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47 Cards in this Set

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In pulseless arrest, What two rythms are immediately shockable?
Ventricular fibrillation (coarse), ventricular tachycardia
In pulseless Arrest, what two rythms are not immediately shockable?
PEA, Asystole
Once you have determined it is a shockable rythm, Do you shock, or perform CPR first?
Shock first. Manual biphasic: device specific- usually 120-200J; AED- device specific; Monophasic- 360J CHECK FOR A PULSE
Your first shock has not affected the heart rythm. What is your next step?
Give 5 cycles of CPR*. Check the rythm.

* after advanced airway is placed, give continuous chest compressions without pauses for breaths. Give 8-10 breaths per minute.
After your first shock, the pt still has a shockable rythm. Your partner is is establishing IV access. What is your next step?
Continue CPR while defibrillator is charging. GIVE 1 SHOCK.
Manual Biphasic- same as first shock or higher dose.
AED-device specific.
Monophasic-360J
Resume CPR immediately after shock.
IV access has been established. Pt has been down less than 10 minutes. What medicine(s) would you give first and second?
Epinephrine (1mg IV/IO) every 3-5min.
OR
Vasopressin (40u IV/IO)

*Order doesn't matter, but you must give both*
How often is Vasopressin given during a pulseless arrest?
1 time dose. It must be given either first, or second in place of a dose of epi.
Two shocks have been given, you have pushed a round of epi, and vasopressin. your pt still has a shockable rythm. What's next?
Continue CPR while defibrillator is charging.
Deliver 1 shock.
Manual Biphasic- same as first shock or higher dose.
AED-device specific.
Monophasic-360J
Resume CPR immediately after shock
what antiarrhythmics would you consider during pulseless arrest?
Amiodarone- 300mg IV/IO once, then consider additional 150 once; or
Lidocaine-1-1.5mg/kg first dose, then 0.5-0.75mg/kg IV/IO max 3 doses, or 3mg/kg
What medicine would you consider for Torsades de pointes?
Magnesium Sulfate-1-2g IV/IO
You arrive on scene and pt is in asystole for less than 10 minutes. Your partner is establishing an IV. Do you shock, or give CPR?
CPR immediately.
An IV has just been established on your asystolic pt. What medicines do you consider?
Epinephrine- 1mg IV/IO every 3-5 min.
OR
Vasopressin 40u IV/IO to replace first or second dose of epi.

Consider atropine 1mg IV/IO for asystole, or slow PEA rate every 3-5 min up to 3 doses.
You have administered your first round of medication to your pt with no shockable rhythm. Do you shock immediately, or give CPR?
Give cycles of CPR unless advanced airway has been placed. After advanced airway placement, give continuous chest compressions without pauses for breaths.
How often per ACLS algorithm do you check the rythm, and rotate compressors?
Every 2 minutes for both.
You arrive on scene and pt is in asystole for less than 10 minutes. Your partner is establishing an IV. Do you shock, or give CPR?
CPR immediately.
An IV has just been established on your asystolic pt. What medicines do you consider?
Epinephrine- 1mg IV/IO every 3-5 min.
OR
Vasopressin 40u IV/IO to replace first or second dose of epi.

Consider atropine 1mg IV/IO for asystole, or slow PEA rate every 3-5 min up to 3 doses.
You have administered your first round of medication. Do you shock immediately, or give CPR?
Give cycles of CPR unless advanced airway has been placed. After advanced airway placement, give continuous chest compressions without pauses for breaths.
How often per ACLS algorithm do you check the rythm, and rotate compressors?
Every 2 minutes for both.
Your preciously asystolic patient has converted to a rhythm with a pulse. What is your next step?
Begin postresuscitation care.
What are the 6H's and 6t's that can cause pulseless electrical activity?
Hypovolemia, Hypoxia, Hydrogen ion(acidosis), Hypo-/ hyperkalemia, hypothermia

