Thursday, June 30, 2011

ACLS review

61. During CPR what is the difference in ventilation technique between an intubated patient and a non-intubated patient?
With an intubated patient the rescuer gives continuous chest compressions without pauses for breaths while the person performing ventilations provides 10 breaths/minute.

62.  What are two airway adjuncts that may be used to maintain an open airway in an adult victim?
Oropharyngeal airway
Nasopharyngeal airway

63. What are some conditions that may predispose a patient to torsades de pointes?
Long QT syndrome
Antiarrhythmic drug toxicity
Other drug toxicities:  phenothiazines, tricyclic antidepressants. Calcium channel blockers

64. What are the ECG characteristics of VF?
P Wave: None are visible.
PRI: There is no PRI.
QRS: None
Rate: None
Rhythm: None. The baseline is totally chaotic

65. Name two calcium channel blockers that may be used to control the rate in a patient in PSVT?
Cardizem 0.25mg/kg (15-20mg) and Verapamil 2.5-5mg IV over 5 minutes

Reviewed 2/28/16

Wednesday, June 29, 2011

ACLS review

56. What is the dose of bicarbonate in a cardiac arrest?
1mEq/kg IV/IO push

57. When using a monophasic defibrillator, what is the initial joule setting used to defibrillate an adult victim?
360 J

58. What is the treatment of choice for pulseless VT/VF ?
Early defibrillation

59. During the treatment of refractory SVT, what is the second dose of adenosine?
12mg IV using fast flush technique

60. What are 3 chronotropic agents that can be used to treat an adult in unstable bradycardia?
Epinephrine at 2-10ug/min infusion titrated according to patient’s response
Dopamine at 2-20ug/kg/min infusion titrated according to patient’s response
Isoproterenol 2-10ug/min infusion titrated according to patient’s response

Reviewed 2/28/16

Tuesday, June 28, 2011

ACLS review

51.  What is the recommended depth of compression when performing CPR on an adult victim in cardiac arrest?
At least 2 inches

52.  What are some indications for endotracheal intubation in the cardiac arrest victim?
The inability of the patient to consciously ventilate
Inability of the rescuer to ventilate the patient adequately with postive pressure ventilations
The patient is unresponsive and unable to protect their own airway.

53.  How does one verify asystole on the monitor?
Increase the size if the waveform
Check the rhythm in another lead
Verify all electrical cords are connected
Verify all electrodes are in place

54. What are some precautions that should be observed before applying the defibrillator pads to the patient?
Make sure the skin surface is fry
Avoid pacemakers and other devices
Avoid letting the pads touch
Remove medication patches
Remove excess chest hair if the pads do not adhere to the chest wall

55. What is the dosage of Lopressor that may be used to control the rate in an adult in symptomatic SVT?
Lopressor 5mg slow IV at 5 minute intervals. It may repeated X 2 for a total dose of 15 mg.

Reviewed 2/28/16

Monday, June 27, 2011

ACLS review

46. What are 5 vagal maneuvers that can be used in the initial treatment of symptomatic SVT?
Valsalva maneuver
Blowing through a straw
Ice water to the face
Carotid sinus massage

47. What is the initial dosage of Cardizem when treating a patient in SVT?
Initial: 0.25mg/kg (15-20mg) over 2 minutes

48. During transcutaneous pacing, what is meant by the term mechanical capture and how would you assess for it?
Mechanical capture refers to actual contraction of the myocardium by the pacing stimulus and results in a palpable pulse

49. What is the initial dose Adenosine when treating an adult in SVT?
6mg IV using fast flush technique

50.  What are two indications for giving morphine sulfate to a patient who is experiencing chest pain associated with a STEMI?

