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240 Cards in this Set
- Front
- Back
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Examples of advanced airway adjuncts include all the following except:
a. oropharyngeal airway b. laryngeal tube c. laryngeal mask airway d. combitube e. endotracheal tube |
a. oropharyngeal airway
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Which is not true about the oropharyngeal airway(OPA):
a. The OPA keeps the airway open during bag-mask ventilation. b. The OPA can stimulate coughing and gagging c.The OPA can prevent the patient from biting on an ET tube. d. The OPA should only be used on a conscious patient |
d. The OPA should only be used on a conscious patient
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Which of the following is performed before and/or during the BLS Survey:
a. make sure the scene is safe b. activate EMS and get an AED if available c. tap the victim's shoulder and say "Are you alright?" d. all of the above |
d. all of the above
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4. When providing BLS/ACLS to a known or suspected cervical spine trauma which of the following is NOT correct when attempting to open the airway?
a. Open the airway using the jaw thrust without head extension. b. Use a head tilt-chin lift maneuver if the jaw thrust is not effective. c. Use manual restriction to stabilize the head d. Use an immobilization device to stabilize the head |
d. Use an immobilization device to stabilize the head
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During post-cardiac care you are using **epinephrine, norepinephrine, and dopamine** to treat HYPOtension.
what should the targeted SBP be? What is the target for MAP? |
SBP > 90 mm Hg
MAP > 65 mm Hg |
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When performing the Airway Assessment portion of the ACLS Survey, the following questions should be asked:
a. Is the airway patent? b. Is an advanced airway indicated? c. Does the patient have a pulse? d. both a and b |
both a and b
a. Is the airway patent? b. Is an advanced airway indicated? |
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During the ACLS Survey when assessing (B)breathing, which of the following is correct about supplementary oxygen delivery?
a. Administer 100% oxygen for cardiac arrest patients b. Other than cardiac arrest, administer oxygen to maintain O2 saturation value o≥ 94% by pulse oximetry c. both a and b are correct d. neither a and b are correct |
both a and b are correct
a. Administer 100% oxygen for cardiac arrest patients b. Other than cardiac arrest, administer oxygen to maintain O2 saturation value o≥ 94% by pulse oximetry |
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During the (C) circulation portion of the ACLS survey, the following actions are carried out:
a. look, listen, and feel b. Obtain IV access, Attach ECG leads, monitor rhythm, given medications to manage rhythm, give IV/IO fluids if needed c. Obtain IV access, give supplemental oxygen, secure the advanced airway, give IV/IO fluids if needed d. Check a pulse, monitor heart rhythm, begin CPR if indicated |
b. Obtain IV access, Attach ECG leads, monitor rhythm, given medications to manage rhythm, give IV/IO fluids if needed
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For conscious patients who may need more advanced assessment and management techniques, healthcare providers should conduct the ACLS Survey first?
True? or False? |
True
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10. In the Final Portion of the ACLS survey, the D stands for:
a. defibrillation b. definitive care c. differential diagnosis d. discuss options |
DDx
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11. Which of the following best describes how to select the proper size of an (OPA) oropharyngeal airway?
a. one size fits all b. the OPA should be the length of the patients middle finger c. the OPA should be the length from the corner of the mouth to the angle of the mandible. d. the OPA should be the length from the patients nose to the ear lobe. |
c. the OPA should be the length from the corner of the mouth to the angle of the mandible.
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Which statement is true:
a. During CPR a compression rate of approximately 100/min should be maintained. b. During CPR a compression rate of at least 100/min should be maintained. |
b. During CPR a compression rate of at least 100/min should be maintained.
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During CPR a compression depth of at least _____is required in adults.
a. 1 ½ -2 inches b. 1 ½ inches c. 2 inches d. 2 ½ inches |
2 inches
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(True or False) The BLS sequence for CPR changed from A-B-C to C-A-B.
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True
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The 2010 guidelines added a 5th link in the AHA ECC Adult Chain of Survival. This addition was:
a. Integrated post-cardiac arrest care b. Rapid defibrillation c. Effective advanced life support d. Early CPR with emphasis on chest compressions |
a. Integrated post-cardiac arrest care
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High Quality CPR includes all of the following except:
a. Allowing for complete chest recoil after each compression b. Minimizing interruptions in chest compressions c. Ensuring a 15:2 compression to ventilation ratio d. Avoiding excessive ventilation |
Ensuring a 15:2 compression to ventilation ratio
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In the A-B-C sequence which of the following would often delay chest compressions?
a. opening the airway to give rescue breaths b. retrieving a barrier device c. assembling ventilation equipment d. all of the above |
all of the above
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(True or False) Healthcare providers are encouraged to tailor rescue actions to the most likely cause of arrest.
True False |
True
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(True or False) Look, listen, and feel followed by two rescue breaths has been removed from the BLS Survey to promote earlier initiation of chest compressions.
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True
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(True or False) Chest compressions should be stopped while the manual defibrillator is charging.
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False
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. All 4 electrode pad placement positions have been shown to be equally effective to treat atrial and ventricular arrhythmias. Which placement position is the default position for pad placement?
a. anterior-posterior b. anterior-right infrascapular c. anterior-lateral d. anterior-left infrascapular |
anterior-lateral
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The recommended initial biphasic energy dose for cardioversion of atrial fibrillation changed. The new range is ___________.
120-200 J 100-200 J 50-100 J 100-150 J |
120-200 J
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(True or False) A precordial thump may be considered for patients with witnessed, monitored, unstable VT if a defibrillator is not immediately available for use.
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True
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AHA guidelines recommended adenosine be given how many times when using the tachycardia algorithm?
a. 1 b. 2 c. 3 d. repeat until conversion |
2
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(True of False) Atropine is no longer recommended for routine use in the management of PEA and asystole.
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true
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When using waveform capnography during CPR what (end-tidal CO2) ETCO2 value would most likely indicate a return of spontaneous circulation (ROSC)?
a. 10-20 mmHg b. >80 mmHg c. 35-40 mmHg d. 5-10 mmHg |
35-40 mmHg
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Which is now recommended for confirming placement of the endotracheal tube after intubation?
a. exhaled carbon dioxide detector b. continuous waveform capnography c. oxygen saturation monitor d. esophageal detector device |
continuous waveform capnography
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Which of the following can be monitored with quantitative waveform capnography?
a. effectiveness of chest compressions b. detection of return of spontaneous circulation (ROSC) c. confirmation of endotracheal tube placement d. all of the above |
all of the above
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The 2010-2015 ACLS guidelines simplified and streamlined the cardiac arrest algorithm to emphasize the importance of :
a. high quality CPR b. uninterrupted CPR c. early intubation d. drug therapy e. both a and b |
both a and b
a. high quality CPR b. uninterrupted CPR |
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Desired target temperature for therapeutic hypothermia in the post-cardiac arrest phase is _______________
a. 25-36 C b. 32-34 C c. < 32 C d. < 30 C |
32-34 C
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(True or False) Adenosine is now recommended in the initial diagnosis and treatment of unstable irregular wide-complex tachycardia.
