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Energy Dose ·          Initial monophasic dose of 2 J/kg is effective in terminating VF 18% to 50% of the time ·          Biphasic shocks are effective 48% of the time ·          It is acceptable to use an initial dose of 2 to 4 J/kg ·          For refractory VF, it is reasonable to increase the dose to 4 J/kg ·          Subsequent energy levels should be at least 4 J/kg, and higher energy levels may be considered, not to exceed 10 J/kg or the adult maximum dose Primary Survey ·          Assess patient ·          Support CABs ·          CPR ·          Attach defibrillator/monitor ·          A...

The effectiveness of PALS is dependent on high-quality CPR ·          Adequate compression rate (at least 100 compressions/min) ·          Adequate compression depth (at least one third of the AP diameter of the chest or approximately ·          1 1⁄2 inches [4 cm] in infants and approximately 2 inches [5 cm] in children) ·          Allowing complete recoil of the chest after each compression ·          Minimizing interruptions in compression ·          Avoiding excessive ventilation Defibrillation ·          Primary treatment of pulseless VF/VT ·          Sudden depolarization of myocardial cells long enough for myocardial pacemaker to resume ·     ...

Cardiac Arrest in Infants and Children ·          Does not usually result from a primary cardiac cause ·          Terminal result of progressive respiratory failure or shock ·          Asphyxia begins ·          Period of systemic hypoxemia, hypercapnia, and acidosis ·          Progresses to bradycardia and hypotension ·          Culminates with cardiac arrest Pulseless Ventricular Tachycardia (VT) and Ventricular Fibrillation (VF) ·          Initial cardiac rhythm in about  5% to 15% of pediatric in-hospital and out-of-hospital cardiac arrests ·          Reported in up to 27% of pediatric in-hospital arrests at some point during the resuscitation ·   ...

Identify the following rhythms: 1. 2. 3. 4. 5. 6. Answers 1. Atrial fibrillation with PVCs Atrial fibrillation with rapid ventricular response and PVCs.   The rhythm is irregular.   There are no P waves present, no PR interval.   There are two PVCs present, the 9th and 15th complexes.   2. NSR with a PJC NSR with a PJC.  The rhythm is regular except for the junctional premature beat of the 6th complex.  The PJC has an inverted P wave that precedes the narrow QRS complex.   3. Ventricular Paced with PVCs Ventricular Paced with PVCs.   The pacer spike precedes the negative QRS complexes.   Two large PVCs are present. 4. NSR with PJCs NSR with PJCs  Trigeminal  PJCs are noted on the 3rd, 6th, and 9th beats.   The P waves on these PJCs are absent which means that the atria and the ventricles were depolarized at the same time. ...

Identify the following rhythms: 1. 2. 3. 4. 5. 6. Answers 1. Sinus arrhythmia with a PVC and some PACs Sinus arrhythmia with a PVC and some PACs (bigeminy pattern)  The PACs are the 7th and 9th complexes. The complexes are early (shorter R-R interval) and are narrow, < .12 sec.  There is an upright P wave before each complex and the morphology of the P waves is different from the previous P waves. 2. Sinus rhythm with a PJC and some PACs (bigminy pattern) Sinus rhythm with a PJC and some PACs (bigminy pattern).   The PJC is the 2nd complex.   Notice the inverted P wave that occurs before the QRS complex.  Recall that with junctional ectopy the P wave will be inverted or absent or occur before or after the QRS complex.  This is followed by a sinus beat (3rd complex) and PACs every other beat.  (4th, 6th, 8th complexes) 3. NSR with a PVC and a junctional escape beat ...

6.  Three hours after admission to your unit a 67 year old who was admitted to the telemetry unit with bradycardia begins to complain of weakness and dizziness.  At the same time the telemetry tech calls you to report that although she remains in a heart block, her rate is now in the 30s.  As you assess the patient you find that she is mildly confused and anxious.  She now has mild chest pain and shortness of breath.  Her BP is 92/40 with a heart rate of 34.  The hospitalist is called and he determines that the patient needs to be prepared for transcutaneous pacing.   After applying the pacing pads and electrodes you slowly increase the mA on the defibrillator monitor and observe the monitor and note the following rhythm: How should this rhythm be treated? A.       The patient should be given 1mg of Atropine IV stat B.       The patient should be given epinephrine (1:10,000) ...

5.   A 67 year old is admitted to the telemetry unit with bradycardia.  She has a medical history that includes a NSTEMI two years ago.  Her cardiac catheterization at that time showed a 25% blockage in her LAD.  Because of some worsening symptoms, she recently went to her family doctor and her dosage of metoprolol was increased from 50mg twice daily to 100mg twice daily and she was scheduled her for a stress test.   As you assess her, you find that she is alert and oriented, BP 106/60.  Her respirations are regular, symmetrical, non-labored.  Her skin is warm and dry.   Her heart rhythm is as follows:    Identify the rhythm. a.        Idioventricular rhythm b.       Complete heart block c.        2 nd degree heart block type II d.       1 st degree heart block Answer:  C. ...