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Identify the following sinus rhythms 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Answers: 1. Sinus Arrhythmia Sinus Arrhythmia.   The rhythm is irregular.  There is one upright P wave for each QRS complex. The rate is between 60-100.  The rhythm is determined by measureing the distance between the adjacent R waves, called the R-R interval.  If the rhythm is regular, the R-R interval should be the same.  With sinus arrhythmia, the difference between the shortest and longest R-R interval is over 0.12. sec. and the PR interval should be the same.  Some normal rhythmic variation occurs with respirations.  The heart rate speeds up slightly with inspiration and decelerates with expiration. 2. Normal Sinus Rhythm Normal Sinus Rhythm.  The rhythm is regular.  There is one upright P wave with each QRS complex.  the PR...

396. How do you determine the correct length of a nasopharyngeal airway? The length of the nasal airway can be estimated as the distance from the nares to the meatus of the ears.   397.   What are the advantages of using a nasopharyngeal airway over an oropharyngeal airway? The NPA is preferred to the OPA in conscious patients because it is better tolerated and less likely to induce a gag reflex and they are better tolerated than oropharyngeal airways in awake or lightly anesthetized patients. 398.   What are some contraindications against inserting a nasopharyngeal airway device? They are contraindicated in patients who are on anticoagulants, patients with basilar skull fractures, patients with nasal infections and deformities as well as in children (because of risk of epistaxis). 399. Describe some techniques for inserting an oropharyngeal device. The preferred technique is to use a tongue blade to depress the tongue and then insert the airway posteri...

391. What is the value of measuring the quantitative waveform capnography on an intubated patient during CPR? Therefore, it is reasonable to consider using quantitative waveform capnography in intubated patients to monitor CPR quality, optimize chest compressions, and detect ROSC during chest compressions or when rhythm check reveals an organized rhythm. 392. 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. 393. What are some advantages of endotracheal intubation during cardiac resuscitation? Advantages of advanced airway placement include elimination of the need for pauses in chest compressions for ventilation, potentially improved ventilation and oxygenation, reduction in the risk of aspiration, and ability to use quantitative waveform capnography to ...

386. What is the most common reason for obtaining a false negative reading on an end-tidal CO2 detector device after intubating the trachea? The most common reason for a false negative reading is that blood flow and delivery of CO2 to the lungs is low.   387. How is a false negative reading defined when using an end tidal CO2 device False-negative readings are defined in as failure to detect CO2 despite tube placement in the trachea.   388. What are some acceptable reasons for interrupting cardiac compressions during CPR? Periodic pauses in CPR should be as brief as possible and only as necessary to assess rhythm, shock VF/VT, and perform a pulse check when an organized rhythm is detected, or place an advanced airway. 389. What is the meaning of the term End-tidal CO2?   End-tidal CO2 is the concentration of carbon dioxide in exhaled air at the end of expiration. It is typically expressed as a partial pressure in mm Hg (PETCO2).   390. What is ...

376. When two health care providers are present, what is the compression to ventilation ratio for a child victim of cardiac arrest? The compression to ventilation ratio for a child is 15:2. 377. A single rescuer is performing CPR on an unresponsive infant that is pulseless and apneic.   What is the correct depth of chest compression on an infant? The rescuer should compress the chest at least 1/3 the AP depth or about 1 ½ inches (4 cm) 378.   You are a health care provider who was called to the scene of a child who suddenly collapsed.   After determining the child is unresponsive and not breathing, you check for a pulse on the child.   Where would you perform a pulse check and how long should it take you? On an unresponsive child, you would check for a carotid pulse and it should take you no longer than 10 seconds to perform the pulse check. 379.   When is it acceptable to use a precordial thump? The precordial thump should not be used for unw...

371.   If multiple rescuers are present, how often should they rotate their tasks? If multiple rescuers are available, they should rotate the task of compressions every 2 minutes. 372. What are two methods for opening the airway in an unresponsive victim who is not breathing? The airway of an unresponsive victim can be opened using the head tilt– chin lift or jaw thrust followed by rescue breaths. 373.   After inserting an advance airway into the victim, how do the rescuers modify their CPR technique? Once an advanced airway is in place, healthcare providers will deliver ventilations at a regular rate 1 breath every 6 seconds (10 breaths/minute) and chest compressions can be delivered without interruption. 374.   The victim’s chance of survival decreases with an increasing interval between the arrest and defibrillation.   True or False True. Thus early defibrillation remains the cornerstone therapy for ventricular fibrillation and pulseless ventric...

