Saturday, March 31, 2012

Identify the appropriate electrical intervention for the following EKG rhythms

Identify the appropriate electrical intervention for the following EKG rhythms
1.



a.  Defibrillate 120-200 J and increase stepwise for refractory rhythm
b.  Initiate transcutaneous pacing at 60 bpm
c.  Synchronize cardiovert with 120 J
d.  Electrical interventions are not appropriate for this rhythm

2.





a.  Synchronized cardioversion with 50 J, increasing to 100 J for a refractory rhythm
b.  Defibrillate with 360 J (monophasic)
c.  Begin transcutaneous pacing at a rate of 60 bpm
d.  Provide unsynchronized shocks beginning at 120-200J

3.
PEA rhythm




a.  Defibrillate 120-200 J (biphasic) and increase stepwise for refractory rhythm
b.  Initiate transcutaneous pacing at 60 bpm
c.  Electrical interventions are not appropriate for this rhythm
d.  Synchronize cardiovert with 50 J


4.








a.  Synchronized cardioversion with 100 J, increasing to 150 J for a refractory rhythm
b.  Electrical interventions are not recommended for this rhythm
c.  Begin transcutaneous pacing at a rate of 60 bpm
d.  Provide unsynchronized shocks beginning at 120-200J


5.
Unstable VT with a pulse






a.  Defibrillate 360 J (monophasic) and increase joule settings  for a refractory rhythm
b.  Initiate immediate fixed rate transcutanous pacing at 60 bpm
c.  Electrical interventions are not appropriate for this rhythm
d.  Synchronize cardiovert with 100 J


Answers
1.  b.  Initiate transcutaneous pacing at 60 bpm
2.  c.  Begin transcutaneous pacing at a rate of 60 bpm
3.  c.  Electrical interventions are not appropriate for this rhythm
4.  b.  Electrical interventions are not recommended for this rhythm
5.  d.  Synchronize cardiovert with 100 J

Reviewed on 3/2/16

Friday, March 30, 2012

Identify the appropriate electrical intervention for the following EKG rhythms

Identify the appropriate electrical intervention for the following EKG rhythms

1.
a.   Defibrillate with 200 J (monophasic)
b.  Transvenous pacing with 200 J with demand rate 80 bpm
c.  Electrical intervention inappropriate for this rhythm
d.  Transcutaneous pacing at 60 bpm


2.

a.   Synchronized cardioversion with 100 J
b.   Deliver an unsynchronized shock at 120 J
c.   Defibrillation with 360 J monophasic and increase joules for refractory rhythms
d.   Standby demand pacing with rate of 60 bpm

3.
Unstable wide complex tachycardia
a.   Transcutanous pacing with 120 mA and a fixed rate of 80
b.   Consider cardioversion at 100 J
c.   Deliver an unsynchronized shock at 300 J monophasic
d.  Defibrillation with 300 J monophasic

4.
a.   Electrical intervention is inapproprate for this rhythm
b.  Immediate defibrillation at 360 J (monophasic)
c.  Attempt transcutaneous pacing with 200 mA
d.  Cardiovert with 200 J and increase joules in a step-wise manner for refractory rhythm

5.






a.  Immediate cardioversion with 360 J (monophasic)
b.  Fixed rate pacing at 100 bpm and increase mA until mechanical capture is obtained
c.  Defibrillation with 120-200 J and increase joule settings for refractory rhythm
d.  Electrical interventions inappropriate for this rhythm



Answers
1.  d.  Transcutaneous pacing at 60 bpm
2.  d.   Standby demand pacing with rate of 60 bpm
3.  b.   Consider cardioversion at 100 J
4.  b.  Immediate defibrillation at 360 J (monophasic)
5.  c.  Defibrillation with 120-200 J and increase joule settings for refractory rhythm


Reviewed on 3/2/16

Thursday, March 29, 2012

Identify the appropriate electrical intervention for the following EKG rhythms

Identify the appropriate electrical intervention for the following EKG rhythms
1.
Pulseless VT
a.   Defibrillate 120-200 J (biphasic)
b.  Synchronized shock at 200 J (monophasic)
c.  Synchronized cardioversion 200 J
d.  Electrical interventions inapproprate for this rhythm

2.
PEA rhythm
a.  Transcutanous pacing (demand) at 60 bpm with 100 mA
b.  Synchronized cardioversion with 120 J, then 200 J for refractory rhythm
c.  Electrical interventions not appropriate for this rhythm
d.  Defibrillate with 360 J monophasic


3

a.   Defibrillate with 120 J and increase to 200 J for subsequent shocks
b.  Transcutaneous pacing at 60 bpm, adjust mA until electrical capture obtained
c.  Transvenous pacing with 360 J
d.  Synchronized cardioversion with 50 J


