolongation of the PR interval (compare this to Mobitz I).
  • Vagal manuever.
  • IV or IO access
  • Synchronized cardioversion
A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the following lead II ECG rhythm: What is the appropriate next intervention?
  • administer a second shock.
  • Defibrillation
  • Administer 1mg of epinephrine
  • Synchronized cardioversion
a patient has been resuscitated from cardiac arrest. During post-ROSC treatment, the patient becomes unresponsive, with the rhythm VT. What tx is indicated
  • CPR
  • Seek expert consultation
  • unsynchronized high energy shock
You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previousy advised "no shock indicated." A rhythm check now finds asystole. After resuming high-quality compressions, which action do you take next?
  • Establish IV or IO access
  • (b) Establish IV or IO access
  • Begin chest compressions.
  • (b) Epinephrine 1 mg IV
A postoperative patient in the ICU reports new chest pain. What actions have the highest priority?
  • Epinephrine 1 mg or vasopressin 40 units IV or IO
  • Hands-free pads allow for a more rapid defibrillation.
  • Determine whether pulses are present.
  • Obtain a 12-lead ECG and administer aspirin if not contraindicated.
When should you determine if the rhythm is shockable for asystole or PEA in the cardiac arrest algorithm?
  • 500-600 mL or half of a bag squeeze
  • Continue CPR while the defibrillator is charging.
  • If the pt is hemodynamically unstable
  • After the first CPR session (2 minutes)
you are caring for a 66 year old man with a history of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. the ct scan is negative for hemorrhage. The patient is receiving oxygen via nasal cannula at 2 L/min, and an IV has been established. His blood pressure is 180/100 mm Hg. Which drug do you anticipate giving?
  • (a) Adenosine 6 mg
  • Gain IV or IO access
  • Synchronized cardioversion
  • aspirin
What should you assess for in the Disability function of ABCDE?
  • VF/pulseless VT associated with torsades de pointes
  • Identifying and treating early clinical deterioration.
  • Neurologic function- Alert- Pain- Voice- Unresponsive
  • Causes gastric insufflationIncr intrathoracic pressureDecr venous return and CODecr survival
If patient is in cardiac arrest and the rhythm is asystole and CPR is beign given. What is the first drug you should give?(a) Atropine 0.5 mg IV/IO(b) Atropine 1 mg IV/IO(c) Dopamine 2 to 20 mcg/kg per min IV/IO(d) Epinephrine 1 mg IV/IO
  • (d) Epinephrine 1 mg IV/IO
  • Give aspirin 160-325 mg to chew
  • Epinephrine 1 mg
  • Seek expert consultation
Your patient has been intubated. IV/IVO access is not available. Which combination of drugs can be administered by endotracheal route?
  • to the side of the left nipple, with the top edge of the pad a few inches below the armpit
  • (d) Start rescue breathing
  • Lidocaine, epinephrine, vasopressin
  • After the first CPR session (2 minutes)
Why should you not excessively ventilate?
  • Causes gastric insufflationIncr intrathoracic pressureDecr venous return and CODecr survival
  • Be sure oxygen is not blowing over the patient's chest during the shock.
  • 1- Immediate activation of EMS2- Early CPR 3- Rapid defibrillation (not in peds)4- Effective advanced life support5- Integrated post-cardiac arrest care
  • To ensure adequate coronary perfusion pressure
If atropine, tcp, dopamine, epinephrine all fail to tx bradycardia, what should you do?
  • Whether or not the sxs of onset are less than 12 hrs
  • Identifying and treating early clinical deterioration.
  • Obtain a 12-lead ECG and administer aspirin if not contraindicated.
  • (1) Seek expert consultation(2) Transcutaneous pacing
What is the recommended second dose of adenosine for patients in refractory but stable narrow-complex tachycardia?
  • 100-120 compressions per min
  • At least 2 inches
  • 12 to 24 hours
  • 12mg
If a patient is in cardiac arrest what are the first two steps?
  • (b) Start high-quality CPR
  • (1) CPR(2) Attach AED
  • (d) Epinephrine 1 mg IV/IO
  • 10 seconds or less
___________ correlates w/ ROSC
  • Antecubital vein
  • High quality CPR
  • Begin chest compressions.
  • Capnography
Which rhythm requires synchronized cardioversion?
  • Administration of IV or IO fluid bolus
  • Unconscious ptsNo gag reflex pts
  • Unstable supraventricular tachycardia
  • 10 to 12 breaths per minute
What is the appropriate interval for an interruption in chest compressions?
  • 8-10 breaths per minute
  • Peripheral IV
  • 100-120 compressions per min
  • 10 seconds or less
What is the appropriate procedure for endotracheal tube suctioning after the appropriate catheter is selected?