Toxins, tamponade(cardiac), tension pneumothorax, thrombosis(coronary, or pulmonary) trauma, tablets
It is important that you minimize _________ in chest compressions, and ensure full chest ______ during CPR.
interruptions, recoil
During your initial assessment of a new patient, he says he just woke up and his pulse was racing. Your EMT pratner verifies that his pulse is 170 bpm. Per the tachycardia algorithm, what are the top 4 basic things you are to do?
-Assess and support ABCs as needed.
-Give OXYGEN
-Monitor ECG (identifyu rhythm), blood pressure, oximetry
-identify and treat reversible causes.
this is straight out of box 2 on the flow chart
Before you can implement a treatment for a tachycardic patient, what must you do regarding the rate?
Discern if this stable or unstable tachycardia.
What sort of things do you expec to to see in a pt with unstable tachycardia of <150bpm?
Altered mental status, ongoing chest pain, hypotension, or other signs of shock.
Are rate related symptoms common if the heart rate is below 150bpm?
No.
You have discerned that your pt is experiencing unstable tachycardia. Provided he is on oxygen, maintaining his airway, and the ECG, BP, and Sp02 has been put on him, What is your next immediate action?
Perform immediate synchronized cardioversion:

-establish IV access and give sedation if pt is still conscious, do not delay cardioversion.
-consider expert consultation
-if pulseless arrest develops, got to pulseless arrest algorithm.
His heart is not beating efficiently, you need to take it over for him.
You discern that your pt is in a stable tachycardia. What are your next steps, and what do you need to discern before continuing treatment?
-Establish IV access
-Obtain 12-lead ECG (when avainable) or rhythm strip.
-discern if the QRS is wide or narrow.
What is considered a wide QRS complex?
Greater than or equal to .12 sec (120 milisec)
You discern that your pt has a wide complex tachycardia. what is your next question, and what is advised?
You need to know is the rhythm regular, or irregular.

Expert consultation is advised.
Your pt who is in a wide complex tachycardia has now become unstable. What is your next move?
Immediate synchronized cardioversion
I hope you have that IV established! But don't delay treatment getting one right now.
Your pt is in a regular rhythm wide complex tachycardia. Per the tachycardia algorithm, what are probable rhythms, and how do you treat them?
If V-tach, or uncertain rhythm:
Amiodarone- 150mg over 10 min. Repeat as needed to max dose of 2.2g/24hrs.
-prepare for elective synchronized cardioversion
-or-
If SVT with aberrancy:
Adenosine 6mg RIVP
Your pt is in an irregular rhythm wide complex tachycardia. Per the tachycardia algorithm, what are probable rhythms, and how do you treat them?
If a-fib with aberrancy:
probable a-fib, or possible a flutter or MAT.
-consider expert consultation
- Control rate ( diltiazem, beta blockers *use beta blockers with caution in pulmonary disease or CHF*)

If afib with WPW:
-expert consultation advised
AVOID AV nodal blocking agents (adenosine, digoxin, diltiazem, verapamil)
-consider antiarrhythmics (amiodarone 150mg IV over 10 min.)

If recurrent polymorphic VT, seek expert consultation.

