Friday, July 29, 2011

ACLS review

201.  AHA concludes that it is reasonable to administer oxygen the first 6 hours after ACS event.  Afterwards there is no clinical benefit except in certain circumstances.  What are those circumstances?
Patients with continuing/recurrent chest pain or hemodynamic instability
Patients with over pulmonary congestion
Patients with oxygen saturations below 90%

202.  What are the most common symptoms of myocardial ischemia?
Retrosternal chest pain
Chest discomfort spreading to the shoulders, neck, one or both arms, or jaw
Chest discomfort that spreads to the back or between the shoulders
Chest discomfort with lightheadedness, fainting, sweating, or nausea
Uncomfortable pressure, fullness, squeezing or pain in the center of the chest lasting several minutes
Unexplained shortness of breath which may occur with or without chest discomfort

203.  What are the AHA characteristics of high-risk unstable angina/NSTEMI?
Ischemic ST-segment depression of 0.5mm or greater or dynamic T-wave inversion with pain or discomfort
Nonpersistent or transient ST elevation of 0.5mm or greater for less than 20 minutes

204. What are some major contraindications for the administration of aspirin for a patient presenting with ACS?
The major contraindications for the administration of aspirin are a true aspirin allergy and active GI bleeding.

Reviewed 2/28/16

Thursday, July 28, 2011

ACLS review

196.  In what circumstances would you consider changing your initial dose of Adenosine?
The initial dose of Adenosine should be reduced to 3mg in patients taking dipyrimadole or carbamazepine.  Larger initial doses may be required for patients with higher blood levels of caffeine, theophylline, or theobromide. 

197.  What are two initial interventions in the treatment of narrow complex tachycardias?
Vagal maneuvers

198.  After delivering a synchronized shock to a patient you notice that the patient’s heart rhythm changes to VF.  What would you do?
If the patient develops VF then deliver an unsynchronized high energy shock at 200 J and follow the pulseless VF/VT algorithm.

199.  What are the cardinal rules for evaluating wide complex tachycardia?
Rule No 1:  Wide complex tachycardia is VT until proven otherwise
Rule No 2:  Always remember rule No 1

200.  What is the initial and subsequent dose of Lidocaine used in the treatment of symptomatic VT?
An initial bolus of 1.0 to 1.5 mg/kg IV
Additional bolus of 0.5 to 0.75 mg/kg can be given over 3 to 5 minutes
Total dose should not exceed 3 mg/kg (or >200 to 300 mg during a 1-hour period
A continuous infusion of initiated at 1 to 4 mg/min.

Reviewed 2/28/16

Wednesday, July 27, 2011

ACLS review

191. What is the difference in the way monomorphic VT and polymorphic VT is treated?
Monomorphic VT is treated with synchronized cardioversion with an initial shock of 100J.   Polymorphic VT is treated with an unsynchronized shock at 200J.  For both, if there is no response to the first shock, then increase the dose in a step wise fashion. 

192.  What is the difference between synchronized cardioversion and defibrillation?
With defibrillation an unsynchronized shock is delivered randomly anywhere within the cardiac cycle. 
These shocks use a higher energy level beginning at 200J
The shock is delivered as soon as the operator pushes the shock button on the defibrillator
Synchronized cardioversion uses a sensor to mark the R wave and delivers the shock on the QRS complex. 
Synchronized cardioversion uses lower energy levels than defibrillation.
During synchronized cardioversion there is a slight delay in delivering the shock after the operator pushes the shock button.  This allows the machine to synchronize with the peak R waves of the QRS complex.

193.  What two tachycardic rhythms will not usually respond to synchronized cardioversion?
Junctional tachycardia and multifocal atrial tachycardia will not usually respond to synchronized cardioversion because these rhythms arise from an automatic focus within the myocardium that is rapidly depolarizing.

194. What are some potential problems associated with synchronized cardioversion?
If the R waves are low in amplitude or the rhythm irregular, the monitor may not be able to identify and synchronize with the R wave peaks
Synchronization can take extra time to complete as the operator is required to apply both the adhesive pads and the monitor electrodes.

