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63 Cards in this Set

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you find a patient who is not breathing. You activate the EMS and you determine there is no pulse. What is your next action?
Start chest compressions
You are evaluating a 58 year old man with chest pain. The BP is 92/50 and HR is 92/mi, nonlabored respiratory rate is 14 breaths/min and the pulse ox reading is 97%. What is the 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 patients?
Peripheral intravenous
An activated AED does not promptly analyze the rhythm. what is the next action
begin chest compressions
completed 2 minutes CPR. the ECG monitor displays PEA and the patient has no pulse. Member of the team resumes chest compressions, IV placed. What is the management step is the next priority?
Admin 1mg Epi
during pause in cpr your monitor shows Normal sinus rhythm with no pulse. What is the next action
Resume chest compressions.
common mistake in cardiac arrest management?
prolonged interuptions in chest compressions
which action is a component in high quality chest compressions
allow complete chest recoil
whisch action increases the chance for successful conversion of V FIB?
providing quality compressions immediately before defib attempts
which situation best describes PEA
Normal sinus rhythm without a pulse
What is the best stratigy for preforming High quality CPR on a PT with advanced airway?
Continous chest compressions without pauses and 10 ventilations per minute.
3 min after witnessed cardiac arrest, 1 member inserts ET TUBE another preforms continious chest compressions during ventilation you notice the presence of waveform on capnography and a PETCO2 level of 8 mm/HG. what is the significance of this finding ?
chest compressions may not be effective
Use of quantitative capnography in intubated pt's does what?
allows for monitoring CPR quality
past 25 minutes EMS crew has attempted resesitation of VFIB after 1st shock the ECG shows Asystole, which has persisted despite 2 doses of epi and fluid bolus and High quality CPR. What is next treatment
consider termination efforts after consult with MO
Which is a safe and effective practice within the defib sequence
be sure o2 is not blowing over patient chest during shocks
during the assessment pt loses consciousness after calling for help and determining the the patient isnt breathing you are unsure if the pt has a pulse, what is next action?
begin chest compressions
what is advantage of hands free defib pads instead of paddles?
hands free pads allow for more rapid defib.
what action is recommended to help minimize chest compressions during CPR
continue CPR while charging the defibrillator
which action is included in bls survey
early defib
which drug and dose is recommended for the management of refractory v fib.
amioderone 300 mg.
what is the appropriate interval for an interuption in chest compressions?
10 seconds or less
what is a sign of effective CPR?
PETCOs > or = 10 mm hg
the primary purpose of a medical emergency team or rapid response team?
id and tx early clinical deterioration
what action improves the quality of chest compressions delivered during a resuscitation attempt?
switch providers ~ every 2 min or q 5 compression cycles
what is appropriate ventilation strategy for an adult in respiratory arrest with a pulse rate of 80 p/min?
one breath q 5-6 seconds
pt presents with new onset of dizzines and fatigue. on exam pt HR 35 b/p 70/50 breaths p/min 22 O2 sats 95%. what is appropriate first med.?
atropine .5 mg
what is the appropriate dose of dopamine for a pt with bradycardia when the initial dose of atropine was ineffective?
2-10 mcg/kg p/min
sudden on set dizziness with HR 180 b/p 110/70, R 18, O2 98% room air, lead II ecg sinus tachy. what is the next appropriate intervention?
vagal maneuvers
an ICU pt developed sudden onset of narrow-complex tachycardia at a rate of 220/min. b/p 128/58, PETCO2 38, O2 98%. IV in left IJ and pt has not been given any vassoactive drugs. a 12 lead ECG confirms a supraventricular tachycardia w/ no evidence of ischemia or infarction. HR not responded to vagal maneuvers. what is the next recommended intervention ?
adenosine 6 mg IV