  • Peripheral IV
  • Suction during withdrawal but for no longer than 10 seconds.
  • 1 breath every 5-6 seconds
  • Not recommended for routine use
What are the consequences of interrupting CPR?
  • After the second CPR session
  • Continue CPR while charging the defibrillator.
  • VFib or pulseless VTach
  • coronary perfusion falls
Bradycardia is categorized as a HR less than...
  • 10 seconds
  • over 150 per minute
  • 300 mg
  • 50
A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks to you for instructions. Your immediate next order is?
  • Administer 1mg of epinephrine
  • Vagal manuever.
  • resume high quality chest compressions
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. What is the recommended route for drug administration during CPR?
  • Give an immediate unsynchronized high-energy shock (defibrillation dose)
  • 0.5mg
  • Seek expert consultation
  • IV or IO
Which intervention is most important in reducing this patient's in-hospital and 30 day mortality rate?(a) Application of transcutaenous pacemaker(b) Atropine administration(c) Nitroglycerin administration(d) Reperfusion therapy
  • Resume chest compressions
  • (c) 150 mg IV push
  • Check the patient's pulse.
  • (d) Reperfusion therapy
when do you consider cardioversion
  • - Severe bradycardia- Tachycardia- Hypotension- Phosphodiesterase inhibitors
  • Initiation of fibrinolytic therapy, if appropriate, within 1 hour of hospital arrival and 3 hours from onset of symptoms
  • if persistent tachycardia is causing:hypotensionaltered mental statussigns of shockchest painacute heart failure
  • To ensure adequate coronary perfusion pressure
You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated". A rhythm check now finds asystole. After resuming high-quality compressions, your next action is to what?
  • (b) Amiodarone 300 mg
  • (d) Reperfusion therapy
  • Gain IV or IO access
  • (d) IV or IO
What is more important to start for a nonresponsive patient with no pulse, putting on an AED or starting rescue breathing?
  • coronary perfusion falls
  • Allowing complete chest recoil
  • 32°C to 34°C
  • Starting rescue breathing
You arrive on scene to find CPR in progress. Nursing staff report the pt was recovering from a pulmonary embolism and suddenly collapsed. Two shocks have been delivered, and an IV has been initiated. What do you administer now?(a) Atropine 0.5 mg IV(b) Epinephrine 1 mg IV(c) Endotracheal intubation(d) Transcutaneous pacing
  • (a) Adenosine 6 mg
  • (d) Resume high-quality chest compressions
  • (b) Amiodarone 300 mg
  • (b) Epinephrine 1 mg IV
If a tachycardia patient is hemodynamically stable, what is the next thing you should assess?
  • If QRS is wide (>= 0.120 sec)
  • Resume chest compressions
  • Determine whether pulses are present.
  • About every 5-6 seconds
When can you use magnesium in cardiac arrest?
  • Unconscious ptsNo gag reflex pts
  • VF/pulseless VT associated with torsades de pointes
  • coronary perfusion falls
  • Switch providers about every 2 minutes or every 5 compression cycles.
Emergency medical responders are unable to obtain a peripheral IV for a patient in cardiac arrest. What is the next most preferred route for drug administration?
  • seek expert consultation
  • Intraosseous (IO)
  • IV or IO
  • adenosine 12 mg
Three minutes after witnessing a cardiac arrest, one member of your team inserts an endotracheal tube while another performs continuous chest compressions. During subsequent ventilation, you notice the presence of a waveform on the capnography screen and a PETCO2 level of 8 mm Hg. What is the significance of this finding?
  • Chest compressions may not be effective.
  • Give aspirin 160-325 mg to chew
  • (b) Establish IV or IO access
  • (b) Epinephrine 2 to 10 mcg/min
What are the contraindications of nitroglycerin according to the ACS algorithm?
  • Determine whether pulses are present.
  • - Severe bradycardia- Tachycardia- Hypotension- Phosphodiesterase inhibitors
  • Begin CPR, starting with chest compressions.
  • Providing quality compressions immediately before a defibrillation attempt.
You are the code team leader and arrive to find a patient with CPR in progress. On the next rhythm check, you see electrical activity on the monitor. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise, and IO access has been established. Which intervention would be your next action?(a) Atropine 1 mg(b) Dopamine at 10 to 20 mcg/kg per min(c) Epinephrine 1 mg(d) Intubation and administration of 100% oxygen
  • (b) Establish IV or IO access
  • (c) Epinephrine 1 mg
  • (d) Vagal manuevers
  • EPI 1 mg
How does complete chest recoil contribute to effective CPR?(a) Allows maximum blood return to the heart(b) Reduces rescuer fatigue(c) Reduces the risk of rib fractures(d) Increases the rate of chest compressions
  • (d) Hold aspirin for at least 24 hrs if rtPA is administered
  • (a) Allows maximum blood return to the heart
  • Allows maximum blood return to the heart
  • hold aspirin for at least 24 hours if rtPA is administered
What is the BEST strategy for performing high-quality CPR on a patient with an advanced airway in place?
