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Supraventricular Tachycardia |
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Atrial fibrillation |
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Second deg AV block: Mobitz 1 |
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Second deg AV block: Mobitz 2 |
Intermittent non-conducted P waves without progressive prolongation of the PR interval (compare this to Mobitz I). |
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Ventricular fibrillation |
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Third deg AV block |
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Sinus bradycardia |
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Ventricular fibrillation |
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Atrial flutter |
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Pulseless electrical activity |
Push Epi Always |
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Second deg AV block: Mobitz 2 |
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Supraventricular tachycardia |
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Polymorphic ventricular tachycardia |
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Sinus bradycardia |
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Sinus tachycardia |
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Ventricular fibrillation |
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Agonal rhythm into asystole |
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If patient is in cardiac arrest and the rhythm is asystole and CPR is beign given. What is the first drug you should give? |
(d) Epinephrine 1 mg IV/IO |
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A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138 bpm. He is asymptomatic, with a blood pressure of 110/70. He has a history of angina. What action is recommended next? |
(d) Seeking expert consultation |
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A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug should be administered first? |
(b) Epinephrine 1 mg IV/IO |
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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, which action do you take next? |
(b) Establish IV or IO access |
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A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next? |
(b) Amiodarone 300 mg |
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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 |
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Pt is in refractory ventricular fibrilation. CPR is in progress. 1 dose of epinephrine given after second shock. An antiarrhythmic drug was given immediately after third shock. Which med is next? |
(a) Epinephrine 1 mg |
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What is the indication for use of magnesium in cardiac arrest? |
(c) Pulseless ventricular tachycardia-associated torsades de pointes |
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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? |
(d) IV or IO |
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Which intervention is most appropriate for the treatment of a patient in asystole? |
(c) Epinephrine |
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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 180/100. Which drug do you anticipate giving to this pt? |
(a) Aspirin |
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Pt is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of amiodarone 300 mg IV. Pt is intubated. Which best describes the recommended second dose of amiodarone for this pt? |
(c) 150 mg IV push |
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A monitored pt in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 200. Pt’s BP is 128/58, PETCO2 is 38, and pulse oximetry reading is 98%. There is vascular access in the left arm, and pt has not been given any vasoactive drugs. 12 lead EKG confirms a supraventricular tachycardia w/ no evidence of ischemia or infarction. Heart rate has not responded to vagal manuevers. What is your next action? |
(a) Administer adenosine 6 mg IV push |
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In which situation does bradycardia require treatment? |
(b) Hypotension |
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A 67 yr old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180/min. She becomes diaphoretic, and her blood pressure is 80/60. Which action do you take next? |
(c) Perform electrical cardioversion |
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Pt w/ sinus bradycardia and a heart rate of 42 has diaphoresis and a blood pressure of 80/60. What is the initial dose of atropine? |
(b) 0.5 mg |
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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 |
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62 yr old man suddenly expereinced difficulty speaking and left-sided weakness. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. Which best describes the guidelines for antiplatelet and fibrinolytic therapy? |
(d) Hold aspirin for at least 24 hrs if rtPA is administered |
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A patient has sinus bradycardia w/ a heart rate of 36. Atropine has been administered to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The pt is confused, and her BP is 88/56. Which therapy is now indicated? |
(b) Epinephrine 2 to 10 mcg/min |
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A 45 yr old woman with a hx of palpitations develops light-headedness and palpitations. She has received adenosine 6 mg IV for the rhythm shown here, without conversion of the rhythm. She is now extremely apprehensive. Her BP is 128/70 mm Hg. What is the next appropriate intervention? |
(a) Administer adenosine 12 mg IV |
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Which action is likely to cause air to enter the victim’s stomach (gastric inflation) during bag-mask ventilation? |
(b) Ventilating too quickly |
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What is the recommended depth of chest compressions for an adult victim? |
At least 2 inches |
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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? |
(c) Epinephrine 1 mg |
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How often should you switch chest compressors to avoid fatigue? |
Every 2 minutes |
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You are providing bag-mask ventilation to a pt in respiratory arrest. How often should you provide ventilations? |
About every 5-6 secs |
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Which intervention is most important in reducing this patient’s in-hospital and 30 day mortality rate? |
(d) Reperfusion therapy |
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How does complete chest recoil contribute to effective CPR? |
(a) Allows maximum blood return to the heart |
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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? |
(d) Resume high-quality chest compressions |
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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) |
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What is the recommended compression rate for high-quality CPR? |
100-120 compressions per min |
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What action minimizes the risk of air entering the victim’s stomach during bag-mask ventilation? |
(a) Ventilating until you see the chest rise |
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Which action should you take immediately after providing an AED shock? |
(c) Resume chest compressions |
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After initiation of CPR and 1 shock for ventricular fibrillation, pt is still in ventricular fibrillation at next rhythm check. A second shock is given, and chest compressions are resumed immediately. An IV is in place, and no drugs have been given. BBag-mask ventilations are producing visible chest rise. What is your next intervention? |
(c) Give epinephrine 1 mg IV/IO |
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What is the maximum interval for pausing chest compressions? |
10 seconds |
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A 35 yr old woman presents w/ a chief complaint of palpitations. She has no chest discomfort, shortness of breath, or light-headedness. Her BP is 120/78. On EKG, it shows she is in SVT. Which intervention is indicated first? |
