Code Blue
Out, out, brief candle!
Life's but a walking shadow, a poor player,
That struts and frets his hour upon the stage,
And then is heard no more. Macbeth Act 5, scene 5
21. When are the acceptable times for interrupting chest
compressions during a pulseless arrest?
25. What is the most frequent initial rhythm seen in
out-of-hospital witnessed sudden cardiac arrest?
Answers.
Life's but a walking shadow, a poor player,
That struts and frets his hour upon the stage,
And then is heard no more. Macbeth Act 5, scene 5
 |
| CPR Rhythm |
1. What is the
initial dose of Amiodarone in treating pulseless VT/VF?
2. What are the
ECG characteristics of Torsades de pointes?
3. Magnesium is the drug of choice in the treatment of
what dysrhythmia?
4. When using a biphasic defibrillator, what is the joule
setting when delivering the initial shock to an adult victim in VT/VF?
5. What is the initial dosage of Lidocaine used in the treatment of pulseless VT/VF?
6. What is the first vasoconstrictor that is administered
during a pulseless arrest?
7. What is the
dosage of magnesium used in the treatment of torsade de pointe?
8. What is the dose of bicarbonate in a cardiac arrest?
9. What is the treatment of choice for pulseless VT/VF?
10. What are some precautions that should be observed before applying the defibrillator pads to the patient?
11. When using a monophasic defibrillator, what is the
initial joule setting used to defibrillate an adult victim?
12. What are the ECG characteristics of VF?
13. Sodium bicarbonate is indicated in the treatment of what cardiac arrest situations?
14. What is the initial dose of Lidocaine when administered to an adult through an ET tube during pulseless VT/VF?
15. What are the recommendations for giving vasopressin during a cardiac arrest?
16. What is the recommended method for administering medications
through a peripheral IV during a cardiac arrest?
17. What are the recommended drug dosages when giving medications through the ET tube?
18. Name 5 medications that may be used in the treatment of pulseless VT?
19. What are 5 ways of verifying endotracheal tube placement in an adult?
20. What is the first antiarrhythmic and dosage that can be administered during a VF arrest?
22. What is the
maintenance dosage of Amiodarone in the post arrest setting?
23. What is the
maintenance dose of Lidocaine that can be given to a patient after returning to
spontaneous circulation?
24. What are some factors that affect transthoracic
resistance or impedance during defibrillation and cardioversion?
26. What is the
difference between a monophasic and a biphasic defibrillator?
27. What is the
next medication may be considered when VF/VT is unresponsive to CPR,
defibrillation, and vasopressor therapy?
28. What is the
advantage of performing CPR prior to defibrillating a patient in VF/VT?
Answers.
1. Amiodarone
300mg IV push
2. 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
3. Torsades
de pointe
4. 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 200 J may
be considered.
5. Lidocaine
1-1.5 mg/kg IV/IO push
6. Epinephrine
1mg IV push or Vasopressin 40 units IV push
7. 1-2
grams IV/IO diluted in 10ml of D5W as a bolus or given over 5-20 minutes
8. 1mEq/kg
IV/IO push
9. Early
defibrillation
10. 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
11. 360 J
12. P Wave:
None are visible.
PRI: There is no PRI.
QRS: None
Rate: None
Rhythm: None. The baseline is
totally chaotic
13. Preexisting hyperkalemia
Preexisting metabolic acidosis
Tricyclic antidepressant OD
Aspirin overdose
Prolonged arrest interval after
return of spontaneous circulation
14. Lidocaine
2-3mg/kg via ET tube
15. Vasopressin
40u IV may be given as a onetime dose before epinephrine or as a second dose
after the initial dose of epinephrine.
16. The medication should be given by bolus injection
followed with a 20ml bolus of saline or IV fluids.
17. Typically the drug dose given by the ET tube route is
2-2.5 times the recommended IV dose.
18. Epinephrine
Vasopressin
Amiodarone
Lidocaine
Magnesium
19. Direct cord visualization
End tidal CO2 monitoring
Bilateral breath sounds
Continuous waveform capnography
CXR
20. Amiodarone 300mg IV/IO push. If necessary, may be repeated in 3-5 minutes
at 150mg IV push.
21.
During pauses for ventilations
During rhythm checks
During delivery of actual shocks
22.
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)
23.
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
24.
Paddle size
Chest size
Distance between the paddles
Paddle pressure
Presence of conductive gel
Lower joule settings
25. Ventricular fibrillation
26. 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.
27. Amiodarone
300mg push IV/IO
28. 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.
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