4.

a.  Defibrillate with 120-200 J and increase joule setting for refractory rhythm
b.  Electrical intervention inappropriate for this rhythm
c.  Demand pacing at 100 mA
d.  Transcutaneous pacing at rate of 80 bpm

5.




a.   Standby transcutaneous pacing with fixed rate of 50 bpm
b.  Synchronized cardioversion with 120 J, increasing joules for subsequent shocks
c.   Demand pacing at 100 bpm
d.  Electrical interventions not appropriate for this rhythm



Answers
1.  a.   Defibrillate 120-200 J (biphasic)
2.  c.  Electrical interventions not appropriate for this rhythm
3.  b.  Transcutaneous pacing at 60 bpm, adjust mA until electrical capture obtained
4.  b.  Electrical intervention inappropriate for this rhythm
5.  d.  Electrical interventions not appropriate for this rhythm

Reviewed on 3/2/16

Wednesday, March 28, 2012

Identify the appropriate electrical intervention for the following EKG rhythms

Identify the appropriate electrical intervention for the following EKG rhythms

1.
a.  Unsynchronized shock at 120-200J
b.  Electrical intervention inappropriate for this rhythm
c.  Synchronized cardioversion at 50 mA
d.  Standby demand pacing at 60 bpm

2.
PEA rhythm

a.  Defibrillation at 360 J (monophasic)
b.  Deliver an asynchronous shock at 200 J (biphasic)
c.  Electrical intervention inappropriate for this rhythm
d.  Epicardial pacing at 100 J

3.
a.  Cardioversion with 50 J
b.  Unsynchronized shock at 120-200 J
c.  Electrical intervention is not appropriate for this rhythm
d.  Fixed rate overdrive pacing at 120 bpm

4.
Pulseless arrest
a.  Demand pacing at 60 bpm
b.  Transcutanous pacing with 2-4J/kg
c.  Defibrillation 120-200 J (biphasic)
d.  Cardioversion 100 J


5.
Unstable polymorphic VT







a.  Fixed rate pacing at 60 bpm
b.  Electrical intervention inappropriate for this rhythm
c.  Unsynchronized shock 120-200 J (biphasic)
d.  Cardioversion 100 J, then 200 J for a refractory rhythm


Answers
1.  d.  Standby demand pacing at 60 bpm
2.  c.  Electrical intervention inappropriate for this rhythm
3.  a.  Cardioversion with 50 J
4.  c.  Defibrillation 120-200 J (biphasic)
5.  c.  Unsynchronized shock 120-200 J (biphasic)


Reviewed on 3/2/16

Tuesday, March 27, 2012

Identify the appropriate electrical intervention for the following EKG rhythms

Identify the appropriate electrical intervention for the following EKG rhythms.
1.
a.  Defibrillation 120-200 J (biphasic)
b.  Defibrillation 120-200  J  (monophasic)
c.  Synchronized cardioversion 50 J
d.  Transcutanous pacing  60 bpm (fixed)

2.
a.  Defibrillation 120-200 J (biphasic)
b.  Defibrillation 120-200  J  (monophasic)
c.  Synchronized cardioversion 50 J
d.  Transcutanous pacing 60 bpm (synchronous)

3.
symptomatic wide complex tachycardia
a.  Defibrillation 120-200 J (biphasic)
b.  Defibrillation 120-200  J  (monophasic)
c.  Synchronized cardioversion 50 J
d.  Transcutanous pacing  100 ma


4.
a.  Defibrillation 120-200 J (biphasic)
b.  Defibrillation 120-200  J  (monophasic)
c.  Synchronized cardioversion 120 J
d.  Transcutanous pacing  50 bpm (fixed)



5.









a.  Defibrillation 120-200 J (biphasic)
b.  Defibrillation 120-200  J  (monophasic)
c.  Synchronized cardioversion 50 J
d.  Transcutanous pacing  60 bpm (demand)


Answers

1.  a.  Defibrillation 120-200 J (biphasic)
2.  d.  Transcutanous pacing 60 bpm (synchronous)
3.  c.  Synchronized cardioversion 50 J
4.  c.  Synchronized cardioversion 120 J
5.  d.  Transcutanous pacing  60 bpm (demand)

Reviewed on 3/2/16

Monday, March 26, 2012

Identify the appropriate electrical intervention for the following EKG rhythms

Identify the appropriate electrical intervention for the following EKG rhythms.

