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A patient is in refractory ventricular fibrillation. High-quality CPR is in-progress. An anti-arrhythmic drug was given immediately after the third shock. You are the team leader. Which medication do you order next?

Epinephrine 1 mg

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?

Establish IV or IO access

Which intervention is most appropriate for the treatment of a patient in asystole?


A patient with possible STEMI has ongoing chest discomfort. What is a contraindication to nitrate administration?

Use of a phosphodiesterase inhibitor within the previous 24 hours

A 57-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 mmHG. Which action do you take next?

Preform electrical cardioversion

A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70 mmHg. He has a history of angina . What action is recommended next?

Seeking expert consultation

A 62-year-old man suddenly experienced 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 anti-platelet and fibrinolytic therapy.

Hold aspirin for at least 24 hours if rtPA is administered

A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 88/56 mm Hg. Which therapy is now indicated?

Epinephrine 2 to 10 mcg/min

A patient 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?

IV or IO

A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. The patient’s blood pressurfe is 128/58 mm hg, the PETCO2 is 38 mm gh, and the pulse oximetry reading is 98%. There is vascular access in the left arm, 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 your next action?

Administration of adenosine 6 mg IV push

A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug should be administered first?

Epinephrine 1 mg IV/IO

A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next?

Amiodarone 300 mg

In which statement does bradycardia require treatment?


A patient with sinus bradycardia and a heart rate of 42/min has diaphoresis and a blood pressure of 80/60 mm Hg. What is the initial dose of atropeine?

0.5 mg

A patient with STEMI has ongoing chest discomfort. Heparin 4000 units IV bolus and heparin infusion of 1000 units per hour are being administered. The patient did not take aspirin because he has a history of gastritis, which was treated 5 years ago. What is your next action?

give aspirin 16-325 mg to chew

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. what is the first drug/dose to administer?

epinephrine 1 mg IV/IO or Vasopressin 40 units IV/IO

What is the indication for the use of magnesium in cardiac arrest?

pulseless ventricular tachycardia-associated with torsades de pointes

You are caring for a 66 – year old man with a history of a large intracrebral 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, an an IV has been established. His blood pressure is 180/100 mm Hg. Which drug do you anticipate giving to this patient?


A 35-yr old woman has palpitations light headedness and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminating the rhythm. An IV has been established. Which drug should be administered?

Adenosine 6 mg

A patient 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. The patient is intubated. Which best describes the recommended second dose of amiodarone for this patient?

150 mg IV push

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