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.
 |
| 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.
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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