Chest pain and anxiety associated with AMI or cardiac ischemia
Acute cardiogenic pulmonary edema (if blood pressure is adequate)

Reviewed 2/28/16

Sunday, June 26, 2011

ACLS review

41. Name the steps for using an AED
Power on AED
Apply pads to patient’s chest
Plug in cord
Analyze heart rhythm

42. What is an esophageal detector device used for?
The aspiration esophageal intubation detector device (EID) is used to verify endotracheal intubation

43.  What are two antiarrhythmics that are used in the treatment of pulseless VT/VF?
Amiodarone 300mg IV push, may be repeated at 150mg IV push
Lidocaine 1-1.5mg/kg IV push, may be repeated at 0.5-.75mg/kg IV push

44. What is maximum cumulative dose of Amiodarone in 24 hours?

45. What is the correct dose and concentration of epinephrine that cam be administered through the endotracheal tube?
2mg of a 1:1000 solution

Reviewed 2/28/16

ACLS review

36. What is the maximum cumulative dosage of atropine that is recommended during the treatment of unstable bradycardia?
3 mg

37. What is the dosage of magnesium used in the treatment of torsade de pointe?
1-2 grams IV/IO diluted in 10ml of D5W as a bolus or given over 5-20 minutes

38.  What is the second dosage of Amiodarone for an adult in refractory VT/VF?
Amiodarone 150mg IV push may be given in 3-5 minutes following the initial dose with a maximum cumulative dose of 2.2g/24h

39. Adenosine is indicated in the treatment of what arrhythmia?
Stable SVT

40. After the initial defibrillation, what are the subsequent joule settings in the treatment of pulseless VT/VF?
200 J or higher for biphasic defibrillators
360 J for monophasic defibrillators

Reviewed 2/28/16

Friday, June 24, 2011

ACLS review

31. What is the ratio of compressions to ventilations when performing CPR on an adult in cardiac arrest?

32.  What is the maximum time that you should suction a patient’s airway?
The airway of the victim should not be suctioned for longer than 10 seconds.

33.  What is the initial joule setting when preparing to cardiovert an adult in unstable atrial fibrillation and atrial flutter?
Atrial fibrillation 120-200 J
Atrial flutter 50-100 J

34. Amiodarone is used in the treatment of what four rhythms?
Pulseless VT/VF, stable VT, wide complex tachycardia, atrial fibrillation

35. What are the ECG characteristics of adult SVT?
P waves absent or abnormal
PR interval absent
QRS complex is usually narrow
Rhythm is regular
Rate over 150

Thursday, June 23, 2011

ACLS review

26. What is the initial joule setting when delivering a synchronized shock to an adult victim in unstable SVT?
50-100 J

27. What is the maximum cumulative dosage of Lidocaine that is recommended during the treatment of stable VT?

28. Name the "T" reversible causes in the treatment of asystole.
Tamponade, cardiac
Tension pneumothorax
Thrombosis coronary
Thrombosis pulmonary

29. What are 5 medications that can be administered through the ET tube?
Narcan, Epinephrine, Atropine, Lidocaine

30. What is the first vasoconstrictor that is administered during a pulseless arrest?
Epinephrine 1mg IV/IO push.  The 2015 AHA guidelines no longer recommend Vasopressin. Vasopressin in combination with epinephrine offers no advantage as a substitute for standard-dose epinephrine in cardiac arrest.

Reviewed 2/28/16

Wednesday, June 22, 2011

ACLS review

21.  The sequence for performing CPR is CAB.  What does CAB stand for
C- Check responsiveness and breathing.  Check for a carotid pulse.  Compressions
A-Open airway and using head-tilt chin lift or jaw thrust maneuver
B-Give two rescue breaths observing for chest rise and fall then resume compressions

 22.  Name three advantage of using an oropharyngeal airway (OPA) on an unconscious victim in cardiac arrest?

The OPA holds the tongue in place and prevents it from occluding the airway
It may serve as a bite block in an intubated patient
It permits easy suctioning of the oropharynx.

