ACLS Review Questions
1. You are working the night shift in ICU and the monitor alarm for your patient in bed 3 begins to go off. When you go in to the room to check your patient you find that he is awake but complaining of a fluttering and pain in the chest, feels dizzy and nausea. His skin is cool and he feels clammy. His blood pressure is 88/42, oxygen saturations 91% on 2L/min via nasal cannula. You observe this rhythm on the monitor.
What would be an appropriate intervention at this time?
B. Selleck's maneuver
C. Sedation and cardioversion
D. Lanoxin 0.125mg IV
Answer: C Sedation and cardioversion
The above rhythm is a narrow complex SVT. Based upon the patient’s signs and symptom you can determine that the patient is unstable. When the patient is in SVT and is unstable then cardioversion is the recommended treatment. Other measures that may be tried as you are setting up for synchronized cardioversion include vagal maneuvers and administering Adenosine. Answer A. Amiodarone is recommended for symptomatic wide complex tachycardia and ventricular tachycardia. Answer B. Selleck’s maneuver is also called cricoid pressure and was previously used to prevent aspiration during intubation. Answer D. Because of its slow onset, Lanoxin is not recommended in an emergency situation.
2. A 56 year old man is brought in by his family with complaints of chest pain radiating to his left arm. He has no other past medical history except for hypertension. He is alert but anxious. His respirations are rapid even though he is now receiving oxygen at 4L/min via face mask. His skin is cool and clammy. BP 101/60. After you place the patient on the monitor the folliwng rhythm is observed:
What is the expected treatment for this patient?
A. MONA: Metoprolol, Aspirin, Nipride, and Oxygen
B. MONA: Morphine, Aspirin, Nitroglycerine, and Oxygen
C. MONA: Morphine, Acetaminophen, Natrecor, and Oxygen
D. MONA: Meperidine, Aspirin, Nystatin, and Oxygen
Answer: B. MONA: Morphine, Aspirin, Nitroglycerine, and Oxygen
Morphine is for pain but it reduces venous capacitance and preload. Aspirin is for antiplatelet activity, Nitroglycerine to promote dilation of the coronary arteries and oxygen to reduce ischemia to the myocardium. Others measures include: Check vital sign, determine oxygen saturation, obtain IV access, obtain 12 lead ECG, obtain brief targeted history, draw blood for cardiac enzymes, draw blood for CBC, Chem-7, PT/PTT, and a chest X ray. Answer A. Metoprolol may be administered later on to reduce remodeling of the myocardium. Nipride is used to promote vasoconstriction and may be helpful in cardiogenic shock. Answer C. Acetaminophen can be used for a headache secondary to taking nitroglycerine but has no immediate value in treating myocardial ischemia. Natrecor is used to promote diuresis and preload reduction in patients with CHF. Answer D. Meperidine may be substituted for morphine if the patient is allergic to morphine. Nystatin is used to treat fungal infections.
Reviewed 3/1/16
Reviewed 3/1/16
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