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False
“Adenosine is recommended as safe and potentially effective for both treatment and diagnosis in the initial management of undifferentiated **regular monomorphic wide complex tachycardia**.” |
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In the bradycardia algorithm, what is now recommended as an equally effective alternative to transcutaneous pacing?
a. CPR b. epinephrine or dopamine infusion c. atropine d. pounding on the chest |
b. epinephrine or dopamine infusion
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When using waveform capnography, what is the desired level of end-tidal CO2 that indicates adequate chest compressions during CPR?
a. >20mm Hg b. >10 mmHg c. >5 mmHg d. between 20-30 mmHg |
b. >10 mmHg
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The “BLS termination of resuscitation rule” was established to consider terminating BLS support before ambulance transport if which of the following criteria are met?
a. unwitnessed arrest by first responder or EMS provider b. No ROSC after 3 compete rounds of CPR and AED analyses c. No AED shocks delivered d. all of the above |
all of the above
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(True or False) 2010 guidelines state that cricoid pressure should not be used routinely during cardiac arrest.
True False |
True
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Providers giving chest compressions should be switched every _____ minute(s) to avoid fatigue.
a. 1 b. 2 c. 3 d. 4 e. 5 |
2 min
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What does ROSC stand for:
a. return of strong circulation b. repeat of shock and compressions c. return of spontaneous circulation d. return of spontaneous compression |
return of spontaneous circulation
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In the post-cardiac arrest phase, you should maintain oxygen saturation levels at _________.
a. 100% b. ≥94% c. ≥90% d. 90-95% |
≥94%
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In the post arrest phase HYPOtension is considered __________.
SBP < 100 SBP < 85 SBP < 80 SBP < 90 |
SBP<90
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The most reliable method of confirming and monitoring correct placement of an ET tube is _____________.
a. continuous waveform capnography b. x-ray c. end-tidal CO2 detector d. oxygen saturation monitor |
continuous waveform capnography
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Which of the following is the only post-resuscitation intervention that has been demonstrated to improve neurologic recovery after cardiac arrest?
a. vasopressor infusion b. continuous waveform capnography c. therapeutic hypothermia d. maintaining an oxygen saturation > 94% |
therapeutic hypothermia
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The treatment of hypotension during the post-cardiac arrest will often include IV bolus of fluids. What is the recommended amount of NS or lactated Ringer’s that should be given?
a. 500 ml 1-2 liters 1 liter 500 ml - 1 liter |
1-2 liters
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If therapeutic hypothermia is indicated in the post-resuscitation phase, what is the recommended temperature fluids should be cooled to?
0 ° C 4 ° C 8 ° C 10 ° C |
4 ° C
(39.2 ° F) |
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Three medications recommended for the treatment of hypotension in the post-resuscitation phase are:
a. labetalol, dopamine, amiodarone b. epinephrine, norepinephrine, and amiodarone c. epinephrine, norepinephrine, and dopamine d. epinephrine, dopamine, sotalol |
. epinephrine, norepinephrine, and dopamine
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(True or False) The medications used for the treatment of hypotension during the post-arrest phase including epinephrine, dopamine, and norepinephrine all use weight based doses?
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True
For control of hypotension in the post cardiac arrest phase, the dosing is weight based: for the treatment of hypotension is listed as a weight based infusion. The dosing is listed as 0.1-0.5 mcg/kg/min (for example a 70kg adult: 7-35 mcg/min would be given). So you see this dose for post-arrest hypotension would be much higher than the dose given for transcutaneous pacing which is 2-10 mcg/min |
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In the post resuscitation phase, what is the decision point for the use of therapeutic hypothermia?
a. the patient's temperature is > 37 ° C b. The patient fails to follow commands c. arrest phase was > than 10 minutes d. defibrillation occurred during resuscitation |
The patient fails to follow commands
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To induce therapeutic hypothermia, health care providers should cool patients to a target temperature of ______________.
30-35 ° C 28-32 ° C 32-34 ° C < 32 ° C |
32-34 ° C
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How long should cooling measures last when using therapeutic hypothermia?
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12-24 hrs
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The purpose of therapeutic hypothermia is to:
A.reduce chances of reoccurrence of cardiac arrest B.slow the heart rate C.improve the effectiveness of medications D.protect the brain and other organs |
protect the brain and other organs
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Which of the following are considered safe and effective for induction of therapeutic hypothermia?
a. rapid IV infusion of ice-cold, isotonic, non-glucose-containing fluid (30ml/kg) b. surface cooling devices c. endovascular catheter infusion of ice-cold, isotonic, non-glucose-containing fluid d. all of the above |
all of the above
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(True or False) In comatose patients who spontaneously develop a mild degree of hypothermia (>32 ° C) after resuscitation from cardiac arrest, avoid active rewarming during the first 12-24 hours after ROSC.
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true
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(True or False) Axillary temperatures are adequate for measurement of core temperature during the post-resuscitation phase.
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False
" Axillary and oral temperatures are inadequate for the measurement of core temperature changes." |
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Which of the following is considered adequate for monitoring core temperatures in the post-arrest phase?
a. esophageal thermometer b. bladder catheter in nonanuric patients c. pulmonary artery catheter d. all of the above |
all of the above
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What does PCI mean?
a. post-cardiac interventions b. percutaneous coronary intervention c. possible cardiac incident d. premature coronary intervention |
b. percutaneous coronary intervention
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In the Post-Cardiac Arrest Care Algorithm flowchart, you are instructed “DO NOT” do one thing. What is it?
a. hyperventilate b. induce hypothermia c. hypoventilate d. none of the above |
a. hyperventilate
" Hyperventilation should be avoided because it can cause excessive cerebral vasoconstriction and lead to worsening brain ischemia. Also, Hyperventilation or excessive tidal volume can contribute to hemodynamic instability in certain patients due to increased intrathoracic pressures." pg.73 |
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(True or False) Health care providers should consider induced hypothermia for comatose adult patients with ROSC after in-hospital cardiac arrest from **ventricular fibrillation only**.
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false
The only criteria for the implementation of therapeutic hypothermia is whether or not the patient can follow verbal commands. The rhythm which was treated during cardiac arrest has no bearing on treatment with therapeutic hypothermia. |
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Waveform capnography measures which of the following:
a. PaCO2 b. PaO2 c. PetCO2 d. PCO2 |
c. PetCO2
PetCO2 stands for Pressure of end-tidal CO2. This is a measurement of the amount of CO2 that is exhaled upon expiration and it is what continuous waveform capnography measures. |
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In the post-resuscitation phase when using continuous waveform capnography, you should titrate breaths per minute to achieve PetCO2 (partial end-tidal carbon dioxide) of ______________.
a. 25-30 mmHg b. 35-40 mmHg c. 5-10 mmHg d. 15-25 mmHg |
b. 35-40 mmHg
This ensures adequate clearance of CO2 during respiration and is an indicator of adequate ventilation. |
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In the post-resuscitation phase when evaluating an arterial blood gas, you should titrate breaths per minute to achieve PaCO2 (partial pressure of carbon dioxide) of ______________.
