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You find an unresponsive pt. who is not breathing.

After activating the

emergency response system, you determine there is no pulse. What is your next
Start chest compressions of at least 100 per min.

You are evaluating a 58 year old man with chest pain. The BP is 92/50 and a
heart rate of 92/min, non-labored respiratory rate is 14 breaths/min and the
pulse O2 is 97%. What assessment step is most important now?
Obtaining a 12 lead ECG.

What is the preferred method of access for epi administration during cardiac
arrest in most pts?
Peripheral IV

An AED does not promptly analyze a rythm. What is your next step?
Begin chest compressions.

You have completed 2 min of CPR. The ECG monitor displays the lead below
(PEA) and the pt. has no pulse. You partner resumes chest compressions and an
IV is in place. What management step is your next priority?
Administer 1mg of epinepherine

During a pause in CPR, you see a narrow complex rythm on the monitor. The
pt. has no pulse. What is the next action?

Resume compressions

What is a common but sometimes fatal mistake in cardiac arrest management?

Prolonged interruptions in chest compressions.

Which action is a componant of high-quality chest comressions?

Allowing complete chest recoil

Which action increases the chance of successful conversion of ventricular

Providing quality compressions immediately before a defibrillation attempt.
Which situation BEST describes PEA?
Sinus rhythm without a pulse

What is the best strategy for perfoming high-quality CPR on a pt.with an

advanced airway in place?
Provide continuous chest compressions without pauses and 10 ventilations per

3 min after witnessing a cardiac arrest, one memeber of your team inserts an
ET tube while another performs continuous chest comressions. During
subsequent ventilation, you notice the presence of a wavefom on the
capnogrophy screen and a PETCO2 of 8 mm Hg. What is the significance of this

Chest compressions may not be effective.

The use of quantitative capnography in intubated pt's does what?

Allows for monitoring CPR quality

For the past 25 min, EMS crews have attempted resuscitation of a pt who
originally presented with V-FIB. 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?
Consider terminating resuscitive efforts after consulting medical control.

Which is a safe and effective practice within the defibrillation sequence?

Be sure O2 is NOT blowing over the pt's chest during shock.

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?
Begin chest compressions.

What is an advantage of using hands-free d-fib pads instead of d-fib paddles?

Hands-free allows for more rapid d-fib.

What action is recommended to help minimize interruptions in chest

compressions during CPR?
Continue CPR while charging the defibrillator.

Which action is included in the BLS survey?

Early defibrillation

Which drug and dose are recommended for the management of a pt. in
refractory V-FIB?
Amioderone 300mg

What is the appropriate interval for an interruption in chest compressions?

10 seconds or less

Which of the following is a sign of effective CPR?

PETCO2 = or > 10mm Hg

What is the primary purpose of a medical emergency team or rapid response

Identifying and treating early clinical deterioration.

Which action improves the quality of chest compressions delivered during

resuscitave attemepts?
Shitch providers about every 2 min or every 5 compression cycles.

What is the appropriate ventilation strategy for an adult in respiratory arrest

with a pulse of 80 beats/min?
1 breath every 5-6 seconds

A pt. presents to the ER with a new onset of dizziness and fatigue. On

examination, the pt's heart rate is 35 beats/min, BP is 70/50, resp. rate is 22
per min, O2 sat is 95%. What is the appropriate 1st medication?
Atropine 0.5mg

A pt. presents to the ER with dizziness and SOB with a sinus brady of 40/min.
The initial atropine dose was ineffective and your monitor does not provide
TCP. What is the appropriate dose of Dopamine for this pt?

A pt. has an onset of dizziness. The pt.s heart rate is 180, BP is 110/70, resp.
rate is 18, O2 sat is 98%. This is a reg narrow complex tach rythm. What is the
next intervention?
Vagal manuever.

A monitored pt. in the ICU developed a sudden onset of narrow complex tach at
a rate of 220/min. The pt's BP is 128/58, the PETCO2 is 38mm Hg, and the O2

sat is 98%. There is an EJ established for vascular access. The pt. denies taking
any vasodialators. A 12 lead shows no ischemia or infarction. Vagal manuevers
are ineffective. What is the next intervention?
Adenosine 12mg IV

You 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?
Divert the pt. to a hospital 15 min away with CT capabilities.

Choose an appropriate inidication to stop or withhold resuscitive efforts.

Evidence of rigor mortis.

A 49 y/ofmaile arrives in the ER with persistant epigastric pain. She has been
taking antacids PO for the past 6 hours because she she had heartburn. BP is
118/72, heart rate is 92/min, resp. rate is 14 non-labored and O2 sat is 96%.
What is the most appropriate next action?
Obtain a 12 lead ECG.

A pt. in respiratory failure becomes apneic but contineues to have a strong

pulse. The heart rate is dropping paridly and now shows a sinus brady rate at
30/min. What intervention has the highest priority?
Simple airway manuevers and assisted ventilations.