1.

a.  Defibrillation 120- 200J (monophasic)
b.  Defibrillation  360 J (biphasic)
c.  Synchronized cardioversion 100 J
d.  Transcutaneous pacing at 60 bpm (demand)

2.





a.  Defibrillation 120- 200J (biphasic)
b.  Defibrillation  360 J (monophasic)
c.  Synchronized cardioversion 50 J
d.  Transcutaneous pacing at 80 bpm (fixed rate)


3.

a.  Defibrillation 120- 200J (biphasic)
b.  Defibrillation  360 J (monophasic)
c.  Synchronized cardioversion 50 J
d.  Transcutaneous pacing at 60 bpm

4.
Pulseless VT
a.  Defibrillation 120- 200J (biphasic)
b.  Defibrillation  200 J (monophasic)
c.  Synchronized cardioversion 360 J
d.  Transcutaneous pacing at 40 bpm  (synchronous)

5.







a.  Defibrillation 100 J (biphasic)
b.  Defibrillation  360 J (monophasic)
c.  Synchronized cardioversion 120 J
d.  Transcutaneous pacing at 200 bpm (asynchronous)


Answers

1.  d.  Transcutaneous pacing at 60 bpm (demand)
2.  c.  Synchronized cardioversion 50 J
3.  d.  Transcutaneous pacing at 60 bpm
4.  a.  Defibrillation 120- 200J (biphasic)
5.  b.  Defibrillation  360 J (monophasic)



Reviewed on 3/2/16

Saturday, March 24, 2012

Identify the pharmacologic therapy for the following rhythms.

Identify the pharmacologic therapy for the following rhythms.
1.
a.  Adenosine 6mg IV fast flush, followed by 12mg if rhythm unchanged
b.  Amiodarone 150mg IV infused over 20 minutes, may repeat once
c.  Atenolol 5mg IV over 5 minutes
d.  Atropine 0.5mg IV up to 0.4mg/kg

2.
Serum potassium of 6.9
a.  Lidocaine 1.5mg/kg IV push
b.  Calcium chloride 10%, D50, Insulin
c.  Epinephrine or Vasopressin
d.  Nitroglycerin and Nipride

3.
a.  Calcium gluconate
b.  Sodium bicarbonate
c.  Thiamine hydrochloride
d.  Magnesium

4.
Wide complex tachycardia
a.   Diltiazem 15-20mg IV over 2 minutes
b.   Dobutamine 2-20mcg/kg/min
c.   Naloxone 0.4mg up to 6mg
d.   Adenosine 6mg rapid IV push

5.





a.   Procainamide 1-4mg/min infused until rhythm surpressed
b.   Lidocaine 0.75mg/kg if rhythm refractory to initial dose
c.   Epinephrine 1mg (1;10,000) IV q3-5 minutes
d.   Digoxin 0.25mg IV q4h x 4.



Answers
1.  d.  Atropine 0.5mg IV up to 0.4mg/kg
2.  b.  Calcium chloride 10%, D50, Insulin
3.  d.  Magnesium
4.  d.   Adenosine 6mg rapid IV push
5.  c.   Epinephrine 1mg (1;10,000) IV q3-5 minutes



Reviewed on 3/2/16

Friday, March 23, 2012

Identify the pharmacologic therapy for the following rhythms.

Identify the pharmacologic therapy for the following rhythms.
1.
a.  Verapamil 2.5mg IV over 2 minutes
b.  Vasopressin 40 units IV if epinephrine unsuccessful
c.  Norepinephrine 0.1-0.5mcg/minute until rhythm surpressed
d.  Flumazenil 0.2mg IV over 15 seconds fast flush technique


2.
a.  Reteplase 10 units IV bolus over 2 minutes
b.  Atropine 0.5mg IVq3-5 minutes not to exceed 0.4mg/kg
c.  Diltiazem 0.25mg/kg IV over 2 minutes
d.  Milrinone 50mcg/kg over 10 minutes IV loading dose, stop if QRS widens over 50%

3.
a.  Atropine 1mg IV push not to exceed 4mg
b.  Nitroglycerin 10mcg/min titrate for effect
c.  Epinephrine 1mg (1:10,000) IV q3-5 minutes
d.  Adenosine 6mg IV push, if ineffective then 12mg IV push

4.
a.  Lidocaine 1-4mg/minute and observe for CNS effects
b.  Dopamine 2mcg/kg/min titrated up to 20 mcg/kg/min
c.  Amiodarone 0.5mg/min x 6 hr, then 1mg/min x 18 hr
d.  Nitroprusside 01.mg/kg/min titrated q3-5 minutes up to 5mcg/kg/min

5.





a.   Amiodarone 300mg IV first dose,  150mg IV second dose
b.   Lidocaine 1.5mcg/kg over 2 minutes
c.   Procainamide 50mg/min over 30 minutes
d.   Vasopressin 40 mg IV once.