30-40 mmHg 35-45 mmHg 40-45 mmHg 50-60 mmHg |
40-45 mmHg
pg. 74 |
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In the post-resuscitation phase what is a reasonable goal for the mean arterial blood pressure?
a. ≥ 65 mmHg b. 55-65 mmHg c. ≥85 mmHg d. 65-70 mmHg |
≥ 65 mmHg
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What is the drug of first choice for symptomatic bradycardia?
a. atropine b. lidocaine c. epinephrine d. vasopressin |
atropine
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Which ECG rhythm is commonly associated with bradycardia?
a. PEA b. Mobitz II c. ventricular fibrillation d. sinus rhythm |
Mobitz II
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What is generally considered the most important and clinically significant degree of block?
a. type I (Mobitz I) b. type II (Mobitz II) c. third-degree AV block d. first-degree AV block |
3rd degree AV block
pg. 105: “Complete block is generally the most important and clinically significant degree of block.” It is also the most likely block to cause cardiovascular collapse. |
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Which drugs are involved in the Bradycardia Algorithm?
a. atropine, epinephrine, dopamine b. atropine, norepinephrine, dopamine c. atropine, lidocaine, adenosine d. atropine, epinephrine, lidocaine |
a. atropine, epinephrine, dopamine
p. 106 |
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Bradyarrhythmia is defined as:
a. any rhythm disorder with a heart rate less than 40 beats per minute b. any rhythm disorder with a heart rate less than 60 beats per minute c. any symptomatic rhythm disorder with a heart rate less than 50 beats per minute d. any rhythm disorder with a heart rate less than 50 beats per min |
b. any rhythm disorder with a heart rate less than 60 beats per minute
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Symptomatic bradycardia exists when_________.
a. the heart rate is slow b. the patient has symptoms c. the symptoms are due to a slow heart rate d. all of the above are needed for symptomatic bradycardia to exist. |
d. all of the above are needed for symptomatic bradycardia to exist.
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(True or False)
Symptoms of bradycardia can include chest discomfort or pain, shortness of breath, decreased level of consciousness, weakness, fatigue, lightheadedness, dizziness, and presyncope or syncope. |
true
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(True or False)
Signs of symptomatic bradycardia include hypotension, orthostatic hypotension, diaphoresis, pulmonary congestion, runs of PVC's or VT. |
true
VT and PVC’s occur as bradycardia related escape rhythms. |
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The primary decision point in the bradycardia algorithm is the determination of:
a. heart rate b. adequate perfusion c. blood pressure d. rhythm |
b. adequate perfusion
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Bradycardia:
After it is determined the patient has inadequate perfusion, what is the next step? |
Atropine, prepare for transcutaneous pacing
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If Bradycardia is causing a patient SYMPTOMS, it will generally be < _______bpm
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<50 bpm
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The correct dose of atropine given in the bradycardia algorithm is:
1 mg atropine, may repeat up to 4 mg 0.5 mg atropine, may repeat up to 2 mg 0.5 mg atropine, may repeat up to 3 mg 1 mg atropine, may repeat up to 3 mg |
0.5 mg atropine, may repeat up to 3 mg
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The correct dose of epinephrine given in the bradycardia algorithm is:
1-5 mcg/min 2-8 mcg/min 2-10 mcg/min 5-10 mcg/min |
2-10 mcg/min
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The correct dose of dopamine given in the bradycardia algorithm is:
2-10 mcg/kg/min infusion 2-8 mcg/kg/min infusion 5-10 mcg/kg/min infusion 1-5 mcg/kg/min infusion |
2-10 mcg/kg/min infusion
**mcg/kg/min infusion** |
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The treatment sequence for bradycardia with poor perfusion is:
prepare for transcutaneous pacing, consider atropine while waiting, use epinephrine or dopamine while awaiting pacemaker or if pacing is ineffective. give epinephrine, if ineffective give atropine, if atropine is ineffective start transcutaneous pacing start IV drip of dopamine or epinephrine, if ineffective begin transcutaneous pacing, and if this is not effective, give atropine begin cpr, give epinephrine, give atropine, defibrillate, repeat epinephrine if needed. |
prepare for transcutaneous pacing, consider atropine while waiting, use epinephrine or dopamine while awaiting pacemaker or if pacing is ineffective
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Bradycardia:
Transcutaneous pacing should be started immediately if: there is no response to atropine atropine is unlikely to be effective or if IV access cannot be quickly established the patient is severely symptomatic all of the above |
all of the above
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Bradycardia:
If Transcutaneous pacing is ineffective for symptomatic bradycardia, the next step would be to prepare for: prepare for transvenous pacing give repeat doses of atropine prepare for pacemaker placement begin CPR |
prepare for transvenous pacing
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Bradycardia:
Atropine doses of less than 0.5mg may paradoxically result in further slowing of the heart rate. True False |
True
pg. 111 "atropine crosses into the CNS stimulating the vagus nerve causing bradycardia at low doses. At higher doses the muscarinic blocking effects of Atropine out weigh the CNS effects, causing tachycardia." |
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For bradycardia unresponsive to atropine, what other drug should be considered?
vasopressin epinephrine magnesium sulfate all of the above |
epinephrine
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The treatment of choice for symptomatic bradycardia with signs of poor perfusion is ____________.
pacemaker placement transcutaneous pacing CPR none of the above |
transcutaneous pacing
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Transcutaneous pacing is contraindicated in the patient with ________________.
severe hypothermia hypokalemia chest pain all of the above |
severe hypothermia
pg. 112: “TCP is contraindicated in severe hypothermia and is not recommended for asystole.” |
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For transcutaneous pacing, the current milliamperes (mA) output should be:
set at 30 mA set 2 mA above capture dose set 4 mA above capture dose set no higher than capture dose |
set 2 mA above capture dose
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For transcutaneous pacing, the demand rate should be set at:
no higher than 60/min started at 60/min with adjustment based on clinical response started at 80/min with adjustment based on clinical response started at 100/min and reduced to minimum for clinical response |
started at 60/min with adjustment based on clinical response
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Transcutaneous pacing is not recommended for which of the following?
a. 2nd degree block type II b. asystole c. complete block d. both a and b |
asystole
(also not for severe hypothermia) |
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Preparation for transcutaneous pacing should be made for which of the following?
unstable sinus bradycardia third degree AV block Mobitz type II second-degree AV block all of the above |
all of the above
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What is the dose and frequency for epinephrine in the bradycardia algorithm?
2-5 micrograms/min 2-10 micrograms/min 0.5 mg, every 3-5 min. 1 mg, every 5 min. |
2-10 micrograms/min
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Go over ACLS rythms
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do it...
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Which definition of complete block is correct.
3rd degree heart block or complete heart block One or more (but not all) of the atrial impulses fail to conduct to the ventricles due to impaired conduction. The impulse conducting from atria to ventricles through the AV node is delayed and travels slower than normal PR interval is lengthened beyond 0.20 seconds The impulse generated in the SA node in the atrium does not propagate to the ventricles and there is no apparent relationship between P waves and QRS complexes. There is no impulse generated from the SA note in the atrium but the ventricles contract from random locations below the AV Node |
The impulse generated in the SA node in the atrium does not propagate to the ventricles and there is no apparent relationship between P waves and QRS complexes.
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Which of the following is not correct?
second degree AV block type 1=Wenckebach complete block=third degree AV block second degree AV block type II=Mobitz I Wenckenbach=Mobitz I |
second degree AV block type II=Mobitz I
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PEA is defined as:
Any rhythm organized or unorganized that does not have a pulse. Any organized rhythm without a palpable pulse. All rhythms which do not have a palpable pulse. Any organized rhythm including VT without a palpable pulse. |
Any organized rhythm without a palpable pulse.