195.  What are two examples of wide complex tachycardia?
Monomorphic VT
Polymorphic VT

Reviewed 2/28/16

Tuesday, July 26, 2011

ACLS review

186.  Match the following medications with the correct dosage
Diltiazem                                         1-4mg/min
Bicarbonate                                     20mg/min
Metoprolol                                      2-10mcg/min
Nitroglycerine (SL)                          0.5-1mcg/min
Isoproterenol                                   0.25mg/kg
Procainamide                                  1mEq/kg
Epinephrine infusion                        5mg
Norepinephrine                              0.4mg
Lidocaine infusion                           2-10mcg/min

187.  What are five rhythms associated with unstable tachycardia?
Atrial fibrillation
Atrial flutter
Monomorphic VT
Polymorphic VT
Wide Complex tachycardia of uncertain type

188. What are some signs and symptoms of unstable tachycardia?
Shortness of breath
Chest pain
Altered mental status
Ischemic ECG changes
Pulmonary edema
Poor peripheral perfusion

189.  What are four initial interventions that are used in the treatment of symptomatic tachycardia?
Support airway, breathing, and circulation
Give oxygen, monitor oxygen saturation
Obtain and ECG to identify rhythm
Identify and treat reversible causes

190.  What are two critical determinations that must be assessed in the management of symptomatic tachycardia?
Determine if the patient have a pulse
Assess for signs and symptoms of hemodynamic instability

186.  Match the following medications with the correct dosage
Diltiazem                                         0.25mg/kg
Bicarbonate                                     1mEq/kg
Metoprolol                                      5mg
Nitroglycerine (SL)                        0.4mg
Isoproterenol                                  2-10mcg/min
Procainamide                                 20mg/min
Epinephrine infusion                     2-10mcg/min
Norepinephrine                              0.5-1mcg/min
Lidocaine infusion                         1-4mg/min

Reviewed 2/28/16

Monday, July 25, 2011

ACLS review

181.  What is the recommended dose of Aspirin for a patient admitted with STEMI?
The recommended dose is 160 to 325 mg

182.  Name four absolute contraindications for receiving reperfusion therapy
Any prior intracranial hemorrhage
Known structural cerebral vascular lesion (eg, AVM)
Known malignant intracranial neoplasm (primary or metastatic)
Ischemic stroke within 3 months EXCEPT acute ischemic stroke within 3 hours
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Significant closed head trauma or facial trauma within 3 months

183.  What is the dose of sublingual nitroglycerine for a patient who complains of chest pain?
Nitroglycerine 0.3 to 0.4 mg, may repeat every 5 minutes

184.  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)

185.  Match the following medications with the correct dosage
Adenosine                                                                          0.5mg
Amiodarone                                                                       2.5-5mg
Lidocaine                                                                           300mg
Verapamil                                                                          2-20mcg/kg/min
Magnesium                                                                        1mg
Atropine                                                                            325mg
Dopamine                                                                         1-1.5mg/kg
Epinephrine                                                                       1-2gm
Aspirin                                                                              6mg

185.  Match the following medications with the correct dosage
Adenosine                                                                          6mg
Amiodarone                                                                       300mg
Lidocaine                                                                           1-1.5mg/kg
Magnesium                                                                        1 - 2 gm
Atropine                                                                            0.5mg 
Dopamine                                                                         2-20mcg/kg/min
Epinephrine                                                                       1mg 
Aspirin                                                                              325mg 
Verapamil                                                                         2.5-5mg

Revieweeed 2/28/16

Sunday, July 24, 2011

ACLS review

176. What is the risk of attempting cardioversion on a patient with atrial fibrillation of longer than 48 hours duration?
They are at increased risk for cardioembolic events.

177.  What medications are the drugs of choice for acute rate control in most individuals with atrial fibrillation and rapid ventricular response?
IV β-blockers and calcium channel blockers such as Diltiazem

178.  What is the treatment strategy for treating a patient with a long QT interval baseline that is found to be in VT that is torsades de pointes?
Stop medications known to prolong the QT interval.
Correct electrolyte imbalance
Treat any other precipitating causes such as drug overdose or poisoning

179.  What is the immediate treatment for a patient who demonstrates rate-related cardiovascular compromise with signs and symptoms such as acute altered mental status, ischemic chest discomfort, acute heart failure, and hypotension?
When a patient presents with symptoms of cardiovascular compromise the rescuer should proceed with immediate synchronized cardioversion