receiving a radio report from ems team enroute, pt may be having acute stroke, the hospital CT scan not working, what should you do in this situation
divert pt to a hospital with CT scan capabilities 15 minutes away.
what is an appropriate indication to stop or withhold resuscitative efforts?
evidence of rigor mortis
49 y/o women ER w/ persistent epigastric pain, she had been taking oral antacids for past 6hrs for self diagnosed heart burn. incial b/p 118/72, P 92 reg. non-labored R 14, Os 96%. what is the most appropriate intervention to perform next?
12 lead ECG
pt in respiratory failure becomes apnic but continues have strong pulse Hr dropping rapidly now showing sinus brady at rate of 30 /min. what intervention has highest priority?
simple airway maneuvers and assisted ventilation
what is appropriate proceedure for ET suction after the appropriate cath is selected?
suction during withdrawl but no longer then 10 seconds
treating a pt with dizziness, b/p 68/30 with cool clammy skin. lead II shows second degree AV block type II (looks like a shark)? what is the most appropriate first intervention?
atropine
a 68 y/0 woman experienced a sudden onset of right arm weakness. b/p 140/90 Hr 78, R 14, O2% 97. lead II ECG: normal sinus rythum. what is the next appropriate action?
cincinnati prehospital stroke scale
EMS is transporting a pt with pos prehospital stroke assessment. upon arrival of the ER, the initial b/p 138/78, P 80, R 12, O2% 95, lead II ECG: sinus rythum, blood glucose in normal limits. what intervention you perform next?
Head CT scan
proper vent rate for a pt in cardiac arrest with advanced airway placed?
8-10 B/min
62 y.o male in ER states hear "beating fast" denies angina or SOB, b/p 142/98, P 200, R 14, O2% 95? what intervention perform next?
12 ECG
you evaluate a 48 man with crushing chest pains. is a semi-truck driver pale, diaphoretic, cool to touch, slow to respond to questions, b/p 58/32, H 190, R 18, O2% unable to obtain due to no pulse, lead II ECG displays regular wide complex tachycardia. what intervention should you perform next?
synchronized cardio-version
what is the initial priority for unconscious patient with any tachycardia on the monitor?
review patients home medications
which rhythm synchronized cardioversion?
NSR on monitor with no pulse
what is the recommended second dose of adenosine for patients in refractory but stable narrow complex tachycardia ?
12 mg
what is the usual post cardiac arrest target range for PETCO2 when ventilating a patient who achieves return of spontaneous circulation? (ROSC)
35-40 mm Hg
Which condition is a contraindication to therapeutic hypothermia during the post cardiac arrest. For patients who achieve return of spontaneous circulation?
responding to verbal commands
What is the potential danger of using ties that pass circumferential around the patients neck when securing a patients airway?
obstruction of venous return from the brain
What is the most reliable method of confirming and monitoring correct placement of ET Tube?
continuous Wave form capnography
what is the recommended IV fluid NS or LR bolus dose for a patient who achieve ROSC but is hypotensive during the post cardiac arrest period?
1-2 liters
what is the minimum systolic BP one should attempt to achieve with fliud, intropic , or vasopressor administration i n a hypotensive post cardiac arrest patient who achieves ROSC.
90
what is the 1st treatment priority in a patient who achieves ROSC ?
Optimizing oxygenation and ventilation
What are the H'S
Hypovolemia
Hypoxia
hydrogen Ion (acidosis)
hypo/hyperkalimia
Hypothermia
What are the T'S
tension Pneumo
tamponade (cardiac)
toxins
thrombosis, pulmonary/coronary
amioderone

cardiac arrest
300mg IV Bolus

second dose 150 mg
epinepherine

cardiac arrest
1mg q 3-5
vasopressin

cardiac arrest
40 u can replace 1st or second dose of epi
epinepherine IV

post cardiac arrest
.1-.5 mcg/kg per minute
dopamine

post cardiac arrest
5-10 mcg /kg
norepinepherine


post cardiac
.1-.5 mcg/kg per minute
Brady with pulse Atropine?
atropine .5 mg bolus repeat every 3-5 minutes

MAX 3 MG
Brady with pulse Dopamine
2-10 mcg/kg per minute
Brady with pulse Epi?
2-10 mcg/min
Tachy with Pulse Adenosine ?
Adenosine 6 mg rapid IV follow with NS flush

2nd dose 12 mg if required
tachy with pulse Amioderone
1st dose 150mg over 10 minutes repeat PRN if VT recurs