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The two most important aspects to treating PEA are:
a, Provide effective CPR and correct the underlying cause of the rhythm. b. Provide effective CPR and promptly use core drugs c. Provide effective CPR and timely transcutaneous pacing of the patient. d. Provide effective CPR and check pulses regularly |
Provide effective CPR and correct the underlying cause of the rhythm.
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Some common causes of PEA are:
a. Hypovolemia, Hypoxia, and Hydrogen Ion (Acidosis) b. Hypovolemia and Hypothermia c. Hypothermia and Hyperkalemia d. All of the above |
All of the Above
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(T/F)
In PEA, advanced airway placement is a priority over establishing IV/IO access. |
False
------------------------------------------------------------------------- pg. 81. Placing an advanced airway is secondary to establishing IV access for several reasons. 1. adequate ventilation can be given with a BVM (bag valve mask) 2. Placing an advanced airway is time consuming. 3. Use of IV fluids and medications are interventions for some of the reversible causes of PEA |
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(T/F)
All resuscitation team members must simultaneously conduct a search for an underlying and treatable cause of the PEA in addition to their roles. |
True
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During PEA/Asystole, As soon as IV/IO access is available, the patient should be given:
A. 1 mg atropine B. 1 mg epinephrine C. 2 mg epinephrine D. 6 mg adenosine |
1 mg epinephrine
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When hypoxia is the primary cause of PEA what clues may be noted on assessment?
A. normal blood gas B. rapid rate on ECG C. wide QRS complex on ECG D. slow rate on ECG |
slow rate on ECG
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During PEA, what step occurs after CPR and medication administration?
A. defibrillation B. rhythm check C. transcutaneous pacing D. 5 cycles of CPR |
rhythm check
------------------------------------------------------------------- pg. 80. After 5 cycles of CPR and a dose of epinephrine 1mg IV push, a rhythm check should be performed. |
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The H's and T's that are possible causes of PEA include all the following except:
hypovolemia, toxins, thrombosis hypoxia, thrombocytopenia, hypoglycemia hydrogen ion, hypokalemia, tamponade hypothermia, tension pneumothorax, hydrogen ion (acidosis) |
hypoxia, thrombocytopenia, hypoglycemia
pg. 83. |
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When hypovolemia is the primary cause of PEA what clues may be noted on assessment?
narrow complex rapid rate on ECG flat neck veins dropping blood pressure prior to PEA all of the above |
all of the above
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Some clues for PEA caused by acidosis (hydrogen ion) would be all of the below except:
recent trauma history of diabetes renal failure smaller-amplitude QRS complexes |
recent trauma
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Recommended treatment to reverse PEA caused by acidosis is:
a. adequate ventilation b. sodium bicarbonate c. normal saline bolus d. both a and b |
both a and b
a. adequate ventilation b. sodium bicarbonate |
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PEA caused by HYPERkalemia may present with which of the following rhythm changes?
A. narrow QRS complex, smaller P-waves, and T- waves taller and peaked B. wide QRS complex, taller P-waves, and T-waves taller and peaked C. wide QRS complex, smaller P-waves, and T-waves taller and peaked D. narrow QRS complex, smaller P-waves, and T-waves smaller and rounded |
wide QRS complex, smaller P-waves, and T-waves taller and peaked
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Patients that you might more commonly see with PEA caused by HYPERkalemia are all the following except which one?
renal failure diabetes elderly dialysis recipient |
elderly
---------------------------------------------------- Any condition that causes impaired renal fxn |
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Reversing HYPERkalemia is done using which of the following medications?
sodium bicarbonate glucose and insulin albuterol any of the above |
any of the above
----------------------------------------------------------- pg. 83 Table 3. These three medications shift potassium intracellularly and enhance potassium elimination. |
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PEA caused by HYPOkalemia may present with which if the following symptoms?
A. flattened T-waves, prominent U waves, wide QRS, prolonged QT B. peaked T-waves, prominent U waves, narrow QRS, prolonged QT C. flattened T-waves, prominent U waves, narrow QRS, shortened QT D. peaked T-waves, non-visible U waves, wide QRS, prolonged QT |
flattened T-waves, prominent U waves, wide QRS, prolonged QT
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Patients that you might more commonly see with PEA caused by HYPOkalemia are:
diabetic patients patients using diuretics patients with chest pain all of the above |
patients on diuretics
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Life threatening hypokalemia is uncommon but can occur in the setting of gastrointestinal and renal losses and is associated with hypomagnesemia. Treatment with magnesium may help during cardiac arrest.
(T / F) |
True
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The “T” that represents drug overdose and chemical exposure among frequent causes of PEA stands for:
thrombosis tension pneumothroax tamponade toxins |
toxins
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A clue that PEA could be caused by drug overdose “Toxins” is:
a. narrow QRS complex b. prolonged QT interval c. tachycardia d. tracheal deviation |
prolonged QT interval
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Reversing PEA caused by Tamponade is performed by:
A) chest tube placement B) emergency surgery C) pericardiocentesis D) needle decompression |
pericardiocentesis
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Tension pneumothroax which can be a cause of PEA may be recognized by all of the following symptoms except:
A) unequal breath sounds B) neck vein distension C) wide QRS complex on ECG D) tracheal deviation |
wide QRS complex on ECG
|
|
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Pulmonary Thrombosis (massive pulmonary embolism) induced PEA may manifest itself with which symptoms?
A) no pulse with CPR B) distended neck veins C) narrow QRS complex on ECG D) all of the above |
all of the above
|
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Fibrinolytic agents are recommended for PEA caused by coronary and pulmonary thrombosis.
True False |
False
------------------------------------------ pg. 85 states: “routine fibrinolytic treatment given during CPR shows no benefit and is not recommended.” also “In patients with cardiac arrest due to presumed or known pulmonary embolism, it is reasonable to administer fibrinolytics.” |
|
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Hypovolemia which is a common cause of PEA can be rapidly reversed by ____________.
increasing core temperature fluid resuscitation epinephrine all of the above |
fluids
|
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Which cause of PEA is least likely to benefit from treatment?
thrombosis (pulmonary/coronary) tamponade tension pneumothroax hypovolemia |
thrombosis (pulmonary/coronary)
--------------------------------------------- pg. 83. PEA caused by thrombosis would require that the thrombosis be dissolved. If a patient is in PEA (needing resuscitation) due to a thrombosis, the prognosis is very poor. |
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The two most common and easily reversible causes of PEA are:
trauma and hydrogen ion (acidosis) trauma and hypoxia hypovolemia and hypothermia hypovolemia and hypoxia |
hypovolemia and hypoxia
|
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For a patient in asystole which has the higher priority?
IV/IO access advanced airway management defibrillation all are of equal importance |
IV/IO access
|
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According to the 2010 guidelines, drugs used in asystole include:
atropine, epinephrine, vasopressin epinephrine, vasopressin epinephrine, lidocaine amiodarone, lidocaine |
epinephrine, vasopressin
|
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What must be ruled out before a patient's rhythm can be classified as “true asystole”?
if the patient is a DNR other causes of asystole other causes of isoelectric ECG all of the above |
other causes of isoelectric ECG
|
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What are some causes of isoelectric ECG (false asystole)?