  • 100-120 compressions per minute
  • 120to200J
  • Provide continuous chest compressions without pauses and 10 ventilations per minute.
  • Obstruction of venous return from the brain
What is the immediate danger of excessive ventilation during the post-cardiac arrest period for patients who achieve ROSC?
  • Prolonged interruptions in chest compressions.
  • Ventilating too quickly
  • 1 breath every 5-6 seconds
  • Decreased cerebral blood flow
A patient with pulseless ventricular tachycardia is defibrillated. What is the next action?
  • Start chest compressions at a rate of at least 100/min.
  • Bypass chest compressions and ventilate every 5-6 seconds
  • Ventilating until you see the chest rise
  • Resume chest compressions
A patient with possible ST-segment elevation MI has ongoing chest discomfort. What is a containdication to the administration of nitrates?
  • Ventilating until you see the chest rise
  • Phosphodiesterase inhibitor within 12 hours
  • Start rescue breathing
  • Right ventricular infarction and dysfunction
Which is a contraindication to nitroglycerin administration in the management of acute coronary syndromes?
  • resume high-quality chest compression
  • Begin CPR, starting with chest compressions.
  • Right ventricular infarction and dysfunction
  • Optimizing ventilation and oxygenation.
EMS is transporting a patient with a positive prehospital stroke assessment. Upon arrival in the emergency department, the initial blood pressure is 138/78 mm Hg, the pulse rate is 80/min, the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95% on room air. The lead II ECG displays sinus rhythm. The blood glucose level is within normal limits. What intervention should you perform next?
  • Initiate BLS
  • Epinephrine 1 mg
  • 5 to 10 seconds
  • Head CT scan
What rhythms are NOT shockable
  • When there is bradycardia and perfusion is low
  • Asystole or PEA
  • At least 100/min
  • Antecubital vein
Which intervention is most appropriate for the treatment of a patient in asystole?(a) Atropine(b) Defibrillation(c) Epinephrine(d) Transcutaneous pacing
  • (c) Epinephrine
  • Atropine 0.5mg
  • (b) Epinephrine 2 to 10 mcg/min
  • (d) Reperfusion therapy
A 45-year-old woman with a history of palpitations develops light-headedness and palpitations. She has received adensoine 6mg IV for the rhythm shown here (SVT), without conversion of the rhythm. She is now extremely apprehensive. Her blood pressure si 128/70mm Hg. What is the next appropriate intervention?
  • Administer adenosine 12 mg IV
  • (c) Perform electrical cardioversion
  • Obtain a 12 lead ECG.
  • Cincinnati Prehospital Stroke Scale assessment
Which of the following is a sign of effective CPR?
  • PETCO2 ≥10 mm Hg
  • Antecubital vein
  • resume chest compressions
  • monitor and observe
During a pause in CPR, you see this lead II ECG rhythm on the monitor. The patient has no pulse. What is the next action?
  • Resume compressions
  • IV or IO access
Which intervention is most appropriate for the treatment of a patient in asystole?
  • Epinephrine
  • 12 to 24 hours
  • Initiate BLS
  • At least 2 inches
What is the recommended dose of epinephrine for the treatment of hypotension in a post- cardiac arrest patient who achieves ROSC?
  • Ventilating until you see the chest rise
  • Begin CPR, starting with chest compressions.
  • 0.1 to 0.5 mcg/kg per minute IV infusion
  • 100-120 compressions per min
A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm: What is the appropriate next intervention?
  • Epinephrine 1 mg IV/IO
  • Defibrillation
Type of breaths (not normal) that may be present in the first minutes after sudden cardiac arrest
  • 32°C to 34°C
  • Agonal gasps
  • 10 to 12 breaths per minute
  • Epinephrine
You are providing bag-mask ventilations to a patient in respiratory arrest. How often should you provide ventilation?
  • Establish IV or IO access
  • About every 5-6 seconds
  • Start rescue breathing
  • Epinephrine 1 mg IV
A 35 yr old female has palpitation, light-headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal manuevers have not been effective in terminating the rhythm. An IV has been established. Which drug should be administered?(a) Adenosine 6 mg(b) Atropine 0.5 mg(c) Epinephrine 2 to 10 mcg/kg per minute(d) Lidocaine
  • (b) Ventilating too quickly
  • (b) Start high-quality CPR
  • (a) Adenosine 6 mg
  • Epinephrine 1 mg IV
A patient is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of 300 mg amiodarone IV. The patient is intubated. A second dose of amiodarone is now called for. The recommend second dose of amiodarone is ?
