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117 Cards in this Set

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  • Back
What is this algorithm for?
Ventricular Fibrillation and Ventricular Tachycardia WITHOUT a pulse after the basic ABCDs (Primary ABCDs) have been started, and there is defibrillator on scene
If you see a person collapse, what do you do?
Shock Immediately?
If you get to the scene, and you see the person go into a shockable rhythm, what do you do?
Shock Immediately
What is a shockable rhythm?
V-Fib or V-Tach WITHOUT A PULSE
What kinds of cardioversion are there?
Electrical
Chemical
What kinds of cardioversion are there?
Synchronized

Unsynchronized
What kinds of defibrillators are there?
Automatic

or

Manual
If a patient is in V-Tach or V-Fib, what kind of cardioversion do you use?
Unsynchronized?
What is the first thing you do for V-Fib/V-Tach without a pulse?
Shock
What are the different kinds of cardioverters are there?
Monophasic

and

Biphasic
What is a monophasic defibrillator?
Electricity goes one way (Forward)?
What is a biphasic defibrillator?
Electricity goes both ways (Forward and back)
If using a monophasic defibrillator, how much power do you use for the first shock?
360 Joules
If using a monophasic defibrillator, how much power do you use for second and following shocks?
360 Joules
If necessary, how often should you shock a patient with V-Fib/V-Tach without a pulse?
Every two minutes
What is the second step in the V-Fib/V-Tach without a pulse algorithm?
CPR
For V-Fib/V-Tach without a pulse, when should you do CPR?
Immediately after shock!
When using a basic airway how many compressions/respirations do you give?
30 Compressions/Two Breaths
At what speed do you give compressions?
100 per minute
At what speed do you give respirations?
12-20 per minute
If you give a breath every three seconds, how many breaths are you giving per minute?
20
If you give a breath every four seconds, how many breaths are you giving per minute?
15
If you give a breath every five seconds, how many breaths are you giving per minute?
12
If you are using an advanced airway, how many compressions do you give?
100 Compressions
If you are using an advanced airway, how many respirations do you give?
12-20
When giving CPR, how long should you give it?
Two minutes
When doing CPR, what should you do every two minutes?
Check heart rhythm and pulse
If a patient shows electrical activity on the ECG, then their heart is always beating...true or false?
FALSE!...just because there is electrical activity on the ECG THAT DOESN'T MEAN THERE IS A PULSE!
When doing CPR, you should always use an advanced airway...true or false?
FALSE!...if the patient is getting enough oxygen using a basic airway you can keep using it?
What is the third step in the V-Fib/V-Tach without a pulse?
Check heart rhythm and pulse
When doing CPR, how often should you check pulse and heart rhythm?
Every two minutes
When doing CPR, make sure you check the heart rhythm while CPR is in progress...true or false?
FALSE! Never check heart rhythm while CPR is in progress
Why shouldn't you check the heart rhythm while CPR is in progress?
You will get an inaccurate rhythm
When doing CPR, you should check the heart rhythm while CPR is in progress...true or false?
FALSE!...the patient's heart should be circulating blood, not you!
After two minutes of CPR and checking heart rhythm and pulse, what do you do?
SHOCK AGAIN if the rhythm is not corrected!
When should you check pulse?
If there is an organized or unshockable rhythm
What is the next step in the V-Fib/V-Tach without a pulse algorithm?
Start advanced ABCs (Secondary ABCDs)
Continue this algorithm if necessary
Give drugs
Minimize interruptions in compressions
Think about differential diagnosis
What are the advanced ABCs (Secondary ABCDs)?
Airway
Breathing
Circulation
Differential Diagnosis
When should you continue this algorithm?
If V-Fib or V-Tach without a pulse continues
If chest compressions have to be interrupted, what is the MOST amount of time it can be interrupted?
<10 seconds
What is the VF/PVT protocol for?
Ventricular Fibrillation

