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37 Cards in this Set
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- Back
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A 62-years-old man suddenly experienced difficulty speaking and left-sided weakness. He was brought to the emergency department. He meets initial critetia for fibrinolytic therapy, and a CT scan of the brain is ordered. What are the guidelines for antiplatelet and fibrinolytic therapy?
● Administer aspirin 160 to 325mg chewed immediately
● Give aspirin 160mg and clopidogrel 75mg orally
● Do not give aspirin for atleast 24hours if rtPA is administered
● Administer heparin if CT scan is negative for hemorrahage
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☆Do not give aspirin for atleast 24H if rtPA is administered |
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Bradycardia requires treatment when?
● the blood pressure is less than 100mmHg systolic with or without symptoms
● chest pain or shortness of breath is present
● the heart rate is less than 60/min with or without symptoms
● the patient's 12-lead ECG shows an MI |
☆Chest pain or shortness of breath is present |
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A patient with ST-segment elevation Myocardiac Infraction has ongoing chest discomfort. Fibrinolytic therapy has been ordered. Heparin 4000 units I.V. bolus was administered, a heparin infusion of 1000 units per hour is being administered. Aspirin was not taken by the patient because he had a history of gastritis treated 5 years ago. Your next action is to?
● substitute clopidogrel 300mg loading dose
● give 325mg enteric-coated aspirin rectally
● give aspirin 160 to 325mg chewed immediately
● give 75mg enteric-coated aspirin orally |
☆Give aspirin 160 to 325mg chewed immediately |
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A patient is in cardiac arrest. High quality chest compression are being given. The patient is intubated, and an I.V. has been started. The rhythm is asystole. Which is the first drug/dose to administer?
● Atropine 0.5mg I.V. or I.O.
● Dopamine 2 to 20mcg/kg/min I.V. or I.O.
● Epineprine 3mg via edotracheal route
● Epinephrine 1mg or Vasopressin 40mg I.V. or I.O.
● Atropine 1mg I.V. or I.O. |
☆Epinephrine 1mg or Vasopressin 40mg I.V. or I.O. |
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You arrive on the scene with the code team. High-quality CPR is in progress. an AED has previously advised "no shock" indicated. A rhythm check now finds asystole. After resuming high-quality compressions, your next action is to?
● place an esophageal-tracheal tube or laryngeal mask airway
● gain an I.V. or I.O. access
● attempt endotracheal intubation with minimal interruptions in CPR
● call for a pulse check |
☆Gain I.V. or I.O. access |
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A patient is in refractory ventricular fibrillation. High-quality CPR is in progress, and a shocks have been given. One dose of epinephrine was given after the second shock. An antiarrhythmic drug was given immediately after the third shock. What drug should the team leader request to be prepared for administration next?
● Escalating dose of epinephrine 3mg
● Sodium bicarbonate 50mEq
● Repeat the antiarrhythmic drug
● Second dose of epinephrine 1mg |
☆Second dose of epinephrine 1mg |
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A patient with sinus bradycardia and a heart rate of 42/min has diaphoresis and a blood pressure of 80/60mmHg. What is the initial dose of atropine? ● 0.5mg ● 3mg ● 1mg ● 0.1mg |
☆0.5mg |
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A patient is in refractory ventricular fibrillation and has recieved multiple appropriate defibrillation shocks, epinephrine 1mg I.V. twice, and an initial dose of 300mg amiodarone I.V. The patient is intubated. A second dose of amiodarone is now called for. The recommended second dose of amiodarone is?
● 300mg I.V. push
● an infusion of 1 to 2 mg/min
● 1mg/kg I.V. push
● 150mg I.V. push
● an endotracheal dose of 2-4mg/kg |
☆150mg I.V. push |
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Which of the following statements is most accurate regarding administrationof vasopressin during cardiac arrest?
● Vasopressin can be administered twice during cardiac arrest.
● Vasopressin is indicated for VF and pulseless VT before delivery of the first shock.
● Vasopressin is recommended instead of epinephrine for the treatment of asystole.
