ACLS_Notes.docx

1. You find an unresponsive pt who is not breathing. After activating the ERS, you determine there is not pulse. What is your next action? a. Start chest compressions of at least 100/min 2. You are evaluating a 58M w/ chest pain. BP 92/50, HR 92, non-labored RR 14, O2 97. What assessment step is most important now? a. Obtaining 12 lead ECG 3. What is the most preferred method of access for epinephrine administration during cardiac arrest in most patients? a. Peripheral IV 4. An AED does not promptly analyze a rhythm. What is your next step? a. Begin chest compressions 5. You have completed 2 min of CPR. The ECG monitor displays the lead below (PEA) and the pt has no pulse. Your partner resumes chest compressions and an IV is in place. What management step is your next priority? a. Administer 1mg epinephrine 6. During a pause in CPR, you see a narrow complex rhythm on the monitor. The pt has no pulse. What is the next action? a. Resume compressions 7. What is a common but sometimes fatal mistake in cardiac arrest managmemt? a. Prolonged interruption in chest compression 8. Which action is a component of high-quality chest compressions? a. Allowing complete chest recoil 9. Which action inc. the change of successful converstion of VF? a. Providing quality compressions immediately before defibrillation attempt 10. Which situation best described PEA? a. Sinus rhythm without a pulse 11. What is the best strategy for performing high quality CPR on a pt with an advanced airway in place? a. Provide continuous chest compressions w/o pauses and 10 ventilations per min 12. 3 min after witnessing a cardiac arrest, one member of your team inserts an ET tube while another performs continuous chest compressions. During subsequent ventilation, you notice the presence of a waveform on the capnography screen and a PETCO2 of 8 mmHg. What is the significance of this finding? a. Chest compressions may not be effective 13. The use of quantitative waveform capnography in intubated pt’s does what? a. Allows for monitoring CPR wuality 14. For the past 25 min, EMS crews have attempted resuscitation of a pt who originally presented w/ VF. After the 1st shock, the ECG screen displayed asystole which has persisted despite 2 doses of epi, a fluid bolus, and high quality CPR. What is your next treatment? a. Consider terminating resuscitation efforts after consulting medical control 15. Which is a safe and effective practice within the defibrillation sequence? a. Be sure O2 is NOT blowing over the pt’s chest during shock 16. During your assessment, your pt suddenly loses consciousness. After calling for help and determining that the pt is not breathing, you are unsure whether the pt has a pulse. What is your next action? a. Begin chest compressions 17. What is an advantage of using hands-free defibrillation pads intead of paddles? a. Hands free allows for more rapid defibrillation 18. What action is recommended to help minimize interruptions in chest compressions during CPR? a. Continue CPR while charging the defibrillator 19. Which action is included in the BLS survey? a. Early defibrillation 20. Which drug and dose are recommended for the management of a pt in refractory VF? a. Amiodarone 300 mg 21. What is the appropriate interval for an interruption in chest compressions? a. 10 sec or less 22. Which of the following is a sign of effective CPR? a. PETCO2 /= 10 mmHg 23. What is the primary purpose of a medical emergency team or rapid response team? a. Identifying and treating early clinical deterioration 24. Which action improved the quality of chest compressions delivered during resuscitative attempts? a. Switch providers about every 2 min or every 5 compression cycles 25. What is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse of 80 bpm? a. 1 breath q5-6 sec 26. A pt presents to the ED with a new onset of dizziness and fatigue. On examination, the pt’s HR 35, BP 70/50, RR22, O295. What ist he appropriate 1st medication? a. Atropine 0.5 mg 27. A pt presents to the ER with dizziness and SOC with a sinus brady of 40. The initial atropine does was ineffective and your monitor does not provide TCP. What is the appropriate dose of dopamine for this pt? a. 2-10 mcg/kg/min 28. A pt has a new onset of dizziness. HR 180, BP 110/70, RR 18, O2 98. This is a regular narrow complex tachycardia rhythm. What is the next intervention? a. Vagal maneuver 29. A monitored pt in the ICU developed a suddent onset of narrow complex tachycardia at a rate of 220/min. BP 128/58, PETCO2 38 mmHg, O2 98. There is an EJ established for vascular access. The pt denies taking any vasodilators. A 12 lead shows no ischemia or infarction. Vagal maneuvers are ineffective. What is the next intervention/ a. Adenosine 12 mg IV 30. You are receiving a radio report from an EMS team enroute with a pt who may be having a stroke. The hospital CT scanner is broken. What should you do? a. Divert the pt to a hospital 15 min away with CT capabilities 31. Choose an appropriate indication to stop or withhold resuscitative efforts? a. Evidence of rigor mortis 32. A 49F arrives in the ER with persistent epigastric pain. She has been taking antacids PO for the past 6hr b/c she has heartburn. BP 118/72 HR 92, RR 14 non-labored, O2 96. What is the most appropriate next action? a. Obtain a 12 lead ECG 33. A pt in respiratory failure becomes