180.  In the absence of ventricular dysfunction, when the ventricular rates are below ______, it is more likely that the tachycardia is secondary to the underlying condition rather than the cause of the instability.
less than 150 beats per minute

Reviewed 2/28/16

Saturday, July 23, 2011

ACLS review

171.  What classes of medication should be avoided for pre-excitation syndromes?
AV nodal blocking drugs including adenosine, calcium blockers, β-blockers, and digoxin

172. What antiarrhythmic medication may be used in patients with pre-excited atrial arrhythmias?

173. For patients who are stable wide complex tachycardia, what medications should be considered?
 IV antiarrhythmic drugs including procainamide, Amiodarone, or sotalol

174. What is the dose of Amiodarone in treating wide complex tachycardia or symptomatic monomorphic VT?
Amiodarone is given 150 mg IV over 10 minutes and dosing should be repeated as needed to a maximum dose of 2.2 g IV per 24 hours

175.  As a second line antiarrhythmic, Lidocaine may be considered for treating monomorphic VT. What is the dosing regimen for Lidocaine?
Lidocaine can be administered at a dose of 1 to 1.5 mg/kg IV bolus followed by a maintenance infusion of 1 to 4 mg/min.

Reviewed 2/28/16

Friday, July 22, 2011

ACLS review

166.  Explain how vagal maneuvers and adenosine may aid in the correct identification of a tachyarrhythmia?
The diagnostic value of vagal maneuvers and adenosine is to transiently slow ventricular rate so that the arrhythmia can accurately be identified

167. What should the health care provider do if the patient fails to respond to an initial dose of adenosine? 
If the rhythm does not convert within 1 to 2 minutes, the health care provider should give 12mg of adenosine rapid IV push.

168. If a patient in symptomatic SVT fails to respond to adenosine, what are two calcium channel blockers may be considered?
Diltiazem and Verapamil

169.  What is the dosing regimen for Verapamil when treating refractory SVT?
Verapamil 2.5 mg to 5 mg IV bolus over 2 minutes.
If there is no therapeutic response, repeated doses of 5 mg to 10 mg may be administered every 15 to 30 minutes to a total dose of 20 mg

 170.  What is the dosing regimen for Diltiazem when treating refractory SVT?
Diltiazem, give a dose of 15 mg to 20 mg (0.25 mg/kg) IV over 2 minutes; if needed, in 15 minutes give an additional IV dose of 20 mg to 25 mg (0.35 mg/kg). The maintenance infusion dose is 5 mg/hour to 15 mg/hour, titrated to heart rate

Reviewed 2/28/16

Thursday, July 21, 2011

ACLS review

161.  Name four rhythms that may be treated with synchronized cardioversion.
Unstable SVT
Unstable atrial fibrillation
Unstable atrial flutter
Unstable monomorphic VT

162. What is the appropriate joule setting when performing cardioversion on a patient with unstable VT, A fib, A flutter, or SVT?
Monomorphic VT 100 J
A fib 120-200 J
A flutter 50-100 J
SVT 50-100 J

163.  What are some characteristics of reentry tachycardia?
A tachycardia that is caused by an abnormal rhythm circuit that allows a wave of depolarization to repeatedly travel in a circle in cardiac tissue.
The QRS complex is narrow (<0.12 second) or wide (broad) if a preexisting bundle branch block is present.
These arrhythmias have characteristic abrupt onset and termination.

164.  What are some characteristics of automatic tachycardias?
These arrhythmias are not due to a circulating circuit but to an excited automatic focus
These arrhythmias have a more gradual onset and termination
These automatic arrhythmias include ectopic atrial tachycardia, MAT, and junctional tachycardia
These arrhythmias are not responsive to cardioversion

165.  What are the preferred initial therapeutic choices for the termination of stable PSVT?
Vagal maneuvers and adenosine

Reveiwed 2/28/16

Wednesday, July 20, 2011

ACLS review

156. What is the advantage of performing CPR prior to defibrillating a patient in VF/VT?
A brief period of chest compressions can deliver oxygen and energy substrates to the myocardium, thus increasing the likelihood that a perfusing rhythm will return after shock delivery.

157. What is the meaning of the term end tidal CO2? 
End-tidal CO2 is the concentration of carbon dioxide in exhaled air at the end of expiration.

