Float Nurse

246 .  List four currently recommended medications in the ventricular fibrillation algorithm. Epinephrine Amiodarone Lidocaine Magnesium 247.   You have been called to a patient in cardiac arrest.  You find a 53 year old male who is unresponsive, pulseless and apneic.  CPR is being properly performed. As the crash cart arrives you quick-look and see ventricular fibrillation.  What is the next appropriate intervention? Charge the paddles and defibrillate the patient with 200 J if using a biphasic defibrillator or 360 J if using a monophasic defibrillator. 248. You are the team leader for the code team.  As you observe the team members performing compressions you want to evaluate both the rate and depth of compressions. What is the correct rate and depth of compression in adult CPR? 100 compressions per minute A compression depth of at least 2- 2.4 inches (5cm). 249. Match the correct dosages with the five currently reco...

241.  Describe the technique for administering medications through the ET tube. When giving drugs via the ET tube route the typical dose is increased by 2-2 ½ times and is diluted in 5-10ml of saline and injected directly into the trachea. 242.  What concentration of epinephrine should be administered via the ET tube? Give epinephrine 1:1000 2-2 ½ mg diluted in 5-10ml of normal saline or sterile water. 243.  How often can epinephrine be repeated in the cardiac arrest victim? Epinephrine may be repeated every 3-5 minutes in the cardiac arrest victim. 244.  What are the recommendations for administering vasopressin to a victim in pulseless arrest? Vasopressin is no longer recommended.  Vasopressin is a nonadrenergic peripheral vasoconstrictor that also causes coronary and renal vasoconstriction.   A single RCT   enrolling 336 patients compared multiple doses of standard-dose epinephrine with multiple doses of standard dose vasop...

236.  What special considerations are made for a cardiac arrest victim who is hypothermic with a core temperature less than 86 ° F (< 30 ° C)? It is appropriate to attempt an initial defibrillation in a hypothermic patient cardiac arrest victim.  But if the patient fails to respond to the initial defibrillation then subsequent attempts and drug therapy should be deferred and resuscitative efforts should focus on effective CPR and active rewarming until the patient’s core temperature is above 86 ° F (< 30 ° C).   237.  What is the major concern about administering cardiac arrest medications to the hypothermic patient with a core temperature below 86 ° F (< 30 ° C)? Since the patient’s metabolism is reduced, the hypothermic heart may be unresponsive to drug therapy.  Because of this, there is a concern that drug levels may rise to toxic levels with standard dosing regimens. 238.  What considerations are made for the hypoth...

231.  What are the therapeutic effects of epinephrine and vasopressin during a pulseless arrest? Epinephrine is use during resuscitation primarily for its alpha-adrenergic effects which lead to peripheral vascular vasoconstriction.  This increases both cerebral and coronary blood flow during CPR.  Vasopressin is a noradrenergic agent which also causes peripheral vasoconstriction.  Overall, the effects of vasopressin have not been shown to be different from that epinephrine. 232.   After a third shock, epinephrine 1mg IV is administered to a patient in pulseless VF/VT.  What would be the next appropriate intervention for this patient? Continue CPR to circulate the epinephrine and complete the 5 cycles of CPR and perform a rhythm analysis and pulse check.  If the rhythm analysis reveals refractory VF/VT, then prepare for a fourth shock and prepare either a second dose of epinephrine 1mg IV or an initial dose of vasopressin 40 U. 233....

226.  What should the rescuer do as he/she is clearing the patient prior to delivering a shock? The person operating the defibrillator should make a visual check to ensure that no one is touching the patient or stretcher.  227.   Why is it necessary to use conductive gels when using defibrillator paddles? Conductive materials are used to reduce transthoracic resistance (resistance to the electrical current).  Conductive materials include electrode gels or pastes or gel pads.  Also remember to maintain firm downward pressure of the paddles to ensure adequate skin to paddle contact. 228.  When treating a cardiac arrest patient, when should pulse checks be performed?  Ideally pulse checks should be performed during the rhythm analysis.  If an organized rhythm is noted on the monitor during the rhythm analysis, then a team member should palpate the patient for a pulse.   This ideally should take no more than 10 seconds...

221.  What are the initial and subsequent joule settings when defibrillating a patient with a monophasic defibrillator? If you are using a monophasic defibrillator, give an initial single 360-J shock and use the same energy setting for subsequent shocks. 222.  In order to maintain rescuer safety, should CPR be interrupted while the defibrillator is charging? No.  Continue CPR while the defibrillator is charging and continue until told to “clear” the patient.  Even a 5-10 second pause in chest compressions reduces the chance that a shock will terminate VF/VT to a profusing heart rhythm. 223.  Biphasic defibrillators are effective at terminating VT over a variety of joule settings.  If you do not know the manufacturer’s effective biphasic dose setting, what joule setting should you use? If you do not know the manufacturer’s effective biphasic dose setting then deliver 200 J for the first shock and an equal or higher joule setting for subsequen...

216.  Is it safe to use an AED in water? No, it is not safe.   The water conducts electricity.   If the patient is in water, move the patient to a dry surface and wipe off as much water from the skin surface as possible.   217.   What problems are posed when attempting to use an AED on a patient with a hairy chest? The hairy chest may prevent the pads from sticking properly to the skin surface.    When this occurs the electricity from the defibrillation is conducted across the skin surface and not through the myocardium.    If too much hair is present, then quickly pull off the pads to remove the hair and reapply fresh pads or use a razor to shave off the hair. 218.   Is the use of an AED contraindicated in patients with an implantable pacemaker or defibrillator? No, an AED can be safely used in patients with an implantable pacemaker or defibrillator.    In such patients, avoid placing the AED electrode pads ove...