apneaic but continues to have a strong pulse. The HR is dropping rapidly and now shows sinus brady rate at HR 30. What intervention has the highest priority? a. Simple airway maneuvers and assisted ventilations 34. What is the appropriate procedure for ET suctioning after the catheter is selected? a. Suction during withdrawl, but no longer than 10 sec 35. While treating a stable pt for dizziness, BP 68/30, cool and clammy, you see a brady rhythm on the ECG. How do you treat this? a. Atropine 0.5 mg 36. A 68F pt experienced a sudden onset of right arm weakness. BP 140/90, HR 78, RR non- labored 14, O2 97. Lead II in ECG shows sinus rhythm. What is your next action? a. Cincinnati Stroke Scale 37. You are transporting a pt with a positive stroke assessment. BP 138/?, HR 80, RR 12, O2 95 RA. BG level normal and ECG shows sinus rhythm. What is next? a. Head CT scan 38. What is the proper ventilation rate for a pt in cardiac arrest who has an advanced airway in place? a. 8-10 breaths/min 39. A 62M pt in the ER says his heart is beating fast. No chest pain or SOB. BP 142/98, HR 200, RR 14, O2 95 RA. What should be the next evaluation? a. Obtain a 12-lead ECG 40. You are evaluating a 48M with crushing sub-sternal pain. He is cool, pale, diaphoretic, and slow to respond to your questions. BP 58/32, HR 190, RR 18, unable to obtain O2 d/t no radial pulse. The ECG shows a wide complex tachycardia rhythm. What intervention should be next? a. Synchronized cardioversion 41. What is the initial priority for an unconscious pt with any tachycardia on the monitor? a. Determine if a pulse is present 42. Which rhythm requires synchronized cardioversion? a. Unstable SVT 43. What is the recommended dose for adenosine for pt’s in refractory, but stable narrow complex tachycardia? a. 12 mg 44. What is the usual post-cardiac arrest target ran for PETCO2 who achieves ROSC? a. 34-40 mmHg 45. Which condition is CI to therapeutic hypothermia during the post-cardiac arrest period for pt’s who achieve ROSC? a. Responding to verbal commands 46. What is the potential danger to using ties that pass circumferentially around the pt’s neck when securing an advanced airway? a. Obstruction of venous return from the brain 47. What is the most reliable method of confirming and monitoring correct placement of an ET tube? a. Continuous waveform capnography 48. What is the recommended IV fluid (NS or LR) bolus dose for a pt who achieves ROSC but is hypotensive during the post-cardiac arrest period? a. 1-2 L 49. What is the minimum SBP one should attempt to achieve with fluid, inotropic, or vasopressure administration in a hypotensive post-cardiac arrest who achieves ROSC? a. 90 mmHg 50. What is the 1st treatment priority for a pt who achieves ROSC? a. Optimizing ventilation and oxygenation 51. Ventilations during cardiac arrest? a. 2:30 with bag mask b. 1:6-8 sec w/ advanced airway (8-10 breaths/min) 52. Ventilations during respiratory arrest? a. 1:5-6 sec b. 10-12 breaths/min 53. Tidal volume delivered w/ bag mask a. 600 mL 54. What does PETCO2 10 mmHg indicated in intubated pt a. Their CO2 is inadequate to achieve ROSC 55. Which drugs can be given with ET route? a. Only epi, vasopressin and lidocaine; will need to double the dose 56. Why do we give a saline bolus after infusion of a drug via peripheral IV? a. To hasten the time for peak response 57. Steps for treating hypotension a. IV bolus 1-2L NS b. Pressor; 0.1-0.5 mcg/kg/min for epinephrine or norepinephrine or 5-10 mcg/kg/min of dopamine c. Treatable causes? H’s and T’s d. Obtain ECG 58. Do you shock PEA? a. DO NOT SHOCK ASYSTOLE OR PEA  TREAT W VASOPRESSOR ONLY 59. Reperfusion goal: door to balloon (PCI) a. 90 min 60. Reperfusion goal: door to needle (fibrinolysis) a. 30 min 61. If pt is hemodynamically unstable, do you give NTG? a. NO, must have SBP 90 62. When it NTG CI? a. Inferior wall MI or right ventricular infarction b. Hypotension, bradycardia or tachycardia c. Recent phosphodiesterase use (Viagra) 63. 4 D’s of in-hospital therapy a. Door to Data to Decision to Drug (or PCI) 64. Treatment of bradyarrythmia a. 0.5 mg atropine q3-5 min; max 3 doses i. if ineffective: transcutaneous pacing or dopamine 2-10 mcg/kg/min or epi 2-10 mcg/min 65. When do you use synchronized shocks a. Unstable SVT b. Unstable Afib c. Unstable Aflutter d. Unstable, regular monomorphic tachycardia w/ pulse 66. Therapy for pt w/ narrow QRS w/ regular rhythm a. Vagal maneuver OR adenosine 67. Stoke a. General assessment w/in 10 min of arrival  fibrinolytic check list b. CT w/in 20 min c. Interpret CT w/in 45 min d. Initiate fibrinolytic therapy w/in 1 hr of arrival and 3hr from sxs onset (LKW) - What is an advantage of EMS transport to a stroke hospital for a patient with suspected acute ischemic stroke? o Responding providers can stabilize critical issues - What is the most appropriate destination for patients with suspected acute ischemic stroke? o Certified stroke center - What is an advantage of EMS altering the receiving facility of the impending arrival of a patient with suspected acute ischemic stroke? o The hospital can perform more efficient evaluation and management - What is the time goal for neurologic assessment by the stroke team or designee and noncontract CT or MRI performed after hospital arrival? o 20 min - What is the primary advantage of using a stroke severity tool?