A) loose leads or leads not connected to the patient B) no power to the monitor C) lead plug disconnected from the defibrillator D) all of the above |
all of the above
|
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|
What are 4 reasons that BLS and ACLS should be stopped or withheld?
A) CPR lasts longer than 10 minutes, DNR status, patient has MRSA, physician is tired B) rigor mortis, DNR status, living will directives, threat to safety of rescuers C) DNR, CPR lasting longer than 12 minutes, patient has terminal cancer, rigor mortis D) None of the above |
rigor mortis, DNR status, living will directives, threat to safety of rescuers
|
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The first drug to be used in the pulseless arrest-PEA/asystole branch is ____________.
epinephrine adenosine atropine any of the above |
epinepherine
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The therapy pathway for asystole/PEA is designed around ________________.
A) first considering treatable symptoms B) early intubation and use of iv access C) rapid defibrillation D) periods of uninterrupted (5 cycles or 2 minutes), high quality CPR |
periods of uninterrupted (5 cycles or 2 minutes), high quality CPR
|
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Which of the following is a consideration for a patient in asystole?
a. underlying causes for the asystole b. possibility of termination of CPR c. external pacing d. both a and b |
both a and b
a. underlying causes for the asystole b. possibility of termination of CPR |
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All of the following are important in the asystole pathway of the pulseless arrest algorithm. Which is the correct order of importance?
A) advanced airway, gain IV/IO access, high quality CPR B) high quality CPR, gain IV/IO access, advanced airway C) advanced airway, high quality CPR, gain IV/IO access D) gain IV/IO access, advanced airway, high quality CPR |
high quality CPR, gain IV/IO access, advanced airway
|
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(True or False)
When starting an IV or administering drugs during CPR, do not stop CPR. |
True
|
|
|
(True or False)
Fine Ventricular Fibrillation may appear as asystole. If this is unclear an initial attempt at defibrillation may be warranted. |
True
|
|
|
Interruption of chest compressions to conduct a rhythm check should not exceed ___seconds.
10 five eight fifteen |
10
|
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The primary ACLS treatment for VF and Pulseless VT is:
A) lidocaine B) high-energy unsynchronized shocks C) synchronized shocks D) epinephrine |
high-energy unsynchronized shocks
|
|
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Drugs used in the VF/Pulseless VT Algorithm include:
A) epinephrine, vasopressin, amiodarone, lidocaine, and magnesium sulfate B) epinephrine, vasopressin, atropine, and magnesium sulfate C) epinephrine, vasopressin, adenosine, beta-blockers, magnesium sulfate D) epinephrine, vasopressin, amiodarone, lidocaine, and atropine |
epinephrine, vasopressin, amiodarone, lidocaine, and magnesium sulfate
pg. 60 |
|
|
During VT/VF:
If an AED is on the patient and a manual defibrillator is available: A) The AED should be used because it reduces user error B) Replacement is not recommended because replacing the AED with the manual defibrillator will interrupt chest compressions for to long C) Replacement is recommended because continued use of the AED may result in unnecessary prolonged interruptions in chest compression for rhythm analysis and shock administration. D) Should be replaced only after delivery of three shocks |
Replacement is recommended because continued use of the AED may result in unnecessary prolonged interruptions in chest compression for rhythm analysis and shock administration.
|
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|
(True or False)
Even a 5- to 10-second pause in chest compressions can reduce the chance that a shock will terminate VF. |
true
|
|
|
(True or False) According to the 2010-2011 Guidelines, chest compressions may be continued while the defibrillator is charging.
|
True
|
|
|
For VF/pulseless VT how many shocks should initially be given?
1 shock 3 stacked shocks none, shocks are not indicated it depends whether the rhythm is VF or VT |
1 shock
|
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The initial energy dose delivered in Pulseless Arrest (VF/VT) with a biphasic defibrillator is typically _________:
180-240 J 150-220 J 120-200 J 90-110 J |
120-200 J
|
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After the first shock in the Pulseless VF/VT you should:
give 1 mg epinephrine IV/IO immediately resume CPR check for a pulse check for a rhythm |
resume CPR
|
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If using a monophasic defibrillator for Pulseless VF/VT the first dose and all subsequent doses should be _______J.
200 260 300 360 |
360
|
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If you do not know the effective biphasic dose range for the defibrillator that you are using, you should deliver a first shock and all subsequent shocks at _________.
120 200 the lowest energy does that is available the maximal energy dose that is available |
maximal energy dose that is available
|
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If VF is initially terminated by a shock but recurs later in the resuscitation attempt you should:
A) shock at the previously successful energy level B) increase energy level 20J for subsequent shocks C) increase energy level to maximum dose that defibrillator can deliver D) use medications to reverse VF |
shock at the previously successful energy level
|
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(Pulseless VF/VT)
Select the sequence that is in the correct order? - give 3 stacked shocks, 5 cycles CPR, check rhythm, give 1 shock, 5 cycles CPR, after 2nd shock give 1mg epinephrine IV push - give 1 shock, 3 cycles CPR, check rhythm, give 1 shock, 3 cycles CPR, after 2nd shock give 1mg epinephrine IV push -give 1 shock, 5 cycles CPR, check rhythm, give 1 shock, 5 cycles CPR, check rhythm after 2nd shock give 1mg epinephrine IV push - give 1 shock, check rhythm, 5 cycles CPR, give 1 shock, check rhythm, 5 cycles CPR, after 2nd shock give 1mg epinephrine IV push |
give 1 shock, 5 cycles CPR, check rhythm, give 1 shock, 5 cycles CPR, check rhythm after 2nd shock give 1mg epinephrine IV push
|
|
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(Pulseless VF/VT)
You have given a patient the 1st shock and CPR for 5 cycles, your next step is to __________ check breathing give the patient epinephrine 1 mg IV check rhythm give a second shock |
Check rhythm
|
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(Pulseless VF/VT)
You have given a patient the 1st shock, CPR for 5 cycles, and now they have an organized rhythm. Your next step is to ___________. A)place the patient in rescue position B)start the patient on an antiarrhythmic drug C)search for possible causes of the VF/VT D)palpate for a pulse |
check pulse
|
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(Pulseless VF/VT)
The drug ___________ can be used as a substitute for epinephrine for the first or second dose during resuscitation. vasopressin adenosine atropine lidocaine |
Vasopressin
40 Units |
|
|
If during VF/VT after a shock, the rhythm check reveals a __________ rhythm and _______, you then should proceed with the asystole/PEA pathway of the ACLS Pulseless Arrest.
|
nonshockable, no pulse
|
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The appropriate dose of vasopressin which may be substituted for epinephrine in the pulseless arrest algorithm is _______.
40 mg 40 U 20 mg 20 U |
40 U
|
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Five cycles of CPR should take about __________minutes.
2 3 1 4 |
2 min
|
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You have shocked the patient, given 5 cycles of CPR and have done a rhythm check. Now, the patient remains in VT with no pulse. What should you do next:
give the patient a second shock give the patient 1 mg epinephrine continue CPR for 5 cycles consider giving antiarrhythmics |
2nd shock
|
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The maximum time chest compressions should be interrupted is ______seconds.
