Megacode Pulseless VF/VT part 4

Continuing with the above senario.  

6/25/12 11:34.   The patient is orally intubated.  Bilateral breath sounds are noted and the end-tidal CO2 detector is positive.   No gurgling noises are noted over the epigastrium.  A STAT portable chest X-ray is ordered.  Magnesium 2gm IV is given as CPR is continued.  The patient remains pulseless and apneic.  

EKG Waveform Caused by CPR

31.  What are agonal respirations?

32. During CPR the rescuer notices that the patient's PETCO2 increases and remains between 35-45mm Hg.  What might a potential cause of this?

33.   What drugs may be administered via the ET route?

a. 

b. 

c. 

d. 

e. 

34. What devise has been shown to be the most effective at monitoring on going correct ET tube placement?

35.  Describe the changes in technique when performing CPR on a victim who has an advance airway in place.

Continuing with the above senario.  

6/25/12 11:38.  The magnesium has been circulated with CPR and a rhythm check reveals refractory torsades de pointe.   A 4^th shock is administered at 360 J.  

After the 4^th shock, a pulse check reveals a weak carotid pulse.   The respirations are spontaneous but gasping in nature so positive pressure ventilations are continued.  Temp 95.4 HR 74 Resp 16.  Pulse oximeter 95%.  BP 82/46.    A second liter of normal saline is started.  Oxygen and IV fluids are continued and the patient is monitored for any further rhythm changes.  A bed assignment has been obtained in ICU. 

36.  What is the maximum cumulative dose of Lidocaine?

a. 2mg/kg

b. 5mg/kg  

c. 4mg/kg

d. 3mg/kg

37.  What is the recommended second dose of epinephrine for a patient in pulseless arrest?

a.  1mg

b.  2mg

c.  3mg

d.  4mg

38.  When treating a patient for pulseless VF/VT it is important to look for underlying problems that may have triggered the cardiac event.  The most common problems are called the 5Hs and the 5Ts.  Name the 5 Hs.

A.        _________________

B.        _________________

C.        _________________

D.        _________________

E.        _________________

39.  When treating a patient for pulseless VF/VT it is important to look for underlying problems that may have triggered the cardiac event.  The most common problems are called the 5Hs and the 5Ts.  Name the 5 Ts.

A.        _________________

B.        _________________

C.        _________________

D.        _________________

E.        _________________

40.  What is one of the most important factors for successful defibrillation for a victim of cardiac arrest?

Answers to Questions

31.  What are agonal respirations?

Agonal respirations are slow, gasping-like respirations that may be present during the first few minutes of a cardiac arrest.  Agonal respirations are not adequate enough to oxygenate the patient and thus require intervention with positive pressure ventilations.   Additionally the patient may not respond and has no pulse and requires CPR.

32. During CPR the rescuer notices that the patient's PETCO2 increases and remains between 35-45mm Hg.  What might a potential cause of this?

If PETCO2 abruptly increases to a normal value (35 to 40 mm Hg), it is reasonable to consider that this is an indicator of ROSC

33.   What drugs may be administered via the ET route?

a. Naloxone

b. Atropine

c. Vasopressin

d. Epinephrine

e. Lidocaine

34. What devise has been shown to be the most effective at monitoring on going correct ET tube placement?

Continuous waveform capnography

35.  Describe the changes in technique when performing CPR on a victim who has an advance airway in place.

When an advanced airway (ie, endotracheal tube, Combitube, or laryngeal mask airway [LMA]) is in place during 2-person CPR, give 1 breath every 6 to 8 seconds without attempting to synchronize breaths between compressions (this will result in delivery of 8 to 10 breaths/minute). There should be no pause in chest compressions for delivery of ventilations

36.  What is the maximum cumulative dose of Lidocaine?

a. 2mg/kg

b. 5mg/kg  

c. 4mg/kg

d. 3mg/kg

37.  What is the recommended second dose of epinephrine for a patient in pulseless arrest?

a.  1mg

b.  2mg

c.  3mg

d.  4mg

38.  When treating a patient for pulseless VF/VT it is important to look for underlying problems that may have triggered the cardiac event.  The most common problems are called the 5Hs and the 5Ts.  Name the 5 Hs.

a.        Hypoxia

b.        Hypovolemia

c.        Hydrogen ions (acidosis)

d.        Hypothermia

e.        Hypokalemia and hyperkalemia

f.         Hypoglycemia

39.  When treating a patient for pulseless VF/VT it is important to look for underlying problems that may have triggered the cardiac event.  The most common problems are called the 5Hs and the 5Ts.  Name the 5 Ts.

a.       Thromobsis coronary

b.       Tension pneumothorax

c.       Toxins/tablets

d.       Tamponade

e.       Thrombosis pulmonary

f.        Trauma

40.  What is one of the most important factors for successful defibrillation for a victim of cardiac arrest?

One of the most important determinants for successful defibrillation is the effectiveness of chest compressions. Defibrillation outcome is improved if interruptions (for rhythm assessment, defibrillation, or advanced care) in chest compressions are kept to a minimum.