  • (d) Epinephrine 1 mg IV/IO
  • 150 mg IV push
  • Give normal saline 250 mL to 500 mL fluid bolus
  • (c) 150 mg IV push
A 62 year old man suddenly experienced difficulty speaking and left-sided weakness. He was brought into the emergency department. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. What are the guidelines for antiplatelet and fibrinolytic therapy?
  • Epinephrine 2 to 10 mcg/min
  • Epinephrine 1 mg
  • Do not give ASA for at least 24 hours if rtPA is administered
  • Give normal saline 250 mL to 500 mL fluid bolus
which action causes air to enter victim's stomach (gastric inflation) during bag-mask ventilation
  • establish IV or IO access
  • Obtain a 12 lead ECG
  • over 150 per minute
  • ventilation too quickly,
refractory ventricular fibrillation. 3rd shock just administered. what is next action
  • 40 units administered IV or IO
  • Produces a small amount of blood flow to the heart
  • (1) Seek expert consultation(2) Transcutaneous pacing
  • resume high-quality chest compression
how do you treat symptomatic bradycardia
  • To ensure adequate coronary perfusion pressure
  • https://www.youtube.com/watch?v=qQTpqjvvduI&list=PLy60DSDPg9urf_l5ss1FLakrRQDKOkTZjThis is a good starting point for Jose (big Megacode at end): https://www.youtube.com/watch?v=8OB7OreUjy0 . Use the feedback after failing to get closer and closer to passing!
  • given rapidly during compressions
  • give 0.5mg atropine every 3-5 mins to max of 3mgif that doesn't work try one of the following:transcutaneous pacing2-10mcg/kg / minute dopamine infusion2-10mcg per minute epinephrine infusion
How often should the team leader switch chest compressors during a resuscitation attempt?
  • (b) Simultaenously
  • Epinephrine
  • . Every 2 minutes
  • Perform immediate electrical cardioversion
A 57 year old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180 bpm. She becomes diaphoretic and her blood pressure is 80/60 mm Hg. What is the next action?
  • Perform immediate electrical cardioversion
  • Obtain a 12 lead ECG.
  • Administer adenosine 12 mg IV
  • Epinephrine 1 mg or vasopressin 40 units IV or IO
What rhythms are shockable?
  • VFib or pulseless VTach
  • Unstable supraventricular tachycardia
  • At least 100 per minute
  • Peripheral IV
How often should you give epinephrine?
  • PETCO2 <10 mm Hg
  • Asystole or PEA
  • Every 3-5 minutes
  • About every 2 minutes
A patient has sudden onset of dizziness. The patient's heart rate is 180/min, blood pressure is 110/70 mm Hg, respiratory rate is 18 breaths/min, and pulse oximetry reading is 98% on room air. The lead II ECG is shown below:
  • Synchronized cardioversion
  • Vagal manuever.
If cases where ______ is the likely cause of cardiac arrest, VENTILATION becomes much more important
  • hypoxia
  • Provide continuous chest compressions without pauses and 10 ventilations per minute.
  • reperfusion therapy
  • 0.5mg
After verifying unresponsiveness and abnormal breathing, you activate the emergency response team. What is your next action?
  • Check for a pulse.
  • Start rescue breathing
  • Start high-quality CPR
  • Gain IV or IO access
What is the primary purpose of a medical emergency team (MET) or rapid response team (RRT)?
  • Prolonged interruptions in chest compressions.
  • Identifying and treating early clinical deterioration.
  • Pulseless ventricular tachycardia-associated torsades de pointes
  • Whether or not the sxs of onset are less than 12 hrs
Most symptomatic tachycardias will present with a HR of greater than
  • 150
  • At least 2 inches
  • ROSC
  • 0.5 mg
What is the dosing of nitroglycerin according to the ACS algorithm?
  • Every 3-5 minutes for a maximum of 3 doses
  • Allowing complete chest recoil
  • Safety threat to providers
  • chest pain or shortness of breath is present
Which drug and dose are recommended for the management of a patient in refractory ventricular fibrillation?
  • (b) Hypotension
  • Amioderone 300mg
  • Epinephrine
  • Epinephrine 1 mg IV
A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. The patient's blood pressure is 128/58 mm Hg, the PETCO2 is 38 mm Hg, and the pulse oximetry reading is 98%. There is vascular access at the left internal jugular vein, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirms a supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal maneuvers. What is the next recommended intervention?