158.  What should the health care provider do for a patient that remains in refractory VF/VT after giving an initial dose of Lidocaine?
If pulseless VF/ VT persists, an additional doses of 0.5 to 0.75 mg/kg IV push may be administered at 5- to 10-minute intervals to a maximum dose of 3 mg/kg.

159.  What is the difference between unstable bradycardia and symptomatic bradycardia?
Unstable bradycardia implies that the patient is acutely impaired and cardiac arrest imminent.
Symptomatic bradycardia implies the patient the patient is more stable and the bradycardia is experiencing symptoms, such as weakness, lightheadedness, or dyspnea.

160.  What are some examples of wide complex tachycardia (QRS 0.12 second)?
Ventricular tachycardia (VT)
SVT with aberrancy
Pre-excited tachycardias (Wolff-Parkinson-White [WPW] syndrome)

Tuesday, July 19, 2011

ACLS review

151.  What is synchronized cardioversion? 
It is a shock delivery that is timed (synchronized) with the QRS complex. This synchronization avoids shock delivery during the relative refractory portion of the cardiac cycle, when a shock could produce VF.

152.  When is it acceptable to use a precordial thump on a patient?
The precordial thump may be considered for patients with witnessed, monitored, unstable ventricular tachycardia including pulseless VT if a defibrillator is not immediately ready for use.

153. When the health care provider uses bag-mask ventilation with an adult (1 to 2 L) bag, what should the provider approximately tidal volume be when delivering ventilations? 
The rescuer should deliver approximately 600 mL of tidal volume sufficient to produce chest rise over 1 second.

154. What are some advantages of placing an endotracheal tube?
Keeps the airway patent
Permits suctioning of airway secretions
Enables delivery of a high concentration of oxygen
Provides an alternative route for the administration of some drugs
Facilitates delivery of a selected tidal volume
With use of a cuff, may protect the airway from aspiration

155.  Ideally, how long should compressions be interrupted to allow endotracheal intubation of a patient in cardiac arrest. 
Ideally they should be interrupted for less than 10 seconds

Reviewed 2/28/16

Monday, July 18, 2011

ACLS review

146. What should a lone provider do to aid an adult drowning victim?
The healthcare provider may give about 5 cycles (approximately 2 minutes) of CPR then activate the emergency response system.

147.  As the health care provider checks the victim of cardiac arrest for responsiveness what else should be assessed?
The health care provider should also check for absence of breathing or abnormal breathing (agonal or gasping respirations).

148.  Describe the correct hand placement when performing chest compressions.
The health care provider should place the heel of one hand on the center of the victim's chest and the heel of the other hand on top of the first so that the hands are overlapped.

149.  If an adult victim has a strong pulse but is not breathing, how often should the health care provider provide rescue breaths?  
The healthcare provider should give rescue breaths at a rate of about 1 breath every 5 to 6 seconds, or about 10 to 12 breaths per minute.

150.  What should the healthcare provider do for a patient who had an implantable cardioverter defibrillator that is delivering a shock?  If the patient has an implantable cardioverter defibrillator (ICD) that is delivering shocks then allow 30 to 60 seconds for the ICD to complete the treatment cycle before attaching an AED

Reviewed 2/28/16

Sunday, July 17, 2011

ACLS review

141.  List the criteria for high quality CPR.
Providing chest compressions of adequate rate (at least 100/minute)
Providing a compression depth of at least 2 inches (5 cm)
Allowing complete chest recoil after each compression
Minimizing interruptions in compressions
Avoiding excessive ventilation

142.  If multiple rescuers are available how often should they rotate the task of compressions?
Every 2 minutes.

143.  Once chest compressions have been started, how should a trained rescuer deliver rescue breaths to the victim of a cardiac arrest?
Deliver each rescue breath over 1 second.
Give a sufficient tidal volume to produce visible chest rise.
Use a compression to ventilation ratio of 30 chest compressions to 2 ventilations.

144. If a bystander is not trained in CPR, what is an acceptable technique for performing CPR?
The bystander should provide Hands-Only (chest compression only) CPR, with an emphasis on "push hard and fast," or follow the directions of the emergency medical dispatcher.

