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63 Cards in this Set
- Front
- Back
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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?
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Start chest compressions
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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?
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Obtaining a 12 lead ECG
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What is the preferred method of access for epi administration during cardiac arrest in most patients?
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Peripheral intravenous
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An activated AED does not promptly analyze the rhythm. what is the next action
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begin chest compressions
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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?
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Admin 1mg Epi
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during pause in cpr your monitor shows Normal sinus rhythm with no pulse. What is the next action
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Resume chest compressions.
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common mistake in cardiac arrest management?
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prolonged interuptions in chest compressions
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which action is a component in high quality chest compressions
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allow complete chest recoil
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whisch action increases the chance for successful conversion of V FIB?
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providing quality compressions immediately before defib attempts
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which situation best describes PEA
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Normal sinus rhythm without a pulse
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What is the best stratigy for preforming High quality CPR on a PT with advanced airway?
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Continous chest compressions without pauses and 10 ventilations per minute.
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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 ?
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chest compressions may not be effective
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Use of quantitative capnography in intubated pt's does what?
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allows for monitoring CPR quality
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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
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consider termination efforts after consult with MO
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Which is a safe and effective practice within the defib sequence
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be sure o2 is not blowing over patient chest during shocks
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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?
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begin chest compressions
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what is advantage of hands free defib pads instead of paddles?
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hands free pads allow for more rapid defib.
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what action is recommended to help minimize chest compressions during CPR
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continue CPR while charging the defibrillator
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which action is included in bls survey
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early defib
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which drug and dose is recommended for the management of refractory v fib.
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amioderone 300 mg.
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what is the appropriate interval for an interuption in chest compressions?
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10 seconds or less
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what is a sign of effective CPR?
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PETCOs > or = 10 mm hg
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the primary purpose of a medical emergency team or rapid response team?
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id and tx early clinical deterioration
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what action improves the quality of chest compressions delivered during a resuscitation attempt?
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switch providers ~ every 2 min or q 5 compression cycles
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what is appropriate ventilation strategy for an adult in respiratory arrest with a pulse rate of 80 p/min?
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one breath q 5-6 seconds
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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.?
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atropine .5 mg
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what is the appropriate dose of dopamine for a pt with bradycardia when the initial dose of atropine was ineffective?
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2-10 mcg/kg p/min
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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?
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vagal maneuvers
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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 ?
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adenosine 6 mg IV
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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
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divert pt to a hospital with CT scan capabilities 15 minutes away.
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what is an appropriate indication to stop or withhold resuscitative efforts?
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evidence of rigor mortis
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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?
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12 lead ECG
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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?
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simple airway maneuvers and assisted ventilation
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what is appropriate proceedure for ET suction after the appropriate cath is selected?
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suction during withdrawl but no longer then 10 seconds
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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?
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atropine
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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?
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cincinnati prehospital stroke scale
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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?
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Head CT scan
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proper vent rate for a pt in cardiac arrest with advanced airway placed?
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8-10 B/min
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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?
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12 ECG
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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?
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synchronized cardio-version
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what is the initial priority for unconscious patient with any tachycardia on the monitor?
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review patients home medications
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which rhythm synchronized cardioversion?
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NSR on monitor with no pulse
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what is the recommended second dose of adenosine for patients in refractory but stable narrow complex tachycardia ?
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12 mg
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what is the usual post cardiac arrest target range for PETCO2 when ventilating a patient who achieves return of spontaneous circulation? (ROSC)
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35-40 mm Hg
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Which condition is a contraindication to therapeutic hypothermia during the post cardiac arrest. For patients who achieve return of spontaneous circulation?
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responding to verbal commands
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What is the potential danger of using ties that pass circumferential around the patients neck when securing a patients airway?
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obstruction of venous return from the brain
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What is the most reliable method of confirming and monitoring correct placement of ET Tube?
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continuous Wave form capnography
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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?
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1-2 liters
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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.
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90
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what is the 1st treatment priority in a patient who achieves ROSC ?
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Optimizing oxygenation and ventilation
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What are the H'S
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Hypovolemia
Hypoxia hydrogen Ion (acidosis) hypo/hyperkalimia Hypothermia |
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What are the T'S
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tension Pneumo
tamponade (cardiac) toxins thrombosis, pulmonary/coronary |
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amioderone
cardiac arrest |
300mg IV Bolus
second dose 150 mg |
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epinepherine
cardiac arrest |
1mg q 3-5
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vasopressin
cardiac arrest |
40 u can replace 1st or second dose of epi
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epinepherine IV
post cardiac arrest |
.1-.5 mcg/kg per minute
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dopamine
post cardiac arrest |
5-10 mcg /kg
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norepinepherine
post cardiac |
.1-.5 mcg/kg per minute
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Brady with pulse Atropine?
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atropine .5 mg bolus repeat every 3-5 minutes
MAX 3 MG |
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Brady with pulse Dopamine
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2-10 mcg/kg per minute
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Brady with pulse Epi?
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2-10 mcg/min
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Tachy with Pulse Adenosine ?
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Adenosine 6 mg rapid IV follow with NS flush
2nd dose 12 mg if required |
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tachy with pulse Amioderone
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1st dose 150mg over 10 minutes repeat PRN if VT recurs
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