  • Adenosine 6mg IV push
  • (d) Resume high-quality chest compressions
  • Synchronized cardioversion
  • Amiodarone 300 mg
What is the recommended duration of therapeutic hypothermia after reaching the target temperature?
  • 100-120 compressions per min
  • At least 100/min
  • 12 to 24 hours
  • 10 to 12 breaths per minute
A patient is in refractory ventricular fibrillation. High quality CPR is in progress, and shocks have been given. One dose of epinephrine was given after the second shock. An antiarrhythmic drug was given immediately after the third shock. What drug should the team leader request to be prepared for administration next?
  • Seek expert consultation
  • (b) Epinephrine 2 to 10 mcg/min
  • Second dose of epinephrine 1 mg
  • amiodarone 300 mg
IV/IO drug administration during CPR should be
  • given rapidly during compressions
  • monitor and observe
  • Unconscious ptsNo gag reflex pts
  • Give aspirin 160-325 mg to chew
A team leader orders 1 mg of epinephrine, and a team member verbally acknowledges when the medication is administered. What element of effective resuscitation team dynamics does this represent?
  • Epinephrine 2 to 10 mcg/min
  • Obtain a 12 lead ECG.
  • Administer adenosine 12 mg IV
  • Closed-loop communication
A 68-year-old woman experienced a sudden onset of right arm weakness. EMS personnel measure a blood pressure of 140/90 mm Hg, a heart rate of 78/min, a nonlabored respiratory rate of 14 breaths/min, and a pulse oximetry reading of 97%. The lead II ECG displays sinus rhythm. What is the most appropriate action for the EMS team to perform next?
  • (c) Epinephrine 1 mg
  • Cincinnati Prehospital Stroke Scale assessment
  • Perform electrical cordioversion
  • Closed-loop communication
During post ROSC, if a pt cannot follow commands, what do you need to do?
  • After the first CPR session (2 minutes)
  • Begin chest compressions.
  • Initiate targeted temperature management
  • Initiate BLS
Which condition is a contraindication to therapeutic hypothermia during the post-cardiac arrest period for patients who achieve return of spontaneous circulation ROSC?
  • Responding to verbal commands
  • Potential oxygen toxicity
  • resume chest compressions
  • (c) Resume chest compressions
What is the recommendation on the use of cricoid pressure to prevent aspiration during cardiac arrest?
  • Determine whether pulses are present.
  • Not recommended for routine use
  • Potential oxygen toxicity
  • 12 to 24 hours
A 62-year-old man in the emergency department says that his heart is beating fast. He says he has no chest pain or shortness of breath. The blood pressure is 142/98 mm Hg, the pulse is 200/min, the respiratory rate is 14 breaths/min, and pulse oximetry is 95% on room air. What intervention should you perform next?
  • ASA 160-325 mg chew
  • Obtain a 12 lead ECG.
  • establish IV or IO access
  • 2 to 10 mcg/kg per minute
If atropine fails in treating bradycardia, what should you do?
  • (1) Transcutaneous pacing(2) Dopamine(3) Epinephrine
  • Produces a small amount of blood flow to the heart
  • Be sure oxygen is not blowing over the patient's chest during the shock.
  • 100-120 compressions per minute
What is the purpose of a medical emergency team (MET) or rapid response team (RRT)?
  • Improving patient outcomes by identifying and treating early clinical deterioration
  • TraumaTension PTXTamponadeToxinsThrombosis (Pulmonary or Coronary)
  • Prolonged interruptions in chest compressions.
  • Hands-free pads allow for a more rapid defibrillation.
Which action is included in the BLS survey?
  • Early defibrillation
  • PETCO2 ≥10 mm Hg
  • (d) Reperfusion therapy
  • Waveform capnography
What action is recommended to help minimize interruptions in chest compressions during CPR?
  • Begin CPR, starting with chest compressions.
  • Continue CPR while charging the defibrillator.
  • Allowing complete chest recoil
  • Switch providers about every 2 minutes or every 5 compression cycles.
how do you treat non-symptomatic bradycardia
  • Initiate BLS
  • monitor and observe
  • 5 to 10 seconds
  • 10 seconds or less
A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next?(a) Adenosine 6 mg(b) Amiodarone 300 mg(c) Epinephrine 3 mg(d) Lidocaine 0.5 mg/kg
  • Atropine 0.5mg
  • (b) Amiodarone 300 mg
  • Start rescue breathing
  • (d) Reperfusion therapy
A pt is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. If no pathway for medication administration is in place, which method is preferred?(a) Central line(b) Endotracheal tube(c) External jugular vein(d) IV or IO
  • (d) IV or IO
  • Simple airway manuevers and assisted ventilations.