● The correct dose of vasopressin is 40units administered I.V. or I.O. |
☆The correct dose of vasopressin is 40units administered I.V. or I.O. |
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A patient with a possible acute coronary syndrome has ongoing chest discomfort unresponsive to 3 sublingual nitroglycerin tablets. There are no contraindications, and 4mg of morphine sulfate was administered. Shortly afterwards, blood pressure falls to 88/60mmHg, and the patient has increased chest discomfort. You should:
● give normal saline 250ml to 500ml fluid bolus
● start dopamine at 2mcg/kg/min and titrate to a systolic blood pressure reading of 100mmHg
● give an additional 2mg of morphine sulfate
● give sublingual nitroglycerin 0.4mg |
☆Give normal saline 250ml to 500ml fluid bolus |
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A 35-years-old woman has palpitation, light-headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuver have not been effective in terminating the rhythm. An I.V. has been established. What drug should be administered I.V.?
● Adenosine 6mg
● Atropine 0.5mg
● Epinephrine 2 to 10mcg/kg/min
● Lidocaine 1mg/kg |
☆Adenosine 6mg |
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A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which is the next drug/dose to anticipate to administer?
● Vasopressin 40units
● Amiodarone 300mg
● Amiodarone 150mg
● Epinephrine 3mg
● Lidocaine 0.5mg/kg |
☆Amiodarone 300mg |
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A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. What is the recommended route for drug administration during CPR?
● Central line
● Endotracheal
● I.V. or I.O.
● External jugular vein
● Femoral vein |
☆I.V. or I.O. |
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A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an second shock. Of the following, which drug and dose should be administered first by the I.V. / I.O. route?
● Epinephrine 1mg
● Atropine 1mg
● Sodium bicarbonate 50mEq
● Vasopressin 20mg |
☆Epinephrine 1mg |
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Your patient has been intubated. I.V. or I.O. access is not available. Which combination of drugs can be administered by the endotracheal route?
● Amiodarone, Lidocaine, Epinephrine
● Vasopressin, Amiodarone, Lidocaine
● Lidocaine, Epinephrine, Vasopressin
● Epinephrine, Vasopressin, Amiodarone |
☆Lidocaine, Epinephrine, Vasopressin |
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A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70mmHg. He has history of angina. Which of the following actions is recommended?
● Giving lidocaine 1-1.5mg I.V. bolus
● Giving Adenosine 6mg I.V. bolus
● Seeking expert consultation
● Immediate synchronized cardioversion |
☆Seeking expert consultation |
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A 57-years-old woman has palpitation, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180/min. She become diaporetic, and her blood pressure is 80/60mmHg. The next action is to?
● perform immediate electrical cardioversion
● obtain a 12-lead ECG
● establish I.V. access
● give amiodarone 300mg I.V. push |
☆Perform immediate electrical cardioversion |
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A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a total dose of 3mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 100/60mmHg. Which of the following is now indicated?
● Start dopamine 10-20mcg/kg/min
● Give additional 1mg atropine
● Give normal saline bolus 250-500ml.
● Start epinephrine 2 to 10mcg/min |
☆Start epinephrine 2 to 10mcg/min |
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A patient with possible ST-segment elevation MI has ongoing chest discomfort. Which of the following would be a contraindication to the administration of nitrates?
● Heart rate 90/min
● Left ventricular infarct with bilateral rales
● Use of phosphodiesterase inhibitor within 12 hours
● Blood pressure greater than 180mHg |
☆Use of phosphodiesterase inhibitor within 12 hours |
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Which of the following statement about the use of magnesium in cardiac arrest is most accurate?
● Magnesium is indicated for shock-refractory monomorphic VT.
● Magnesium is contraindicated for VT associated with a normal QT interval.
● Magnesium is indicated for VT refractory to shock and amiodarone or lidocaine.
● Magnesium is indicated for VT/pulseless, VT associated with torsades de pointes. |
☆Magnesium is indicated for VT/pulseless, VT associated with torsades de pointes. |
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This patient has been resuscitated from cardiac arrest. During the resuscitation, amiodarone 300mg was administered. The patient developed severe chest discomfort with diaphoresis. He is now unresponsive. What is the next indicated action?
● Perform immediate synchronized cardioversion.
● Repeat amiodarone 300mg I.V.
● Give an immediate unsynchronized high-energy shock (defibrillation dose).
● Repeat amiodarone 150mg I.V.
● Give lidocaine 1 to 1.5mg/kg I.V. |
☆Give an immediate unsynchronized high-energy shock (defibrillation dose). |
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You arrived on the scene to find a 56- years-old diabetic woman with dizziness. She is pale and diaphoretic. Her blood pressure is 80/60mmHg. The cardiac monitor documents the rhythm above. She is recieving oxygen at 4L/min by nasal cannula, and an I.V. has been established. Your next order is:
● morphine sulfate 4mg I.V.