or

Ventricular Tachycardia With No Pulse (Pulseless Ventricular Tachycardia)
What is V-Fib?
When the heart's electricicity becomes disorganized, and the ventricles squeeze fast and out of rhythm (AKA they "flutter" instead of beat).
What does V-Fib look like?
What are the types of V-Fib??
Course

and

Fine
What does fine V-Fib look like?
V-Fib with small waves?
What does course V-Fib look like?
V-Fib with medium to large waves?
During V-Fib, the heart pumps twice as much blood, true or false?
False, DURING V-FIB THE HEART PUMPS LITTLE OR NO BLOOD?
What is "Pulseless Ventricular Tachycardia"?
A fast heartbeat that comes from one or both? of the ventricles of the heart, and there is no pulse.
What does "Pulseless Ventricular Tachycardia" (PVT) look like?
Is PVT the same as VT?
What is the acronym for the VF/PVT protocol?
SCREAM
What does "SCR EAM" stand for?
Shock
CPR
Rhythm
(At this point, do secondary ABCD's, continue the protocol if necessary,and do problem search?)
Epinephrine
Antiarrhythmic
Medications
(Antiarrhythmic and Medications are together)
When do you use the VF/PVT protocol?
IF THERE IS V-FIB OR PVT, and;

PRIMARY ABCD's are started, and;

You have an AED or manual defibrillator.
What is the first step in the VF/PVT protocol?
PRIMARY ABCD's
What is the second step in the VF/PVT protocol?
Get AED or manual defibrillator?
What is the third step in the VF/PVT protocol?
Check rhythm.
If rhythm is VF or PVT what do you do?
Use "SCREAM".
What is the first step in "SCREAM"?
Shock
For the first and following shocks, how much power should you use?
The manufactur's recomendation, but if that is not available:

360J Monophasic

200J Biphasic (Depending on model)
How many times do you shock and do a cycle of CPR before you give drugs in the VF/PVT protocol?
TWO TIMES:

Shock
CPR
Shock
CPR
Drugs (During CPR?)
Shock
If a manual defibrillator is biphasic, how much power should you use?
Manufacturer's recomendation?, or 200J if recomendation not available.
If manual defibrillator is biphasic, and manufactur's recomendation is unavailable, how much power should you use?
200J for first shock, and same or more power for following shocks.
After the first shock, how many more times should you shock?
Until problem is solved, or given to higher care?
After the first shock, how often should you do it?
Every two minutes if necessary (In between cycles of CPR?)?
After the first shock, what do you do?
CPR
How do you do CPR with a basic airway?
30 compressions and 2 breaths.
How do you do CPR with an advanced airway?
100 compressions per minute with 8-10 breaths per minute?
During CPR, you should check rhythm and pulse, true or false?
False, you should check neither DURING CPR.
After the first two minutes of CPR and every following cycle, what do you do?
Check heart rhythm and speed?, and shock if necessary.
You should check for a pulse after every two cycles of CPR, true or false?
False, YOU SHOULD ONLY CHECK PULSE IF THERE IS AN ORGANIZED OR UNSHOCKABLE RHYTHM.
After checking the rhythm, what should you do?
Start the SECONDARY ABCD's, and continue protocol if necessary.
When can you give drugs in the VF/PVT protocol?
During CPR, and before or after shock.
Twenty seconds is the longest you should stop chest compressions, true or false?
False, TEN seconds is the absolute most you should stop chest compressions.
In between the "R" and "E" in "SCREAM", what should you do?
Secondary ABCD's, continue protocol if necessary, and problem search?
After secondary ABCD's, continuing protocol if necessary, and problem search what do you do?
"E"...Epinephrine or Vasopressin
When should you use epinephrine for the VF/PVT protocol?
???
When should you use vasopressin for the VF/PVT protocol?
???
How much epinephrine should you give for the VF/PVT protocol?
1mg IV or IO push
In the VF/PVT protocol, how often should you give epinephrine?
Every 3-5 minutes
What is the maximum amount of epinephrine you should give in the VF/PVT protocol?
???
Is there any time you SHOULD NOT use epinephrine in the VF/PVT protocol?
???
If you choose to give vasopressin, how much should you give?
40 Units IV or IO push
If you choose to give vasopressin, how often should you give it?
You must wait ten minutes after giving it to give another drug.
When can you use vasopressin in the VF/PVT protocol?
In place of the first or second dose of epinephrine.
If you choose to use vasopressin, how many times can you give it?
ONCE
What is the most vasopressin you can give in the VF/PVT protocol?
40 Units (Because you can only give it ONCE)
After epinephrine or vasopressin, what is the next step in the VF/PVT protocol?
Antiarrhythmic Medicines
What are the antiarrhythmic medicines used in the VF/PVT protocol?
Amiodarone