Answers
1.  a.  Verapamil 2.5mg IV over 2 minutes
2.  c.  Diltiazem 0.25mg/kg IV over 2 minutes
3.  c.  Epinephrine 1mg (1:10,000) IV q3-5 minutes
4.  b.  Dopamine 2mcg/kg/min titrated up to 20mcg/kg/min
5.  a.  Amiodarone 300mg IV first dose,  150mg IV second dose                                                                 

Reviewed on 3/2/16                                      

Wednesday, March 21, 2012

Identify the pharmacologic therapy for the following rhythms.

Identify the pharmacologic therapy for the following rhythms. 
1.





a.  Lidocaine 300mg IV followed by 150mg for a refractory rhythm
b.  Vasopressin 40mg IV as a one time dose
c.  Atropine 1mg IV every 3-5 minutes
d.  Epinephrine (1:10,000) 1mg IV q3-5 minutes
2.





a.  Amiodarone 150mg infused over 10 minutes
b.  Atropine 1mg IV for a total cumulative dose of 3mg
c.  Epinephrine 1 mg IV every 3 - 5 minutes
d.  Magnesium 1-2g IV until rhythm surpressed

3.





a.  Magnesium 1-2gm IV
b.  Procainamide 50mg IV push and observe for hypotension
c.  Amiodarone 0.5mg/min over 18 hours
d.  Eptifibatimide 180mcg/kg IV bolus

4.





a.  Metoprolol 5mg IV q5 minutes x 3 doses
b.  Amiodarone 150 mg IV
c.  Magnesium 4gm in 100ml of D5W infused over 1 hour
d.  Epinephrine 1mg (1:10,000) IV q3-5 minutes

5.
Symptomatic VT





a.  Amiodarone 150mg in D5W over 10 minutes
b.  Lidocaine 2gm IV infused over 2 hours
c.  Adenosine 6mg IV administered over 1 minute.  hold if sinus pause occurs
d.  Epinephrine 2-10mcg/min titrated to maintain systolic pressure above 90


Answers
1.  d.  Epinephrine (1:10,000) 1mg IV q3-5 minutes
2.  c.  Epinephrine 1 mg IV every 3 - 5 minutes
3.  a.  Magnesium 1-2gm IV
4.  d.  Epinephrine 1mg (1:10,000) IV q3-5 minutes
5.  a.  Amiodarone 150mg in D5W over 10 minutes



Reviewed on 3/2/16

Tuesday, March 20, 2012

Identify the pharmacologic therapy for the following rhythms.

Identify the pharmacologic therapy for the following rhythms. 
1.
a.  Vasopressin 40 units IV repeated in 10 minutes
b.  Atropine 1mg IV push, may repeat up to 3mg/kg
c.  Epinephrine 1mg (1:10,000) IV q3-5 minutes
d.  Isoproterenol 2-10mcg/min titrated for effect


2.
a.  Diltiazem 0.25mg/kg IV, may repeat in 5 minutes at 0.35mg/kg
b.  Atropine 0.5mg IV may repeat up to total dose of 3mg
c.  Dopamine 2-10mcg/kg titrated for heart rate and BP
d.  Magnesium 1-2gm IV infused over 20 minutes

3.
Pulseless VT
a.  Epinephrine 1mg (1:10,000) IV q3-5 minutes
b.  Amiodarone 300mg IV over 10 minutes and observe for hypotension
c.  Magnesium 1 - 2 grams IV
d.  Metoprolol 5mg IV, may repeat up x 3 up to 15mg

4.





a.  Nitroglycerin 5mcg/min infusion
b.  Lidocaine 0.75mg/kg IV for a refractory rhythm
c.  Procainamide 20mg/kg IV push
d.  Adenocard 6mg IV, may repeat at 12mg if needed

5.
P wave asystole





a. Vasopressin 0.01mcg/min infusion, titrate for BP and heart rate
b. Nipride 0.1mg IV push, observing a widening QRS complex
c.  Epinephrine 2mg via the ET tube
d.  Atropine 0.5mg IV, may repeat in 3-5 minutes


Answers
1.  c.  Epinephrine 1mg (1:10,000) IV q3-5 minutes
2.  b.  Atropine 0.5mg IV may repeat up to total dose of 3mg
3.  a.  Epinephrine 1mg (1:10,000) IV q3-5 minutes
4.  d.  Adenocard 6mg IV, may repeat at 12mg if needed
5.  c.  Epinephrine 2mg via the ET tube


Reviewed on 3/2/16