145.  What should a lone healthcare provider do if he/she sees a victim of cardiac arrest suddenly collapse?
Call for help and call the emergency response number
Get an AED and attach to the victim and use the AED
Provide CPR

Reviewed 2/28/16

Saturday, July 16, 2011

ACLS review

136.  What is the difference between a monophasic and a biphasic defibrillator?
Monophasic defibrillators deliver current in one direction of current flow and require a higher joule setting.  Whereas biphasic defibrillators deliver current in two directions of current flow and require a lower joule setting.

137.  Cardioversion has been shown to be ineffective in the treatment of what two rhythms?
Cardioversion is not effective for treatment of junctional tachycardia or multifocal atrial tachycardia.

138. What is the next medication that may be considered when VF/VT is unresponsive to CPR, defibrillation, and vasopressor therapy?
Amiodarone 300mg push IV/IO

 139. If tension pneumothorax is clinically suspected as the cause of PEA what might the initial management include?
Needle decompression

140. If an advanced airway is in place, the provider should ventilation the patient at what rate?    
The provider delivering ventilations should give 1 breath every 6  (10 breaths per minute) and should be careful to avoid hyperventilating the patient.  After placement of a supraglottic airway or an endotracheal tube, the provider performing chest compressions should deliver at least 100 - 120 compressions per minute continuously without pauses for ventilation. The provider delivering ventilations should give 1 breath every 6 seconds (10 breaths per minute) and should be particularly careful to avoid delivering an excessive number of ventilations.

Reviewed 2/28/16

Friday, July 15, 2011

ACLS review

131.  For an adult victim receiving two person CPR, what is the ratio of compressions to ventilations? 
30 compressions:  2 ventilations for and adult for both one and two rescuer CPR

132.   Compare the amount of oxygen a patient receives from a BVM devise that it not hooked to an oxygen source to one that is hooked to an oxygen source at 15L/min.  
A BVM that is not hooked to an oxygen source delivers 21% oxygen to the patient while one that is hooked to an oxygen source at 15L/min will deliver 40-60% oxygen to the patient.

133.  What is meant by the term functional or relative bradycardia?
A heart rate that is too slow relative to a low blood pressure or the patient’s condition, eg a heart rate of 66 with a blood pressure of 84/40 and symptoms of shock.

134.  What is the most frequent initial rhythm seen in out-of-hospital witnessed sudden cardiac arrest?
Ventricular fibrillation

135. If no CPR is provided, by what percentage do the survival rates from witnessed VF sudden cardiac arrest decrease per minute?
For every minute that passes between collapse and defibrillation, 7% to 10% 

Reviewed 2/28/16

Thursday, July 14, 2011

ACLS review

126.  What are the therapeutic effects of Nitroglycerine?
Decreases pain of ischemia
Increases venous dilation
Decreases venous blood return to heart
Decreases preload and cardiac oxygen consumption
Dilates coronary arteries

127.  What are some precautions to observe during the administration of Nitroglycerine?
Use extreme caution if systolic BP <90 mm Hg
Use extreme caution in RV infarction
Suspect RV infarction with inferior ST changes
Limit BP drop to 10% if patient is normotensive
Limit BP drop to 30% if patient is hypertensive
Watch for headache, a drop in BP, syncope, and tachycardia

128.  What are the ECG characteristics of atrial fibrillation?
Rate:  Atrial rate may be 200-400, ventricular rate will vary
Rhythm:  ventricular rhythm is irregular
P waves:  No identifiable P waves, fibrillatory waves are present
PR interval is not measurable
QRS complex will usually be less than .10 seconds

130.  What are some factors that affect transthoracic resistance or impedance during defibrillation and cardioversion?
Paddle size
Chest size
Distance between the paddles
Paddle pressure
Presence of conductive gel
Lower joule settings

Reviewed 2/28/16

Wednesday, July 13, 2011

ACLS review

121.  You come upon an unconscious victim who is not breathing but has a carotid pulse.  What actions should you take?
Assess responsiveness and breathing
Activate EMS system and get and AED
Feel for carotid pulse for 5-10 seconds
If a pulse is present but the victim is not breathing then ventilate the patient every 5-6 seconds (10-12 breaths per minute) and reassess the pulse every couple of minutes.