  • (d) Seeking expert consultation
  • Atropine 0.5mg
What is the first treatment priority for a patient who achieves ROSC?
  • Continuous waveform capnography
  • Starting rescue breathing
  • At least 100 per minute
  • Optimizing ventilation and oxygenation.
If QRS is not wide for a tachycardia patient, what should you do next?
  • (1) Vagal manuevers(2) Adenosine(3) Bblock or CCB(4) Expert consultation
  • Provide continuous chest compressions without pauses and 10 ventilations per minute.
  • Initiate targeted temperature management
  • Identifying and treating early clinical deterioration.
what are the 5 h's and 5 t's
  • - Severe bradycardia- Tachycardia- Hypotension- Phosphodiesterase inhibitors
  • The Hs and Ts is a mnemonic used to aid in remembering the possible reversible causes of cardiac arrest.[1] A variety of disease processes can lead to a cardiac arrest; however, they usually boil down to one or more of the "Hs and Ts".hypovolemiahypoxiahydrogen ion (acidosis)hypo/hyperkalemiahypothermiatension pneumothoraxtamponade, cardiactoxinsthrombosis, pulmonary (PE)thrombosis, coronary
  • coronary perfusion falls
  • give 0.5mg atropine every 3-5 mins to max of 3mgif that doesn't work try one of the following:transcutaneous pacing2-10mcg/kg / minute dopamine infusion2-10mcg per minute epinephrine infusion
Chest compression fraction should be around
  • 12mg
  • 500-600 mL or half of a bag squeeze
  • 60-80%
  • IV or IO
While treating a patient with dizziness, a blood pressure of 68/30 mm Hg, and cool, clammy skin, you see this lead II ECG rhythm:What is the first intervention ?
  • Intermittent non-conducted P waves without progressive prolongation of the PR interval (compare this to Mobitz I).
  • Vagal manuever.
  • Atropine 0.5mg
Which treatment or medication is appropriate for the treatment of a patient in asystole?
  • (a) Epinephrine 1 mg
  • At least 2 inches
  • (c) Epinephrine
  • Epinephrine
When do you use oropharyngeal airways?
  • (c) Resume chest compressions
  • Unconscious ptsNo gag reflex pts
  • given rapidly during compressions
  • Lidocaine, epinephrine, vasopressin
A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. The next intervention is to
  • Push Epi Always
  • administer a second shock.
You have completed your first 2-minute period of CPR. You see an organized, nonshockable rhythm on the ECG monitor. What is the next action?
  • Have a team member attempt to palpate a carotid pulse.
  • About every 5-6 seconds
  • Simple airway manuevers and assisted ventilations.
  • Lidocaine, epinephrine, vasopressin
what constitutes symptomatic bradycardia
  • Conscious, semiconscious, or unconscious pts with or without gag flex
  • Providing quality compressions immediately before a defibrillation attempt.
  • Unconscious ptsNo gag reflex pts
  • hypotensionaltered mental statussigns of shockchest painacute heart failure
Which action is likely to cause air to enter the victim's stomach (gastric inflation) during bag-mask ventilation?(a) Giving breaths over 1 second(b) Ventilating too quickly(c) Providing a good seal btwn the face and mask(d) Providing just enough volume for chest to rise
  • Allowing complete chest recoil
  • (b) Ventilating too quickly
  • (c) Resume chest compressions
  • (b) Amiodarone 300 mg
You patient has been intubated. IV/IO access is not available. Which combination of drugs can be administered by the endotracheal route?
  • Epinephrine 1mg IV/IO
  • (d) Start rescue breathing
  • Ventilating until you see the chest rise
  • Lidocaine, epinephrine, vasopressin
A patient presents to the emergency department with new onset of dizziness and fatigue. On examination, the patient's heart rate is 35/min, the blood pressure is 70/50 mm Hg, the respiratory rate is 22 breaths/min, and the oxygen saturation is 95%. What is the appropriate first medication?
  • Atropine 0.5mg
  • adenosine 12 mg
  • 150 mg IV push
  • Amiodarone 300 mg
What is the recommended energy dose for biphasic synchronized cardioversion of atrial fibrillation?
  • 120to200J
  • Administration of IV or IO fluid bolus
  • Epinephrine
  • Identifying and treating early clinical deterioration.
