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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
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
finding?
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.
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.
Which drug and dose are recommended for the management of a pt. in
refractory V-FIB?
Amioderone 300mg
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?
2-10mcg/kg/min
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.
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.
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
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
monitor?
Determine if a pulse is present.
What is the recommended dose for adenosine for pt's in refractory, but stable
narrow complex tachycardia?
12mg
What is the usual post-cardiac arrest target range for PETCO2 who achieves
return of spontaneous circulation (ROSC)?
35-40mm Hg
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 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.
why do we give a saline bolus after infusion of a drug via peripheral IV?
to hasten the time for peak response
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
stroke
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