Lidocaine

Magnesium Sulfate
What is the acronym for the anitarrhythmic medicines used in the VF/PVT protocol?
Any Legitimate Medication
What does "Any Legitimate Medication" stand for?
Amiodarone

Lidocaine

Magnesium Sulfate
What is a "Unit"?
???
After epinephrine, what is the first drug you should give for VF/PVT?
"Any"...Amiodarone
If you use amiodarone for the VF/PVT protocol, how much should your first dose be?
300 mg IV or IO push
What is the most amiodarone you can give a patient in the VF/PVT protocol?
450mg in TWO DOSES.

First Dose=300mg

Second Dose=150mg
If you give a second dose of amiodarone for the VF/PVT protocol, how much should it be?
150 mg
How often should you give amiodarone in the VF/PVT protocol?
Every 3-5 minutes.
After epinephrine, what is another drug you can give for VF/PVT protocol if amiodarone is unavailable?
"Legitimate"...Lidocaine
When should you give lidocaine in the VF/PVT protocol?
ONLY IF AMIODARONE IS UNAVAILABLE?
If you give lidocaine, how much should the first dose be for the VF/PVT protocol?
1 - 1.5mg/kg IV or IO push
What is the most doses of lidocaine you can give for VF/PVT?
A total of THREE.
If a second and third dose of lidocaine is needed for VF/PVT, how much should you give?
0.5 - 0.75mg/kg IV or IO push
What is the maximum lidocaine loading dose you can give in the VF/PVT protocol?
3mg
If you have to give a second and third dose of lidocaine for VF/PVT, how often should you give it?
Every 5-10 minutes
What is the maximum LOADING dose of lidocaine for the VF/PVT protocol?
3mg/kg
What is a loading dose?
A large first dose of a drug, or series of doses given to build up a therapeutic amount of the drug in the body.
After epinephrine and lidocaine, what is another drug you can give in the VF/PVT protocol?
"Medication"...Magnesium Sulfate
What are the only things you can give magnesium sulfate for in the VF/PVT protocol?
Tordades de Pointes

Hypomannesemia
What is torsades de pointes?
A kind of V-Tach that changes more than once?, and in which the QRS waves are different from beat to beat.
What does torsades de pointes look like?
(Is this from lead II?)
How do you tell the difference between V-Fib/PVT and Torsades?
???
What is hypomagnesemia?
Not enough magnesium.
What are the signs and/or symptoms of hypomagnesemia?
Muscle Cramps
Weakness
Tremors
Irregular Heartbeats
If a patient has torsades de pointes or hypomagnesemia, how much magnesium sulfate should you give for the VF/PVT protocol?
1-2g IV or IO push diluted in 10 ml D5W
What is D5W?
5% sugar (Dextrose) in water?
If you give magnesium sulfate in the VF/PVT protocol, how long should you take inject it into an IV or IO port?
5-20 minutes
If you give magnesium sulfate in the VF/PVT protocol, how many times should you give it?
???
According to Doogie, if you witness the VF/PVT after you get there, what should you do?
Shock immediately.
According to Doogie, if you don't witness the VF/PVT after you get there, what should you do?
Two minutes of CPR, and then shock?