● dopamine at 2 to 10mcg/kg/min
● sublingual nitroglycerin 0.4mg
● atropine 0.5mg I.V.
● atropine 1mg I.V. |
☆Atropine 0.5mg I.V. |
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A patient has been resuscitated from cardiac arrest and is being prepared to transport. She is intubated and is receiving 100% oxygen. Blood pressure is 80/60mmHg. During the resuscitation, she recieved 2 doses of epinephrine 1mg and 1 dose of amiodarone 300mg I.V. You now observe the above rhythm on the cardiac monitor. The rhythm abnormality is becoming more frequent and increasing in number. You should order;
● lidocaine 1 to 1.5mg I.V.; start infusion
● amiodarone 150mg I.V. bolus; start infusion
● a repeat dose of epinephrine 1mg I.V.
● amiodarone 300mg I.V.
● 1 to 2L of normal saline |
☆1 to 2L of normal saline |
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This patient was admitted to the general medical ward with a history of alcoholism. A code is in progress, and he has recurrent episodes of this rhythm. You review his chart. Notes about 12-leads ECG say that his basline QT interval is high normal to slighly prolonged. He has received 2 doses of epinephrine 1mg and 1 dose of amiodarone 300mg I.V. so far. What would you order for his next medication?
● Repeat amiodarone 150mg I.V.
● Gibe sodium bicarbonate 50mEq I.V.
● Repeat amiodarone300mg I.V.
● Lidocaine1 to 1.5mg I.V. and start infusion 2mg/min
● Give magnesium sulfate 1 to 2g I.V. diluted in 10ml D5W given over 5 to 20 minutes |
☆Give magnesium sulfate 1 to 2g I.V. diluted in 10ml D5W given over 5 to 20 minutes |
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A 45-years-old woman with a history of palpitatons develops light-headedness and palpitations. She has received adenosine 6mg I.V. for the rhythm shown above without conversion of the rhythm. She is now extremely apprehensive. Blood pressure is 108/70mmHg. What is the next appropriate intervention?
● Perform immediate unsynchronized cardioversion
● Repeat adenosine 12mg I.V.
● Perform vagal maneuvers and repeat adenosine 6mg I.V.
● Sedate and perform synchronized cardioversion
● Repeat adenosine 3mg I.V. |
☆Repeat adenosine 12mg I.V. |
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You are the code team leader and arrive to find a patient with the above rhythm and CPR in progress. Team members report that the patient was well but reported chest pain and then collapsed. She has no pulse or respirations. Bag-mask ventillations are producing chest rise, high quality CPR is in progress, and an I.V. has been established. What would be your next order?
● Perform endotracheal intubation.
● Administer epinephrine 1mg.
● Start dopamine at 10 to 20 mcg/kg/min
● Administer atropine 1mg.
● Administer amiodarone 300mg. |
☆Administer epinephrine 1mg. |
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A patient's 12-lead ECG was transmitted by the paramedics and showed an acute Myocardial Infraction. The above findings are seen on rhythm strip when a monitor is placed in the emergency department. The patient has resolution of moderate (5/10) chest pain with 3 doses of sublingual nittoglycerin. Blood pressure is 104/70mmHg. Which intervention below is most important, reducing in-hospital and 30-day motality?
● Reperfusion therapy
● I.V. Nitroglycerin for 24 hours
● Atropine 0.5mg I.V., total dose 2mg as needed. ● Atropine 1mg I.V., total dose 3mg as needed.
● Temporary pacing |
☆Reperfusion therapy |
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A patient becomes unresponsive. You are uncertain if faint pulse is present with the above rhythm. What is your next action?
● Start an I.V. and give atropine 1mg.
● Start an I.V. and give epinephrine 1mg I.V.
● Order transcutaneous pacing
● Consider causes of pulseless electrical activity
● Begin CPR, starting with high-quality chest compression |
☆Begin CPR, starting with high-quality chest compressions. |
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You are monitoring a patient. He suddenly has the above persistent rhythm. You ask about symptoms, and he reports that he has mild palpitations, but otherwise he is clinically stable with unchanged vital signs. What is your next actions?
● Give sedation and perform synchronized cardioversion.
● Administer adenosine 6mg; seek expert consultation.
● Administer magnesium sulfate 1 to 2G I.V. diluted in 10ml D5W given over 5 to 20 minutes.