5 seconds 10 seconds 8 seconds 15 seconds |
10 sec
|
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The initial energy dose used during defibrillation is dependent upon ____________.
whether the patient has an internal pacemaker whether the arrest was witness or unwitnessed whether the defibrillator is monophasic or biphasic none of the above |
whether the defibrillator is monophasic or biphasic
|
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Epinephrine hydrochloride is used during resuscitation primarily for its alpha-adrenergic effects. Alpha-adrenergic effects include:
A) increase in coronary blood flow resulting from vasoconstriction B) increased cerebral blood flow resulting from vasodilation C) increased oxygenation resulting from bronchoconstriction D) increased renal blood flow resulting from vasoconstriction |
increase in coronary blood flow resulting from vasoconstriction
|
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(True or False)
Overall vasopressin effects have not been shown to differ from epinephrine with regard to ROSC (return of spontaneous circulation), 24 hour survival, or survival to hospital discharge. |
True
|
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When treating pulseless VF/VT remember to __________.
ensure full chest recoil push hard and fast (100/min) search for treatable contributing factors (H and T's) all of the above |
all of the above
|
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|
The H's of treatable contributing factors are:
A) hypovolemia, hypoxia, hydrogen ion, hypo-/hyperkalemia, hypothermia B) hypovolemia, hydrogen ion, hypo-/hyperkalemia, hyperglycemia, hypothermia C) hypovolemia, hypoxia, hydrogen ion, hypo-/hypercalcemia, hypoglycemia, hypothermia D) hemophilia, hypoxia, hydrogen ion, hypo-/hyperkalemia, hypoglycemia |
hypovolemia, hypoxia, hydrogen ion, hypo-/hyperkalemia, hypothermia
|
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After the third shock in the pulseless VF/VT algorithm with no change in rhythm/pulse, you should __________.
get a different defibrillator check for a pulse consider giving antiarrhythmic drugs consider giving a beta-blocker |
consider giving antiarrhythmic drugs
------------------------------------- pg. 80. See Diagram for the left pathway of the pulseless arrest algorithm. |
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|
Four important aspects to the Pulseless VF/VT algorithm are:
A) early defibrillation, effective CPR(hard and fast), secure the airway, establish IV/IO access B) stacked shocks with defibrillation, minimize delay in CPR, establish IV/IO access, avoid hyperventilation C) use only biphasic defibrillator, avoid hyperventilation, establish IV/IO access, CPR immediately after shock D) early defibrillation, atropine after first shock, consider antiarrhythmic use, establish IV/IO access |
early defibrillation, effective CPR(hard and fast), secure the airway, establish IV/IO access
|
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For the pulseless VF/VT algorithm, the proper first dose of IV Amiodarone is ________.
150 mg 300 mg 200 mg 100 mg |
300 mg
|
|
|
A second dose of ________IV Amiodarone can be given.
150 mg 300 mg 200 mg 100 mg |
150 mg
|
|
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A tachyarrhythmia is defined as "any rhythm other than sinus tachycardia with a rate greater than ______."
60 100 80 150 |
100
|
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(True or False)
Unstable tachycardia exists when the heart rate is too fast for the patient’s clinical condition and the excessive heart rate causes symptoms. |
true
|
|
|
Symptoms that may be due to tachycardia include all the following except:
shortness of air facial droop altered mental status chest pain |
facial droop
|
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Serious signs or symptoms of tachycardia can include which of the following:
hypotension poor peripheral perfusion acutely altered mental status acute heart failure all of the above |
all of the above
|
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Heart rates from _____to_____ (per minute) usually are the result of an underlying process (fever, anemia, blood loss, etc.) and are generally sinus tachycardia.
90-150 100-130 150-200 none of the above |
100-130
|
|
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(True or False)
The higher the rate, the more likely symptoms are due to tachyarrhythmia and not an underlying comorbidity. |
True
|
|
|
(Tachy)
The decision point for performing immediate synchronized cardioversion is: The patient is unstable and no other reversible causes are identified The patient's heart rate is greater than 150 Advised by expert consultation Adenosine does not convert the patient's rhythm |
The patient is unstable and no other reversible causes are identified
|
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Tachyarrhythmias respond to cardioversion. Sinus tachycardia will not respond to cardioversion. What will often occur if a shock is delivered with sinus tachycardia?
heart rate decreases asystole heart rate increases ventricular fibrillation |
heart rate increases
|
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Which of the following would be considered a tachyarrhythmia if the ventricular rate is greater than 100 ?
atrial flutter atrial fibrillation supraventricular tachycardia all of the above |
all of the above
|
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(True or False)
When performing synchronized electrical cardioversion on a patient, the shock will occur at the exact time that you press the "deliver shock button." |
False
|
|
|
Which of the following is not an appropriate initial intervention when addressing tachycardia with a pulse?
give oxygen (if hypoxemic) monitor ECG, blood pressure, and oximetry identify and treat reversible causes attempt vagal maneuvers |
vagal maneuvers
|
|
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True or False Tachycardia rates less than 150 per minute usually do not cause serious signs or symptoms.
|
true
|
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Which of the following are key questions that should be addressed during the assessment and management of a patient with tachycardia?
Are symptoms present or absent? Is the patient stable? Is the QRS narrow or wide? Is the rhythm regular or irregular? All of the above |
All of the above
|
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True or False With tachycardia, if a patient is seriously ill or has significant underlying heart disease or other conditions, symptoms may be present at a lower heart rate?
|
true
|
|
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If a tachyarrhythmia is causing a patient to become unstable what is the most important intervention?
cardioversion IV fluids expert consultation antiarrhythmic medications |
cardioversion
|
|
|
True or False Unstable Monomorphic VT and Polymorphic VT are treated with the same interventions?
|
False
----------------------------------------------------------- Unstable polymorphic tachycardia is treated with an unsynchronized shock. If a patient has polymorphic VT and is unstable, treat the rhythm as VF and deliver high-energy unsynchronized shocks (ie, defibrillation doses). Although synchronized cardioversion is preferred for treatment of an organized ventricular rhythm, for some irregular rhythms, such as polymorphic VT, synchronization is not possible. See pg. 121 |
|
|
Which is the correct treatment for unstable polymorphic VT?
treat as VF with high-energy unsynchronized shocks treat with 3 stacked shocks treat with medications only treat with synchronized cardioversion and an initial shock of 100 J |
treat as VF with high-energy unsynchronized shocks
|
|
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Which is the correct treatment of unstable monomorphic VT with a pulse ?
treat as VF with high-energy unsynchronized shocks treat with 3 stacked shocks treat with medications only treat with synchronized cardioversion and an initial shock of 100 J |
treat with synchronized cardioversion and an initial shock of 100 J
|
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If there is any doubt about whether an unstable patient has monomorphic or polymorphic VT what should you do?
treat with high-energy unsynchronized shocks treat with 3 stacked shocks treat with medications only treat with synchronized cardioversion and an initial shock of 100 J |
treat with high-energy unsynchronized shocks
|
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If the patient is unstable with a narrow-complex SVT what IV medication can be given as you prepare for immediate synchronized cardioversion? (not shown in unstable pathway but can be given)
amiodarone 150 mg IV adenosine 6 mg rapid IV push atropine 1 mg IV epinephrine 1 mg IV |
adenosine 6 mg rapid IV push
|
|
|
Which is the correct definition of unsynchronized shock ?