(d) Vagal manuevers |
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Your patient is not responsive and is not breathing. You can palpate a carotid pulse. Which action do you take next? |
(d) Start rescue breathing |
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What is more important to start for a nonresponsive patient with no pulse, putting on an AED or starting rescue breathing? |
Starting rescue breathing |
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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? |
(b) Epinephrine 1 mg IV |
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A patient becomes unresponsive. You are uncertain if a faint pulse is present. An IV is in place. Which action do you take next? |
(b) Start high-quality CPR |
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If cases where ______ is the likely cause of cardiac arrest, VENTILATION becomes much more important |
hypoxia |
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___________ correlates w/ ROSC |
High quality CPR |
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What are the consequences of interrupting CPR? |
coronary perfusion falls |
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__________ can help indicate coronary perfusion pressure |
Capnography |
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Adequate CPR compression are at least |
2 inches |
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Why should chest compressions recoil? |
To ensure adequate coronary perfusion pressure |
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Chest compression fraction should be around |
60-80% |
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Don’t spend more than ____ seconds without compressions |
10 seconds |
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What should the tidal volume be for adequate ventilations? |
500-600 mL or half of a bag squeeze |
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What should be the first thing you do when you arrive on scene? |
See if patient is conscious or unconscious |
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What do you do next If the patient is unconscious when you first arrive on scene? |
Initiate BLS |
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If a patient is not responsive when you first arrive on scene, what should you do next? |
Call code Get AED |
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During BLS, should you check breathing and pulse |
(b) Simultaenously |
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If pt is not breathing normally but has pulse, what should you do? |
Bypass chest compressions and ventilate every 5-6 seconds |
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After intubating someone, what should you do next? |
Provide 1 ventilation every 6 seconds |
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What should you assess for in the Disability function of ABCDE? |
Neurologic function – Alert – Pain – Voice – Unresponsive |
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What are the H’s of PEA? |
Hypovolemia Hypoxia H+ (acidosis) HyperK+ HypoK+ Hypothermia |
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What are the T’s of PEA? |
Trauma Tension PTX Tamponade Toxins Thrombosis (Pulmonary or Coronary) |
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Why should you not excessively ventilate? |
Causes gastric insufflation Incr intrathoracic pressure Decr venous return and CO Decr survival |
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When do you use oropharyngeal airways? |
Unconscious pts No gag reflex pts |
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When do you use a nasopharyngeal airway? |
Conscious, semiconscious, or unconscious pts with or without gag flex |
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Oropharyngeal airway |
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Nasopharyngeal airway |
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When should you proceed with an advanced airway? |
Difficult to bag mask vent Airway compromise Need to isolate airway |
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What should you use to monitor ET tube? |
Waveform capnography |
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If waveform capnography jumps up, it may indicate… |
ROSC |
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If a patient is in cardiac arrest what are the first two steps? |
(1) CPR (2) Attach AED |
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What rhythms are shockable? |
VFib or pulseless VTach |
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What rhythms are NOT shockable |
Asystole or PEA |
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How often should you give epinephrine? |
Every 3-5 minutes |
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When should you consider giving amiodarone? |
After you have given 3 shocks and 3 CPR sessions and they are still in VF or pVT |
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When should you determine if the rhythm is shockable for asystole or PEA in the cardiac arrest algorithm? |
After the first CPR session (2 minutes) |
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When should you start treating reversible causes of asystole or PEA? |
After the second CPR session |
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Bradycardia is categorized as a HR less than… |
50 |
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When should you give atropine? |
When there is bradycardia and perfusion is low |
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If atropine fails in treating bradycardia, what should you do? |
(1) Transcutaneous pacing (2) Dopamine (3) Epinephrine |
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If atropine, tcp, dopamine, epinephrine all fail to tx bradycardia, what should you do? |
(1) Seek expert consultation (2) Transcutaneous pacing |
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When should you use synchronized cardioversion in tachycardia? |
If the pt is hemodynamically unstable |
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What should you do if you encounter a pt who has a pulseless tachycardia? |
Manage it like a cardiac arrest algorithm |
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Most symptomatic tachycardias will present with a HR of greater than |
150 |
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If a tachycardia patient is hemodynamically stable, what is the next thing you should assess? |
If QRS is wide (>= 0.120 sec) |
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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 |
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What things do you need to do after ROSC? |
(1) Optimize ventilation and oxygenation (2) Treat Hypotension (3) EKG (4) See if pt follows commands |
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During post ROSC, what things do you need to do to optimize ventilation and oxygenation? |
– O2 > 94% – Advanced airway + capnography – Don’t hyperventilate |
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During post ROSC, if a pt cannot follow commands, what do you need to do? |
Initiate targeted temperature management |
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If a patient is responsive and talking, what is the next step of the ACS algorithm? |
Obtain a 12 lead ECG |
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What is the dosing of nitroglycerin according to the ACS algorithm? |
Every 3-5 minutes for a maximum of 3 doses |
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What are the contraindications of nitroglycerin according to the ACS algorithm? |
– Severe bradycardia – Tachycardia – Hypotension – Phosphodiesterase inhibitors |
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Initiation of fibrinolytic therapy, if appropriate, within _____ of hospital arrival and ______ from onset of symptoms |
Initiation of fibrinolytic therapy, if appropriate, within 1 hour of hospital arrival and 3 hours from onset of symptoms |
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In ACS algorithm, what determines whether or not a STEMI gets reperfusion or not? |
Whether or not the sxs of onset are less than 12 hrs |
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