122.  Describe the technique for determining the correct size of an OPA for a patient.
Place the OPA on the side of the face with one end at the corner of the mouth and the other end at the angle of the jaw

123.  Question has been removed.

124.  What is the maintenance dose of Lidocaine that can be given to a patient after returning to spontaneous circulation?
Maintenance dose of Lidocaine 1-4mg/min
Reduce maintenance dose (not loading dose) in presence of impaired liver function or left ventricular dysfunction
Discontinue infusion immediately if signs of toxicity develop

125.  What are the indications for the administration of Calcium Chloride?
Known or suspected hyperkalemia (eg, renal failure)
Hypocalcemia (blood transfusions)
As an antidote for toxic effects of calcium channel blocker overdose

Reviewed 2/28/16

Tuesday, July 12, 2011

ACLS review

116.  What is meant by the term pulseless electrical activity?
Describes a condition in which electrical activity or rhythm is displayed on the cardiac monitor but the patient has lost the contractile function of the heart.

117.  Give some examples of slow PEA rhythms.
Idioventricular rhythms
Ventricular escape rhythms
Bradyasystolic rhythms

118.   The 6H’s and the 6T’s describe some of the possible causes that may lead to PEA.  Name the 6H’s.
Hydrogen ion (acidosis)

119.  Fibrinolytic therapy for a patient presenting with an acute MI is most beneficial if given within ___ hours of the onset of symptoms?
12 hours.  In general, the shorter the time to reperfusion, the greater the benefit.

120.  What are the ECG characteristics for ST-segment elevation myocardial infarction (STEMI)?
STEMI is characterized by ST segment elevation greater than 1mm in 2 or more contiguous precordial leads or two or more adjacent limb leads or new or presumably new LBBB 

Reviewed 2/28/16

Monday, July 11, 2011

ACLS review

110.  Explain how to technique for performing a Valsalva maneuverer
Document the dysrhythmia before treating
Explain the procedure to the patient
Instruct the patient to inhale and hold their breath and
Bear down as if to have a bowel movement, and to hold this position for 20-30 seconds
Document any rhythm changes on the monitor.

111.  During CPR how long should the rescuer check the carotid pulse?
The pulse check should be checked for a least 5 seconds but no more than 10 seconds.

112.  What are some complications that can occur from using bag-mouth ventilation?
Gastric inflation

113.  What are some contraindications for performing carotid sinus massage?
Avoid in elderly
Carotid bruits
History of CVA
Recent MI or myocardial ischemia

114.  When are the acceptable times for interrupting chest compressions during a pulseless arrest?
During pauses for ventilations
During rhythm checks
During delivery of actual shocks

115.  What is the maintenance dosage of Amiodarone in the post arrest setting?
Begin with an IV loading dose of 150mg IV over 10 minutes
Follow by a slow infusion of 360mg IV over the next 6 hrs.  (1mg/min)
Follow this with a maintenance infusion of 540mg IV over the next 18 hours (0.5mg/min)

Sunday, July 10, 2011

ACLS review

106.  Describe the ECG characteristic of 2nd degree heart block type II
Atrial rate is greater than the ventricular rate
Presence of extra or non-conducted P waves not followed by QRS complexes
PR interval is normal or prolonged but remains the same on conducted beats
QRS complex is usually narrow < .12 sec
Atrial rate is regular, Ventricular rate is irregular.

107. How do you perform a “quick look” with the defibrillator paddles?
Change the lead selector to paddles mode
Apply conduction gel or gel pads to the paddles
Apply the paddles to the patient’s bear chest with one paddle over the apex of the heart and the other over the right sternal border
Observe the rhythm on the monitor

108.   Name 5 causes common causes of bradycardia.
Hypoxia, hypothermia, heart blocks, head injury, heart medications, high vagal tone

109.   How do you differentiate between sinus tachycardia and SVT?
ST is a nonspecific clinical sign.  The causes include hypoxemia, hypovolemia, hyperthermia, metabolic stress, toxins, pain, and anxiety.  Heart rate varies with activity.  P waves present/normal. Rate is usually below 150. 
SVT is usually sustained and unrelated to activity or the above clinical causes.  P waves are usually absent.  The rate is over 150 bpm.

Friday, July 8, 2011

ACLS review

101.  During two person CPR how often should the one providing compressions switch positions?
The provider giving chest compressions should switch at every 2-minute cycle to minimize fatigue

102.  What is the liter flow and oxygen concentration that can be delivered by nasal cannula?
The nasal cannula has a liter flow of 1-6L/min and delivers a concentration of oxygen from 24-44%.