The electrical shock is delivered as soon as the operator pushes the SHOCK button to discharge the machine. The shock can fall randomly anywhere within the cardiac cycle. The electrical shock is delivered with a peak of the R wave in the QRS Complex thus avoiding the delivery of a shock during cardiac repolarization (t-wave) |
The electrical shock is delivered as soon as the operator pushes the SHOCK button to discharge the machine. The shock can fall randomly anywhere within the cardiac cycle.
|
|
|
(True or False)
Synchronized cardioversion uses a higher energy level than used with unsynchronized cardioversion (defibrillation). |
False
---------------------- pg. 121. “Synchronized cardioversion uses a lower energy level than attempted defibrillation. Low-energy shocks should always be delivered as synchronized shocks to avoid precipitating VF.” |
|
|
Low-energy shocks are always delivered synchronized due to the fact that low energy shocks have the potential to produce which rhythm if delivered unsynchronized?
VT asystole VF atrial flutter |
VF
|
|
|
Which of the following cases is unsynchronized shock NOT advised?
for the patient who is pulseless for a patient who is unstable with polymorphic VT for a patient who has unstable tachycardia with a pulse for the patient who is unstable and you are unsure what type of VT exists |
for a patient who has unstable tachycardia with a pulse
|
|
|
According to the new 2010 ACLS Guidelines, how many doses of adenosine rapid IV push can be give with the tachycardia algorithm?
2 3 4 5 |
2
1st: 6mg rapid IV push, followed by NS flush 2nd: 12 mg |
|
|
(True or False)
Two interventions that can be performed for a regular narrow-complex tachyarrhythmias are vagal maneuvers and adenosine administration? |
True
|
|
|
Adenosine can be given 2 times to attempt conversion of tachyarrhythmia. What is the recommended dosing schedule?
12 mg, if no conversion then 6 mg 12 mg, if no conversion then 12 mg 6 mg, if no conversion then 12 mg 6 mg, if no conversion then 6 mg |
6 mg, if no conversion then 12 mg
|
|
|
(True or False)
Cardioversion is contraindicated for SINUS tachycardia because the increased heart rate is being caused by an external influence such as fever, blood loss, or exercise. |
true
|
|
|
(True or False)
With sinus tachycardia the goal is to identify and treat the underlying systemic causes. |
True
|
|
|
(True or False)
From the new 2010 guidelines on tachyarrhythmia: Adenosine can now be considered for the diagnosis and treatment of stable undifferentiated wide-complex tachycardia when the rhythm is regular and the QRS waveform is monomorphic. |
True
|
|
|
Immediate assessments and actions for a patient presenting with symptoms suggestive of ACS include:
a. oxygen b. aspirin c. nitroglycerin d. morphine e. 12-lead ECG f. all of the above |
all of the above
|
|
|
Once a patient has arrived in the emergency department with ACS symptoms, the goal is to analyze the ECG within _____ minutes of arrival.
a. 5 minutes b. 10 minutes c. 20 minutes d. 30 minutes |
10 min
|
|
|
3. What is the primary focus of treatment of a patient with ACS?
a. Early reperfusion of the STEMI patient b. Early hospital arrival c. Early use of medications to prevent plaque formation d. Assessing family history of coronary artery disease |
early reperfusion
|
|
|
Which rhythms is most commonly caused by acute myocardial ischemia and is the leading cause of sudden cardiac death?
a. VT b. Bradycardia c. SVT d. VF |
VF
|
|
|
Reperfusion therapy may involve which of the following:
a. PCI (percutaneous coronary intervention) b. fibrinolytic therapy c. heparin d. both a and b e. all of the above |
both a and b
a. PCI (percutaneous coronary intervention) b. fibrinolytic therapy |
|
|
Which of the following drugs are used in the initial treatment of ACS (acute coronary syndrome)?
a. aspirin, morphine, nitroglycerin b. heparin, metoprolol, aspirin c. aspirin, fibrinolytics, ACE inhibitors d. simvastatin, labetalol, oxygen |
a. aspirin, morphine, nitroglycerin
|
|
|
Which of the following is essential to the risk and treatment stratification process in the ACS algorithm?
a. obtaining a family history b. obtaining a 12-lead ECG c. assessing pain level using symptoms to identify an MI |
b. obtaining a 12-lead ECG
|
|
|
What is the most common symptom of myocardial ischemia and infarction?
a. discomfort in the retrosternal chest b. radiating left arm pain c. jaw pain d. discomfort in the upper back between the shoulder blades |
discomfort in the retrosternal chest
|
|
|
EMS/ED providers should administer oxygen if the oxyhemoglobin saturation is <(less than) _______%.
a. 90 b. 92 c. 94 d. 95 |
94%
|
|
|
(True or False) There is insufficient evidence to support the routine use of oxygen in uncomplicated ACS without signs of hypoxemia and heart failure or both.
|
true
-------------------------------------- |
|
|
What arrhythmia is most likely to develop in the first 4 hours after onset of acute coronary syndrome?
a. VT b. VF c. atrial flutter d. PEA |
VF
|
|
|
For the patient with chest pain, nitroglycerine should be administered if the patient's systolic blood pressure remains >(greater than) ________ and the heart rate is 50-100/min.
a. 100 |
90
|
|
|
Which pain medication is indicated in STEMI when chest discomfort is unresponsive to nitrates?
a. Motrin b. morphine c. dilaudid d. hydrocodone |
Morphine
-------------------------------------- Morphine is indicated because it does the following: produces central nervous system analgesia, causes venous dilation which reduces left ventricular preload and oxygen requirements, decreases systemic vascular resistance which reduces left ventricular afterload. |
|
|
(True or False) For the patient with acute coronary syndrome, use of Non-steroidal anti-inflammatory drugs (NSAIDs) is contraindicated (excpet for aspirin) and should be discontinued.
|
True
--------------------------------- The use of NSAIDs is contraindicated because of the increased risk of mortality, reinfarction, hypertension, heart failure, and myocardial rupture associated with their use. Pg. 98 ACLS provider manual |
|
|
(True or False) Response to nitroglycerine (nitrate therapy) is not diagnostic for acute coronary syndrome.
|
true
|
|
|
One of the goals of reperfusion therapy is to perform PCI (percutaneous coronary intervention) within ________ minutes of arrival in the ED.
a. 30 minutes b. 60 minutes c. 90 minutes d. 120 minutes |
90 min
|
|
|
What is the major contraindication to aspirin administration?
a. true aspirin allergy b. recent GI bleed c. hypotension d. fever >100 F (37.7 C) e. all of the above f. both a and b |
both a and b
a. true aspirin allergy b. recent GI bleed |
|
|
Fibrinolytic agents or "clot busters" are effective in about ______% of the patients given these drugs.
a. 20 b. 40 c. 50 d. 70 |
50%
|
|
|
Fibrin specific agents include which of the following?
a. rtPA b. reteplase c. tenecteplase d. all of the above |
All of the above
|
|
|
What is the recommended dosage of oral aspirin to be given within the ACS protocol?