A 49-year-old man has retrosternal chest pain radiating into the left arm. The patient is diaphoretic, with associated shortness of breath. The blood pressure is 130/88 mm Hg, the heart rate is 110/min, the respiratory rate is 22 breaths/min, and the pulse oximetry value is 95%. The patient's 12-lead ECG shows ST-segment elevation in the anterior leads. First responders administered 160 mg of aspirin, and there is a patent peripheral IV. The pain is described as an 8 on a scale of 1 to 10 and is unrelieved after 3 doses of nitroglycerin. What is the next action?
  • Produces a small amount of blood flow to the heart
  • Begin chest compressions.
  • Epinephrine 2 to 10 mcg/min
  • Administer 2 to 4 mg of morphine by slow IV bolus.
In which situation does bradycardia require treatment?(a) 12-lead ECG showing a normal sinus rhythm(b) Hypotension(c) Diastolic blood pressure > 90(d) Systolic blood pressure > 100
  • Seek expert consultation
  • adenosine 12 mg
  • (b) Hypotension
  • (b) Simultaenously
A 49-year-old woman arrives in the emergency department with persistent epigastric pain. She had been taking oral antacids for the past 6 hours because she thought she had heartburn. The initial blood pressure is 118/72 mm Hg, the heart rate is 92/min and regular, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry reading is 96%. Which is the most appropriate intervention to perform next?
  • Start chest compressions of at least 100 per min.
  • (c) Perform electrical cardioversion
  • Cincinnati Prehospital Stroke Scale assessment
  • Obtain a 12 lead ECG.
A patient in respiratory failure becomes apneic but continues to have a strong pulse. The heart rate is dropping rapidly and now shows a sinus bradycardia at a rate of 30/min. What intervention has the highest priority?
  • Simple airway manuevers and assisted ventilations.
  • Seek expert consultation
  • Give ASA 160-325 chewed immediately
  • Resume high quality chest compressions
What are the T's of PEA?
  • Suction during withdrawal but for no longer than 10 seconds.
  • 40 units administered IV or IO
  • (1) Transcutaneous pacing(2) Dopamine(3) Epinephrine
  • TraumaTension PTXTamponadeToxinsThrombosis (Pulmonary or Coronary)
Which is an appropriate and important intervention to perform for a patient who achieves ROSC during an out-of-hospital resuscitation?
  • Transport the patient to a facility capable of performing PCI.
  • Provide continuous chest compressions without pauses and 10 ventilations per minute.
  • Responding to verbal commands
  • Use of a phosphodiestrase inhibitor within the previous 24 hours
Bradycardia require treatment when?
  • Ventilating until you see the chest rise
  • Allows maximum blood return to the heart
  • Whether or not the sxs of onset are less than 12 hrs
  • chest pain or shortness of breath is present
If the heart muscle resets and initiates an organized rhythm this is called
  • wide QRS?greater than 0.12 seconds
  • ROSC return of spontaneous circulation
  • 100-120 compressions per min
  • Obtain a 12 lead ECG
An AED advises a shock for a pulseless patient lying in snow. What is the next action?
  • - Severe bradycardia- Tachycardia- Hypotension- Phosphodiesterase inhibitors
  • Initiate targeted temperature management
  • Administer the shock immediately and continue as directed by the AED.
  • Begin CPR, starting with chest compressions.
A patient has been resuscitated from cardiac arrest. During post-ROSC treatment, the patient becomes unresponsive, with the rhythm shown here. Which action is indicated next?
  • Use of a phosphodiestrase inhibitor within the previous 24 hours
  • (b) Epinephrine 2 to 10 mcg/min
  • Give an immediate unsynchronized high-energy shock (defibrillation dose)
  • Divert the patient to a hospital 15 minutes away with CT capabilities.
What is the recommended oral dose of aspirin for patients suspected of having one of the acute coronary syndromes?
  • 160 to 325 mg
  • Potential oxygen toxicity
  • 120to200J
  • At least 100/min
You arrive on the scene to find CPR in progress. Nursing staff report the patient was recovering from a pulmonary embolism and suddenly collapsed. Two shocks have been delivered, and an IV has been initiated. What do you administer now?
  • (a) Aspirin
  • (d) Start rescue breathing
  • Obtaining a 12 lead ECG.
  • Epinephrine 1 mg IV
What is the potential danger of using ties that pass circumferentially around the patient's neck when securing an advanced airway?
  • Obstruction of venous return from the brain
  • 10 to 12 breaths per minute
  • Begin CPR, starting with chest compressions.
  • Suction during withdrawal but for no longer than 10 seconds.
What is the usual post-cardiac arrest target range for PETCO2 when ventilating a patient who achieves return of spontaneous circulation (ROSC)?