103. What the clinical signs and symptoms that transvenous pacing is effective in an adult victim with unstable bradycardia?
Improved BP
Palpable pulse
Improved level of consciousness
Improved respiratory status
Cessation of chest pain
Improvement in skin color

104. What signs and symptoms may be observed in an unstable patient requiring synchronized cardioversion?
Chest pain
Shortness of breath
Cold and clammy skin
Decreased level of consciousness
Pulmonary congestion

105.  Name three rhythms may be suspected in irregular, narrow complex tachycardia?
Atrial fibrillation
Atrial flutter
Multifocal atrial tachycardia

Reviewed 2/28/16

Thursday, July 7, 2011

ACLS review

96. When assessing the effectiveness of transcutaneous pacing, the rescuer observes for electrical capture.  What is meant by the term electrical capture?
 Electrical capture is observed when a pacer spike is immediately followed by a QRS complex

97.  How often can Atropine be administered to a patient in unstable bradycardia?
Atropine 0.5mg IV/IO every 3-5 minutes up to a total dose of 3mg (0.04mg/kg)

98. What three drugs may be used in the treatment of wide complex tachycardia?
Amiodarone 150mg infused over 10-20 minutes
Lidocaine 1-1.5mg/kg IV push.  May repeat at 0.5-.75mg/kg in 5-10 minutes
Procainamide 20mg/kg infused over 30-60 minutes

99. A patient with stable SVT fails to respond to an initial dose of 6mg adenosine. What would be the next appropriate step in treating this patient?
Administer a second dose of adenosine at 12mg IV using the fast flush technique

100.  Can Polymorphic VT be cardioverted? 
No.  Arrhythmias with a polymorphic QRS appearance will not permit synchronization.  Thus the rhythm should be treated as if it were VF and defibrillated at 200 J. 

Reviewed 2/28/16

Wednesday, July 6, 2011

ACLS review

91. During adult CPR describe technique for administering compressions. 
The person performing the compressions should push hard and fast and compress the chest at least 2 inches and allow for full chest recoil. 

92. What is the correct way of sizing the patient for a nasopharyngeal airway (NPA) prior to inserting it into the patient?
The length of the nasal airway can be estimated as the distance from the nares to the patient’s ear lobes.  The diameter of the NPA should not be larger than the diameter of the patient’s nostril.

93. What is the first antiarrhythmic and dosage that can be administered during a VF arrest?
Amiodarone 300mg IV/IO push.  If necessary, may be repeated in 3-5 minutes at 150mg IV push.

94.  What are the ECG characteristics of ventricular tachycardia?
P Wave: Not usually visible.
PRI: None
QRS: The QRS is wide and bizarre, usually 0.12 or greater.
Rhythm: The rhythm is usually regular.
Rate: The ventricular rate is 150 - 250. If the rate is below 150, it is called a slow VT.

95.  After administering adenosine to a patient with SVT, what ECG changes might be observed on the monitor prior to conversion to a profusing rhythm?
The patient may experience a brief sinus pause or sinus arrest. 

Reviewed 2/28/16

Tuesday, July 5, 2011

ACLS review

86.  An adult patient in unstable SVT does not respond to an initial cardioversion attempt at 50 J.  What would the next step be in the treatment of this patient?
Activate synchronized button on the monitor
Increase the joule setting to 100 J and cardiovert the patient again

87.  What are three precautions to keep in mind before giving Atropine in unstable bradycardia?
Doses of atropine sulfate of <0.5 mg may paradoxically result in further slowing of the heart rate
Atropine will not work on denervated hearts (heart transplants). 
Atropine may be considered, but if 2nd degree type II or 3rd degree block present, it may extend the block to 3rd degree or asystole

88. Give 5 examples of narrow complex tachycardia.
Sinus tachycardia, SVT, atrial fibrillation, atrial flutter, junctional tachycardia

89. What is the role of cricoid pressure during intubation? 
Cricoid pressure may reduce the risk if aspiration during intubation but it is no longer recommended.