300 mg 160-325 mg 80-120 mg 120-200 mg |
160-325 mg
|
|
|
Which item(s) below can be used to identify a STEMI?
a. retrosternal chest pain b. 12-lead EKG c. troponin d. all of the above |
12-lead EKG
|
|
|
One goal of reperfusion therapy is to give fibrinolytics within _______minutes of arrival.
a. 60 b. 20 c. 30 d. 90 |
30 min
------------------------------------------- Reperfusion goal is w/in 30 min PCI goal is w/in 90 min |
|
|
(True or False) Morphine is recommended for patients suspected of having ischemic chest discomfort that does not respond to nitrates.
|
True
pg. 100 |
|
|
(True or False) Consultation with a cardiologist should take place before treatment of STEMI.
|
False
|
|
|
Patients with suspected ACS should have oxygen administered if the patient is ___________.
a. dyspenic b. hypoxemic c. oxyhemaglobin saturation is < 94% d. any of the above |
any of the above
|
|
|
The 4 agents that are routinely recommended for consideration in patients with ischemic-type chest discomfort are:
a. aspirin, nitroglycerin, morphine, and oxygen if hypoxemic (o2<94%) b. motrin, morphine, nitroglycerine, and oxygen if hypoxemic (o2<94%) c. aspirin, nitroglycerin, dilaudid, and metoprolol d. epinephrine, dopamine, morphine, and oxygen if hypoxemic (o2<94%) |
a. aspirin, nitroglycerin, morphine, and oxygen if hypoxemic (o2<94%)
(MONA) |
|
|
What is the major contraindication to the administration of nitroglycerine and morphine?
a. recent bleeding b. changes in level of consciousness c. chest pain d. hypotension |
hypotension
|
|
|
For cases in which fibrinolytics are contraindicated, what intervention should be performed?
a. heparin therapy b. PCI (percutaneous coronary intervention) c. bypass surgery d. observation |
PCI (percutaneous coronary intervention)
|
|
|
(True or False) routine use of IV nitroglycerine is not indicated for STEMI and has not been shown to significantly reduce mortality in STEMI.
|
True
|
|
|
Indications for the use of intravenous nitroglycerine in STEMI are:
a. recurrent or continuing chest pain unresponsive to sublingual or spray nitroglycerine b. pulmonary edema complicating STEMI c. hypertension complicating STEMI d. all of the above |
all of the above
|
|
|
Which is a contraindication for the use of nitroglycerin in the ACS protocol?
a. right ventricular infarction b. hypotension c. recent phosphodiesterase inhibitor use d. all of the above |
all of the above
**Remember that** |
|
|
The most common form of stroke is:
a. cardiogenic b. hemorrhagic c. ischemic d. neurogenic |
ischemic
|
|
|
T/F
Hemorrhagic stroke occurs when a blood vessel in the brain suddenly ruptures into the surrounding cerebral tissue |
True
|
|
|
True or Fasle
T/F Hemorrhagic strokes are potentially eligible for fibrinolytic therapy. |
False
-------------------------------- Fibrinolytic therapy is contraindicated for hemorrhagic stroke. |
|
|
Upon arrival to the ED, how soon should a suspected stroke patient receive an assessment and order for a non-contrast CT scan?
a. within 5 minutes b. within 10 minutes c. within 15 minutes d. within 20 minutes |
within 10 min
|
|
|
(Stroke)
A neurological assessment and CT scan should be completed within ______ minutes of ED arrival. a. 15 b. 20 c. 25 d. 30 |
25 min
|
|
|
(Stroke)
Interpretation of the CT scan should be completed within _________ minutes of ED arrival. a. 25 b. 30 c. 40 d. 45 |
45 min
|
|
|
(Stroke)
For patients who qualify for fibrinolytic therapy, it should be initiated within _____ minutes of hospital arrival. a. 45 b. 50 c. 55 d. 60 |
60 min
|
|
|
The correct order of the 8 D's of stroke care is:
a. dispatch, detection, door, delivery, data, decision, drug, disposition b. detection, dispatch, delivery, door, data, decision, drug, disposition c. detection, decision, dispatch, disposition, drug, delivery, door, data d. decision delivery, data, dispatch, detection, drug, door, disposition |
detection, dispatch, delivery, door, data, decision, drug, disposition
*** pg 133 |
|
|
The Cincinnati Prehospital Stroke Scale identifies a stroke on the basis of these three physical findings:
a. headache, arm drift, abnormal speech b. facial droop, arm drift, abnormal speech c. dizziness, facial droop, arm drift d. vision changes, arm drift, abnormal speech |
b. facial droop, arm drift, abnormal speech
|
|
|
From the time of onset of symptoms for ischemic stroke, how long do you generally have to initiate fibrinolytic therapy?
a. 90 minutes b. 3 hours c. 5 hours 60 minutes |
3 hours
|
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he critical decision point in the assessment of the patient with acute stroke is the performance and interpretation of a ________________.
a. ECG b. EEG c. non-contrast CT scan d. Cincinnati Stroke Scale |
non-contrast CT scan
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What should not be given until intracranial hemorrhage has been ruled out?
a. aspirin b. heparin c. rtPA d. all of the above |
all of the above
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If hemorrhage is not present on the initial CT scan and the patient is not a candidate for fibrinolytics for other reasons, consider giving what medication?
a. aspirin b. heparin c. enoxaparin d. metoprolol |
Aspirin
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Which of the following will exclude someone from the use of fibrinolytic therapy?
a. head trauma or prior stroke in the previous 3 months b. elevated systolic blood pressure > 185 or diastolic >110 c. evidence of active bleeding d. all of the above |
all of the above
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(Stroke)
For inclusion of fibrinolytic therapy, the onset of symptoms must be less than _____________hours before beginning treatment. a. 2.5 b. 3 c. 3.5 d. 4 |
less than 3 hrs
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(Stroke)
The minimum age for inclusion of fibrinolytic therapy is __________ years of age. a. 12 b. 18 c. 20 d. 25 |
18
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(Stroke)
Anticoagulants or antiplatelet treatment should not be administered for __________ hours after administration of rtPA. 48 36 24 12 |
24 hrs
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(Stroke)
In certain instances, the time allowed for consideration of treatment can be pushed back to ______ hours after onset of symptoms. 4 4.5 5 5.5 |
4.5 hrs
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Intra-arterial administration of rtPA, which is not yet approved by the FDA, can be given within the first _______ hours after onset of symptoms and has been documented to improve functional outcomes after stroke.
a. 4 b. 5 c. 6 d. 7 |
6 hrs
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During rtPA treatment, blood pressure should be monitored every _______ minutes for 2 hours from the start of rtPA therapy.
a. 10 b. 15 c. 30 d. 60 |
15 minutes
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Lidocaine can be used instead of amiodarone as an antiarrhythmic for pulseless arrest. What is the proper dosing of lidocaine?
1.5 mg IV first dose, then 0.75 mg IV 3 mg/kg rapid IV push 0.5 to 0.75 mg/kg IV, if no affect 1 to 1.5 mg/kg IV 1 to 1.5 mg/kg first dose, then 0.5 to 0.75 mg/kg IV |
1 to 1.5 mg/kg first dose, then 0.5 to 0.75 mg/kg IV
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Tachycardia:
There is no response to adenosine 6mg rapid IV push, and a second dose 12mg dose fails to convert the patient as well. What is another medication that you could consider using in the tachycardia algorithm ? lidocaine 2mg/kg atropine 1mg IV amiodarone 150mg IV over 10 minutes epinephrine 1mg IV |
amiodarone 150mg IV over 10 minutes
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