If torsades de pointes, give mag sulfate (load 1-2g over 5-60 minutes, then infuse)
During your initial assessment, your pt says he just woke up and his pulse was racing. Your EMT partner verifies that his pulse is 174 bpm. Per the tachycardia algorithm, what are the top 4 basic things you are to do?
-Assess and support ABCs as needed.
-Give OXYGEN
-Monitor ECG (identify rhythm), blood pressure, oximetry
-identify and treat reversible causes.
You discern that your pt is in a stable tachycardia. What are your next steps, and what do you need to discern before continuing treatment?
-Establish IV access
-Obtain 12-lead ECG (when available) or rhythm strip.
-discern if the QRS is wide or narrow.
You discern that your pt has a narrow complex tachycardia. what is your next question, and what is advised?
You need to know is the rhythm regular, or irregular.
Your pt who is in a narrow complex tachycardia has now become unstable. What is your next move?
Perform immediate synchronized cardioversion
our pt is in a regular rhythm narrow complex tachycardia. Per the tachycardia algorithm,how do you treat?
-Attempt vagal maneuvers
- give Adenosine 6mg rapid IV push. If no conversion, give 12 mg rapid IV push; may repeat 12 mg dose once
You will probably need another set of hands for this. And oh yeah, if you can please tell the pt what you are about do!
You have given the recommended dose of Adenosine to your pt with a regular narrow tachycardia rhythm. What will decide your next course of action?
Whether or not the rhythm converts.
Note: consider expert consultation. This is an easy question. Box 8
Your pt with a regular narrow tachycardia rhythm has tolerated your treatment well and the rhythm has converted with Adenosine. What is the probable rhythm, and what is your next step?
Probable reentry SVT:
_ Observe for recurrence with Adenosine or longer acting AV nodal blocking agents (eg, diltiazem, beta-blockers)
Remember, you dance with the partner you came with. If the treatment works, MAINTAIN the effects
Your pt with a regular narrow tachycardia rhythm has tolerated your treatment well but the rhythm has not converted after giving the maximum doses of Adenosine. What is the probable rhythm, and what is your next step?
Possible atrial flutter, ectopic atrial tachycardia, or junctional tachycardia:
- Control rate (eg, diltiazem, beta-blockers- use beta-blockers with caution in pulmonary disease or CHF)
- Treat underlying cause
- Consider expert consultation
Your pt is in an irregular rhythm narrow complex tachycardia. Per the tachycardia algorithm, what are probable rhythms, and how do you treat them?
Probable atrial fibrillation or possible atrial flutter or MAT (multifocal atrial tachycardia)
- Consider expert consultation
- Control rate (eg, diltiazem, beta-blockers- use beta blockers with caution in pulmonary disease or CHF)
You have been dispatched to a 54 yo female complaining of "not feeling well, and very tired." You arrive to find your female patient looking pale and diaphoretic. Pulse is 56bpm. What are your initial treatment steps per the bradycardia algorithm?
-Maintain patent airway; assist breathing as needed.
- Give oxygen
- monitor ECG(identify rhythm), blood pressure, oximetry
- Establish IV access
What are signs and symptoms of poor perfusion caused by bradycardia?
Acute altered mental status, ongoing chest pain, hypotension or other signs of shock.
You have just applied O2, started an IV and attached the monitor to your bradycardic patient. She is adequately perfusing, and her rhythm is showing sinus bradycardia. What is your treatment plan per the ACLS bradycardia algorithm?
Observe and monitor
You have just applied O2, started an IV and attached the monitor to your bradycardic patient. She is not adequately perfusing, and her ECG is showing second degree AV block type II. What is your treatment plan per the ACLS bradycardia algorithm?
Prepare for transcutaneous pacing; use without delay for high-degree block (second degree type II or third degree)
- Consider atropine 0.5mg IV while awaiting pacer. May repeat to a total dose of 3mg. If ineffective, begin pacing
- Consider epinephrine (2-10 mcg/min) or dopamine (2-10 mcg/kg/min) infusion while awaiting pacer or if pacing is ineffective.
You are pacing your bradycardic patient. What else should you prepare for and do?
-Prepare for transvenous pacing
-Treat contributing causes
-Consider expert consultation
QUICK!!!!!
What are the 6Hs and 6Ts?
-Hypovolemia
-Hypoxia
-Hydrogen ion (acidosis)
-Hypo-/hyperlkalemia
-Hypoglycemia
-Hypothermia
-Toxins
-Tamponade, cardiac
-Tension pneumothorax
-Thrombosis (coronary or pulmonary)
-Tablets
:)

You may only have 5, but i was given 6Ts