366. What are the links in the American Heart Association Chain of Survival? ● Immediate recognition of cardiac arrest and activation of the emergency response system ● Early CPR with an emphasis on chest compressions ● Rapid defibrillation ● Effective advanced life support ● Integrated post– cardiac arrest care 367. What is the difference in the etiology of cardiac arrest between and adult and child victim of cardiac arrest? Most cardiac arrests in adults are sudden, resulting from a primary cardiac cause; circulation produced by chest compressions is therefore paramount.16 In contrast, cardiac arrest in children is most often asphyxial, which requires both ventilations and chest compressions for optimal results. 368.   What are the key components the lone rescuer should perform when he/she comes upon a victim of cardiac arrest? ·          Recognize that the victim has experienced a cardiac arrest, based on unresponsiven...

356. What is a living will? A living will may be referred to as a “medical directive” or “declaration” or “directive to physicians,” and it provides written direction to healthcare providers about the care that the individual approves should he or she become terminally ill and be unable to make decisions. 357. What is a durable power of attorney? A durable power of attorney for health care is a legal document that appoints an authorized person to make healthcare decisions (not limited to end-of-life decisions). 358.   What are comprehensive healthcare advance directives? Comprehensive healthcare advance directives combine the living will and the durable power of attorney for health care into one legally binding document. 359.   What is a DNR? A Do Not Attempt Resuscitation (DNAR) order is given by a licensed physician or alternative authority as per local regulation; should explicitly describe the resuscitation interventions to be performed in the event of a...

351. While the general rule is to provide emergency treatment to a victim of cardiac arrest, what are a few exceptions where withholding CPR might be appropriate? ● Situations where attempts to perform CPR would place the rescuer at risk of serious injury or mortal peril ● Obvious clinical signs of irreversible death (eg, rigor mortis, dependent lividity, decapitation, transection, or decomposition) ● A valid, signed, and dated advance directive indicating that resuscitation is not desired, or a valid, signed, and dated DNAR order 352. Once rescuers start BLS, how long should they continue resuscitative efforts? ● Restoration of effective, spontaneous circulation ● Care is transferred to a team providing advanced life support ● The rescuer is unable to continue because of exhaustion, the presence of dangerous environmental hazards, or because continuation of the resuscitative efforts places others in jeopardy ● Reliable and valid criteria indicating irreversible death...

Tablets: Digoxin ·          Toxicity many cause a variety of dysrhythmias ·          Rx Digibind follow normogram in PDR or drug insert for correct dosing information Tablets: Cocaine ·          Elevates blood pressure ·          Increases cardiac contractility ·          Decreases coronary blood flow ·          Increases coronary vasoconstriction ·          Increases myocardial oxygen consumption Tablets: Cocaine- Treatment ·          MONA ·          Benzodiazepines- modulates stimulatory effects of cocaine on CNS ·          Avoid blockers- increases coronary vasoco...

Hypothermia ·          Assess core temperature ·          Cardiac dysrrhythmias when < 86F (30C) ·          Many meds. are ineffective until temp >86F ·          Defibrillation ineffective unless temp >86F ·          Remember   “No patient is dead until he is warm and dead” ·          Hypothermic algorithim Tablets ·          Assess for drug overdose ·          Assess for hx of drug use ·          Consult poison control Tablets: Calcium Channel Blockers ·          Hypotension ·          Bradycardia with variable...

Hyperkalemia Assess serum potassium levels Tall T waves, widened QRS 3.5-5.3             Normal 5.3-6.0             Mild 6.1-7.0             Moderate >7.0                  Severe Hyperkalemia Hyperkalemia ·          Rule of 10 10ml of 10% calcium chloride 10 units of regular insulin IV One amp D50 over 10 minutes ·          Lasix IV Kayexalate upon ROSC Hypokalemia ·          ST segment depression, flattened T waves, prominent U wave ·          Potassium replacement ·          No boluses...

Peripheral IV Drug Delivery ·          Adults peak drug concentrations are lower and circulation times longer ·          Does not require interruption of CPR ·          Administer the drug by bolus injection and follow with a 20-mL bolus of IV fluid ·          Elevate the extremity for 10 to 20 seconds to facilitate drug delivery to the central circulation. Endotracheal Drug Delivery ·          Results in lower blood concentrations than the same dose given intravascularly. ·          Give 2 to 2½ times the recommended IV dose. ·          Providers should dilute the recommended dose in 5 to 10 ml of water or normal saline and inject the drug directly into the endotracheal tube Intrao...