23.  What are four differences between defibrillation and cardioversion?
Cardioversion delivers electrical current to the heart during a specific time during the cardiac cycle
Cardioversion can be used on a variety of rhythms including SVT, Afib, Aflutter, Stable VT, and wide complex tachycardia
Defibrillation does not need to be synchronized with the ECG
Defibrillation uses higher energy levels
Defibrillation is used in the treatment of pulseless VT/VF

24. What is the initial dosage of Lidocaine used in the treatment of pulseless VT/VF?
Lidocaine 1-1.5 mg/kg IV push

25. What is the dosage and method of administration of dopamine during unstable bradycardia?
Dopamine 2-20mcg/kg/min as an infusion titrated to the patient’s response

Tuesday, June 21, 2011

ACLS review

16. Describe the location for placing the defibrillator pads on an adult.
Apex/right chest wall

17. AVPU describes what?
AVPU describes the patient's level of consciousness.
Responds to voice
Responds to pain

18. What does the term MONA refer to?
M- morphine
O- oxygen
N- Nitroglycerine
A- Aspirin

19. Describe the ECG characteristics of sinus tachycardia.
Sinus tachycardia is a nonspecific clinical sign; often related to a specific cause: fever, pain, activity;  P waves are normal and present; heart rate between 100 and 150, the rhythm is regular.

20 What is the initial joule setting when performing cardioversion on a patient with monomorphic VT?
100 J

Monday, June 20, 2011

ACLS review

11.  How do you open the airway of a patient with suspected cervical spinal trauma?
You open the airway by using the jaw-thrust technique without head extension.

12. After intubating a patient, asymmetric chest rise is noted and breath sounds are absent on the right during positive pressure ventilation.  What is the suspected problem?
The left main stem bronchus was intubated.   The ET tube should be pulled back and the breath sounds reassessed.

13. Magnesium is the drug of choice in the treatment of what dysrhythmia?
Torsades de pointe

14. When using a biphasic defibrillator, what is the joule setting when delivering the initial shock to an adult victim in VT/VF?
For biphasic defibrillators, providers should use the manufacturers recommended energy dose (eg, initial dose of 120 to 200 J) If the manufacturer's recommended dose is not known, defibrillation at the maximal dose of 200J may be considered.

15.  What is the dose of Procainamide used in the treatment of VT with a pulse?
Procainamide can be infused at 20 to 50 mg/min until the arrhythmia is suppressed,  hypotension develops, the QRS widens by >50%, or the maximum dose of 17 mg/kg is given.

Reviewed 2/28/16

Sunday, June 19, 2011

ACLS Review

6.  What are four non-profusing heart rhythms in an adult patient?
Asystole, PEA, pulseless VT, and pulseless VF

7. In the treatment of asystole, how often can epinephrine be repeated?
Epinephrine 1mg IV every 3-5 minutes

8. What is the dose of atropine used in the treatment of stable bradycardia?
Atropine 0.5mg IV/IO every 3-5 minutes

9. What is the primary treatment for ventricular fibrillation?

10. Name five ways in which you can positively confirm ET tube placement
Direct cord visualization
End-tidal CO2
Bilateral breath sounds
Continuous capnography

Reviewed 2/28/16

Saturday, June 18, 2011

ACLS review

1. What is the rate of compressions when performing CPR on an adult victim of cardiac arrest?
100 - 120/min

2.  What are the meanings to the three color changes that are observed on an End Tidal CO2 Detector?
Yellow- positive CO2 is detected
Tan- low CO2 is detected, questionable tube placement
Purple- no CO2 is detected. 

3.  What is the initial dose of Amiodarone in treating pulseless VT/VF?
Amiodarone 300mg IV push
4. Lidocaine is indicated in the treatment of what cardiac problems?
Pulseless VT/VF
VT with a pulse
Wide complex tachycardia

5.  What are the ECG characteristics of Torsades de pointes?
There are no P waves
There is no PR interval
The QRS complex appears wide, bizarre and changes from beat to beat
The amplitude of the QRS complex begins smaller and gets larger then begins to get smaller again.
The rate is usually over 150
The rhythm is irregular

Update 2/28/16