90.  What are the indications for transcutaneous pacing?
Standby for clinically stable bradycardia
Therapeutic bridge until placement of a transvenous pacemaker is inserted
Hemodynamically unstable bradycardia

Reviewed 2/28/16

Monday, July 4, 2011

ACLS review

81. List the steps for performing CPR on a victim of an unwitnessed cardiac arrest.
Assess responsiveness and breathing
Feel for a pulse for up to 10 seconds
If no pulse then begin CPR beginning with chest compressions
After 2 minutes or 5 cycles of CPR activate the EMS system

82. How is an esophageal detector device used?
Attach the detector device to the ETT while maintaining ETT placement
Squeeze the bulb and allow the bulb to self- expand; if the bulb expands in < 5 sec, then the ETT is in the trachea.   Ventilate the patient and clinically check placement: check for symmertical chest rise and auscultate over the stomach and lungs.
If bulb expands slowly (over 5 sec) tracheal intubation is questionable
If bulb remains collapsed or gastric contents obtained, the ETT is in the esophagus.  Remove the ETT immediately and ventilate with BVM device

83. What are the therapeutic endpoints for the administration of Procainamide for VT with a pulse?
The patient receives the maximum dose of 17mg/kg
The rhythm is suppressed
The patient becomes hypotensive
The QRS complex widens over 50% from baseline.

84. What are the ECG characteristics of 3rd degree heart block?
Atrium and ventricles are beating asynchronously.
No relationship between the P waves and the QRS complex
QRS complex is often wide: > .12 sec
Rate is less than 60 bpm

85.  Name 5 precautions that should be considered prior to performing carotid sinus massage?
Avoid carotid massage in older adults
Never perform bilateral carotid massage
Listen for bruits before carotid massage- contraindicated if bruits are present
It should not be continued for more than 10 sec.
Patient should be on cardiac monitor
Should have IV access before attempting vagal maneuvers

Reviewed 2/28/16

Sunday, July 3, 2011

ACLS review

76. What devise has been shown to be the most effective at monitoring on going correct ET tube placement?
Continuous waveform capnography

77. What is the recommended method for administering medications through a peripheral IV during a cardiac arrest?
The medication should be given by bolus injection followed with a 20ml bolus of saline or IV fluids.

78. What are the recommended drug dosages when giving medications through the ET tube?
Typically the drug dose given by the ET tube route is 2-2.5 times the recommended IV dose.

79. Name 5 medications that may be used in the treatment of pulseless VT?

80. What is the recommended dosage of isoproterenol in treating unstable bradycardia?
Isoproterenol 2-10ug/min by IV infusion titrated to the patient’s response

Saturday, July 2, 2011

ACLS review

71.  You observe a victim fall to the ground in cardiac arrest.  What should you do? 
Activate EMS and obtain the AED
Begin CPR beginning with chest compressions while AED is set up
Analyze the rhythm and defibrillate if needed

72. What are 5 ways of verifying endotracheal tube placement in an adult?
Direct cord visualization
End tidal CO2 monitoring
Bilateral breath sounds
Continuous capnography

73. Where is the J point on an ECG waveform?
The J point is used to measure ST elevation in an acute MI. Locate where the S wave meets the T wave then measure 0.4 sec to the right. ST elevation or depression over 1mm is significant for AMI

74. What is the recommended rate setting when preparing to pace an adult with unstable bradycardia?
60-80 bpm

Reviewed 2/28/16

Friday, July 1, 2011

ACLS review

66. What is the difference in the way Amiodarone is administered in pulseless VT and stable VT?
In pulseless arrest, Amiodarone is given IV push at 300mg.  In stable VT Amiodarone 150mg IV infusion is given as an infusion over 10 minutes.

67.  Sodium bicarbonate is indicated in the treatment of what cardiac arrest situations?
Preexisting hyperkalemia
Preexisting metabolic acidosis
Tricyclic antidepressant OD
Aspirin overdose
Prolonged arrest interval after return of spontaneous circulation

68. Name three antiarrhythmics that can be used to treat stable VT?

69. You are a lone rescuer and come upon an unresponsive adult victim who is pulseless and apneic.  What should you do?  
Provide 2 minutes of CPR then activate the EMS system.

70. What is the initial dose of Lidocaine when administered to an adult through an ET tube during pulseless VT/VF?
Lidocaine 2-3mg/kg via ET tube

Reviewed 2/28/16