● Give an immediate synchronized shock.
● Give an immediate unsynchronized shock |
☆Administer adenosine 6mg; seek expert consultation. |
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You are evaluating a patient with chest discomfort lasting 15minutes during transportation to the emergency department. He is receiving oxygen, and 2 sublingual nitroglycerin tablets have relieved his chesy discomfort. He reports no other symptoms but appears anxious. Blood pressure i s 130/70mmHg. You observe the above rhythm on the monitor. What is your next action?
● Start epinephrine2 to 10mcg/min and titrate to patient response.
● Initiate transcutaneous pacing (TCP)
● Continue monitoring the patient and seek expert consultation.
● Administer sublingual nitroglycerin 0.4mg
● Give atropine 0.5mg IV |
☆Continue monitoring the patient and seek expert consultation. |
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You are monitoring the patient and note the above rhythm on the cardiac monitor. She has dizziness, and her bloodpressure is 80/40mmHg. She has an I.V. in place. What is your next action?
● Give atropine 0.5mg I.V.
● Start transcutaneous pacing
● Administer sedation and begin immediate transcutaneous pacing at 80/min
● Start dopamine at 2 to 10mcg/kg/min and titrate to patient response
●Give atropine 1mg I.V. |
☆Give atropine 0.5mg I.Vm |
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Following initiation of CPR and 1 shock for VF, this rhythm is present on the next rhythm check. A second shock is given, and chest compressions are resumed immediately. An I.V. is in place, and no drugs have been given. Bag - mask ventilation are producing visible chest rise what is your next order?
● Administer 3 sequential (stacked) shocks at 360 J (Monophasic Defibrillator)
● Prepare to give amiodarone 300mg I.V.
● Perform endotracheal intubation; administer 100% oxygen.
● Prepare to give epinephrine 1mg I.V.
● Administer 3 sequential (stacked) shocks at 200 J (Biphasic Defibrillator) |
☆Prepare to give epinephrine 1mg I.V. |
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A 35-years-old woman presents to the energency department with chief complaint of palpitations. She has no chest discomfort, shortness of breath, or light-headednes. Which of the following is indicated first?
● Give adenosine 3mg I.V. bolus.
● Perform vagal maneuvers.
● Give adenosine 12mg I.V. slow push (over 1 to 2 minutes)
● Give metoprolol 5mg I.V. and repeat if necessary. |
☆Perform vagal maneuvers. |
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A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks to you for instructions. Your immediate next order is
● check the carotid pulse
● give atropine 1mg I.V.
● give amiodarone 300mg I.V.
● perform endotracheal intubation
● resume high-quality chest compression |
☆Resume high-quality chest compression |
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You arrive on the scene to find CPR in progress. Nursing staff report that the patient was recovering from a pulmonary embolism and suddenly collapsed. There is no pulse and spontaneous respirations. High-quality CPR and effective bag-mask ventilation are being provided. An I.V. has been imitiated. What would you do now?
● Give epinephrine 1mg I.V.
● Order immediate endotracheal intubation
● Give atropine 1mg I.V.
● Initiate transcutaneous pacing
● Give atropine 0.5mg I.V. |
☆Give epinephrine 1mg I.V. |
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A patient presents with the above rhythm and reports an irregular heartbeat. She has no other symptoms. Her medical history is significant for myocardial infraction 7 years ago. Blood pressure is 110/70mmHg. What would you do at this time?
● Continue monitoring and seek expert for consultation
● Administer nitroglycerin 0.4mg sublingual or spray
● Perform elective synchronized cardioversion with presedation.
● Perform emergency synchronized cardioversion.
● Administer lidocaine 1mg/kg I.V. |
☆Continue monitoring and seek expert for consultation |
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A patient in the emergency department develops recurrent chest discomfort (8/10) suspicious for ischemia. His monitoring rhythm becomes irregular as seen above. Oxygen is being administered by nasal cannula at 4L/min, and an I.V. line is in place. Blood pressure is 160/96mmHg. There are no allergies or contraindications to any medication. You would first order
● I.V. nitroglycerin initiated at 10mcg/min and titrate to patient responce.
● lidocaine 1mg/kg I.V. and infusion 2mg/min
● morphine sulfate 2 to 4mg I.V.
● sublingual nitroglycerin 0.4mg
●amiodarone 150mg I.V. |
☆Sublingual nitroglycerin 0.4mg |