What is the appropriate procedure for ET suctioning after the catheter is


Suction during withdrawl, but not for longer than 10 seconds.

While treating a stable pt for dizziness, a BP of 68/30, cool and clammy, you
see a brady rythm on the ECG. How do you treat this?
Atropine 0.5mg

A 68 y/o female pt. experienced a sudden onset of right arm weakness. BP is

140/90, pulse is 78/min, resp rate is non-labored 14/min, 02 sat is 97%. Lead
2 in the ECG shows a sinus rythm. What would be your next action?
Cinncinati Stroke Scale

You are transporting a pt. with a positive stroke assessment. BP is 138, pulse is
80/min, resp rate is 12/min, 02 sat is 95% room air. Glucose levels are normal
and the ECG shows a sinus rythm. What is next.
Head CT scan

What is the proper ventilation rate for a pt. in cardiac arrest who has an
advanced airway in place?
8-10 breaths per minute

A 62 y/o male pt. in the ER says his heart is beating fast. No chest pain or SOB.
BP is 142/98, pulse rate is 200/min, reps rate is 14/min, O2 sats are 95 at
room air. What should be the next evaluation?
Obtain a 12 lead ECG.

You are evaluating a 48 y/o male with crushing sub-sternal pain. He is cool,
pale, diaphretic, and slow to respond to your questions. BP is 58/32, pulse is
190/min, resp rate is 18, and you are unable to obtain an 02 sat due to no
radial pulse. The ECG shows a wide complex tach rythm. What intervention
should be next?
Syncronized cardioversion.

What is the initial priority for an unconscious pt. with any tachycardia on the
Determine if a pulse is present.

Which rythm requires synchronized cardioversion?

Unstable SVT

What is the recommended dose for adenosine for pt's in refractory, but stable
narrow complex tachycardia?

What is the usual post-cardiac arrest target range for PETCO2 who achieves
return of spontaneous circulation (ROSC)?
35-40mm Hg

Which conditionis a contraindication to theraputic hypothermia during the

post-cardiac arrest period for pt's who achieve return of spontaneous
circulation (ROSC)?
Responding to verbal commands

What is the potential danger to using ties that pass circumfrentially around the
pt's neck when securing an advanced airway?
Obstruction of veneous return from the brain

What is the most reliable method of confirming and montioring correct

placement of an ET tube?
Continuous waveform capnography

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?
1 to 2 Liters

What is the minimum systolic BP one should attempt to achieve with fluid,
Inotropic, or vasopressor administration in a hypotensive post-cardiac arrest
who achieves ROSC?
90mm Hg

What is the 1st treatment priority for a pt. who achieves ROSC?
Optimizing ventilation and oxygenation.

Ventilations during Cardiac Arrest

2 every 30 compressions with a bag mask
1 every 6 to 8 seconds w/advanced airway (8-10 breaths/minute)

ventilations during respiratory arrest

1 every 5 to 6 seconds
10 to 12 breaths/minute

tidal volume delivered w/bag mask


what does a PETCO2 of <10mmHg indicate in an intubated patient

their CO is inadequate to to achieve ROSC

which drugs can be given with endotracheal route?

only epi, vasopressin and lidocaine and you will need to double the dose

why do we give a saline bolus after infusion of a drug via peripheral IV?
to hasten the time for peak response

steps for treating hypotension

1. IV bolus 1-2L normal saline

2. pressor: 0.1-0.5 mcg/kg/min for epi or norepi
or 5-10mcg/kg/min of dopamine
3. treatable causes? (H's and T's)
4. obtain ECG

Do you shock PEA?

do not shock asystole or PEA!
treatment is vasopressor only!

reperfusion goal: time from door to balloon inflation (PCI)

90 minutes

reperfusion goal of 30 minutes is for...

door-to-needle (fibrinolysis)

if pt is hemodynamically unstable do you give nitroglycerin?

No, must have SBP >90mmHg

when is nitroglycerin contraindicated?

inferior wall MI or RT ventricular infarction
hypotension, brady or tachycardia
recent phosphodiesterase use (Viagra)

4 D's of in-hospital therapy

door to data to decision to drug (or PCI)

treatment of bradyarrhythmia
0.5 mg Atropine every 3-5 minutes, max of 3 mg
if ineffective:
transutaneous pacing or dopamine 2-10mcg/kg/min or epi 2-10mcg/min

when do you use synchronized shocks

unstable SVT
unstable afib
unstable a flutter
unstable, regular, monomorphic tachycardia w/a pulse

therapy for pt w/narrow QRS w/regular rhythm

vagal maneuver
give adenosine

general assessment w/in __ minutes of arrival
CT w/in __ minutes
interpret CT within __ minutes
initiate fibrinolytic therapy within ?
door-to-admission time of 3 hours

general assessment w/in 10 minutes of arrival

CT w/in 25 minutes
interpret CT within 45 minutes
-initiate fibrinolytic therapy within 1 hour of arrival and 3 hours from symptom