  • 120to200J
  • 35-40mm Hg
  • 300 mg
  • 0.1 to 0.5 mcg/kg per minute IV infusion
Which action should you take immediately after providing an AED shock?(a) Check pulse rate(b) prepare to deliver a second shock(c) Resume chest compressions(d) Start rescue breathing
  • Seek expert consultation
  • (c) Resume chest compressions
  • Start rescue breathing
  • Ventilating too quickly
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  • Hands-free pads allow for a more rapid defibrillation.
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What should the tidal volume be for adequate ventilations?
  • 500-600 mL or half of a bag squeeze
  • Allows maximum blood return to the heart
  • After the first CPR session (2 minutes)
  • 8-10 breaths per minute
A patient is in refractory ventricular fibrillation. High CPR is in progress and shocks have been given. One dose of epinephrine was given after the second shock. An anti arrhythmic drug was given immediately after the the third shock. What drug should the team leader request to be prepared for administration next?
  • Use of a phosphodiestrase inhibitor within the previous 24 hours
  • Epinephrine 1 mg
  • Epinephrine 2 to 10 mcg/min
  • second dose of epinephrine 1 mg
when does bradycardia require treatment?
  • hypotension
  • PETCO2 ≥10 mm Hg
  • reperfusion therapy
  • Peripheral IV
Which action improves the quality of chest compressions delivered during a resuscitation attempt?
  • Transport the patient to a facility capable of performing PCI.
  • Switch providers about every 2 minutes or every 5 compression cycles.
  • Continue CPR while charging the defibrillator.
  • Allowing complete chest recoil
When should you use synchronized cardioversion in tachycardia?
  • 40 units administered IV or IO
  • VF/pulseless VT associated with torsades de pointes
  • Resume chest compressions
  • If the pt is hemodynamically unstable
A patient is in cardiac arrest. High quality chest compressions are being given. The patient is intubated and an IV has been started. The rhythm is asystole. Which is the first drug/dose to administer?
  • Epinephrine 1 mg IV
  • 2 to 10 mcg/kg per minute
  • Epinephrine 1 mg or vasopressin 40 units IV or IO
  • (b) Epinephrine 2 to 10 mcg/min
if persistent tachycardia does not present with symptoms what do you need to consider
  • Allowing complete chest recoil
  • wide QRS?greater than 0.12 seconds
  • Evidence of rigor mortis.
  • Begin chest compressions.
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug and dose should be administered first by the IV/IO route?
  • (d) Epinephrine 1 mg IV/IO
  • adenosine 12 mg
  • amiodarone 300 mg
  • Epinephrine 1 mg
What is the recommended initial intervention for managing hypotension in the immediate period after return of spontaneous circulation (ROSC)?
  • Administration of IV or IO fluid bolus
  • Potential oxygen toxicity
  • Every 3-5 minutes for a maximum of 3 doses
  • Determine whether pulses are present.
A patient with a possible acute coronary syndrome has ongoing chest discomfort unresponsive to 3 SL NTG tablets. There are no contraindications, and 4 mg of morphine sulfate was administered. Shortly afterward, blood pressure falls to 88/60 mm Hg, and the patient has increased chest discomfort. What should you do?
  • Resume high quality chest compressions
  • Seek expert consultation
  • Give normal saline 250 mL to 500 mL fluid bolus
  • ASA 160-325 mg chew
what do you do after return of spontaneous circulation
  • Obstruction of venous return from the brain
  • over 150 per minute
  • maintain O2 sat at 94%treat hypotension (fluids vasopressor)12 lead EKGif in coma consider hypothermiaif not in coma and ekg shows STEMI or AMI consider re-perfusion
  • At least 2 inches
A pt w/ STEMI has ongoing chest discomfort. Heparin 4000 units IV bolus and a heparin infusion of 1000 units per hr are being administered. The pt did not take aspirin because he has a hx of gastritis, which was treated 5 yrs ago. What is your next action?(a) Give aspirin 160 to 325 mg to chew(b) Give clopidogrel 300 mg orally(c) Give enteric-coated aspirin 75 mg orally(d) Give enteric-coated aspirin 325 mg rectally
  • Administer adenosine 6mg IV push
  • (a) Give aspirin 160 to 325 mg to chew
  • hold aspirin for at least 24 hours if rtPA is administered
  • (c) Give epinephrine 1 mg IV/IO
How long should it take to perform a pulse check during the BLS Survey?
  • After the second CPR session
  • Agonal gasps
  • 5 to 10 seconds
  • Amioderone 300mg
What are the H's of PEA?
  • HypovolemiaHypoxiaH+ (acidosis)HyperK+HypoK+Hypothermia
  • Measure from the corner of the mouth to the angle of the mandible.
  • Not recommended for routine use
  • - Severe bradycardia- Tachycardia- Hypotension- Phosphodiesterase inhibitors
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