Megacode Pulseless VF/VT Part 1


06/25/12 11:15  A 70 year old man was brought to the emergency room by his concerned neighbors who stopped by to check on him.   He is lethargic and appears malnourished and dehydrated with sunken eyes, temporomandibular wasting, and a generally thin frail appearance.  His only know medical problem is hypertension.  His neighbors have noted that he has become more reclusive since the death of his wife 8 months ago.

06/25/12 11:21  As he is being examined he loses consciousness and his breathing becomes agonal in nature.   A code blue is announced and CPR is initiated.   He is placed on the defibrillator monitor and the following rhythm is observed:







1.  Identify the following rhythm.
a.    Monmorphic VT
b.    Wide complex tachycardia
c.    Polymorphic VT
d.    Torsades de pointe

2.  What is the initial treatment of choice for this patient?
a.    CPR and early Intubation
b.    Defibrillation at 200 J (biphasic)
c.    Cardioversion at 120-200 J
d.    Epinephrine 1mg IV

3.  What are some differences between defibrillation and cardioversion?
a.    
b.   
c.    
d.    
e.    

4.  What is the correct joule setting when using a monophasic defibrillator on the above rhythm?
a.    120 J
b.    360 J
c.    300 J
d.    200 J

5.   Name 4 rhythms that can be defibrillated
a.    
b.    
c.    
d.    

Continuing with the previous scenario.  
6/25/12 11:22  CPR is in progress.  Ventilations are adequate with good chest rise.   Coworkers are attempting to establish IV access.   


6/25/12 11:23 Hands- free defibrillators pads are placed on the patient.
EKG waveform caused by cardiac compression during CPR












6/25/12 11:24.  There is no rhythm change after the initial defibrillation.   The patient remains pulseless and apneic and CPR is resumed.  An IV is established and a fluid bolus of normal saline is being infused.  Blood specimens are obtained for CBC, chemistries including Mg and Phos, PT, PTT, as well as cardiac enzymes. 

6.  What is the correct depth of compression on an adult?
a.  1-1 ½ inches
b. 1 ½- 2 inches
c. 2-3 inches
d.  2 - 2.4 inches

7..  According to the AHA was is the criteria for high quality CPR?
a.    
b.   
c.  
d.    
e.    

8.   What is the rate of compressions when performing CPR on an adult victim of cardiac arrest?
a.  80 - 100/min
b.  70 -90/min
c   60 -80/min
d.  100 -120/min

9.  The sequence for performing CPR is CAB.  What does CAB stand for?


10.  What is the ratio of compressions to ventilations when performing CPR on an adult in cardiac arrest?
a.    30:2
b.    15:2
c.    30:1
d.    15:1






Answers to questions
1.  Identify the following rhythm.
d. Torsades de pointe

2.  What is the initial treatment of choice for this patient?
b. Defibrillation at 200 J (biphasic)

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

4.  What is the correct joule setting when using a monophasic defibrillator on the above rhythm?
b. 360 J

5.   Name 4 rhythms that can be defibrillated
a. Pulseless VF
b. Pulseless VT
c.  Torsades de pointe
d. Unstable polymorphic VT

6.  What is the correct depth of compression on an adult?
d.  2 - 2.4 inches

7..  According to the AHA was is the criteria for high quality CPR?
a.  Providing chest compressions of adequate rate (at least 100/minute)
b.  Providing a compression depth of at least 2 inches (5 cm)
c.  Allowing complete chest recoil after each compression
d.  Minimizing interruptions in compressions
e. Avoiding excessive ventilation

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

9.  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

10.  What is the ratio of compressions to ventilations when performing CPR on an adult in cardiac arrest?
c. 30:2


Reviewed 3/2/16

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