ACLS

Question 1

Electrophysiology studies (EPS)

Answer 1

Special wire inserted to inc the HR and produce the irregular beats that cause SnS such as ventricular tachycardia

Question 2

Atrial fibrillation

Answer 2

Pulse over 100, irregular rhythm (sinus), no definite P waves. Sinoatrial node no longer functions as the hearts pacemaker and impulses are initiated at sites within the atria. Conduction thru atria disturbed> atrial contractions are reduced and stasis of blood in atria occurs> emboli. Cardioversion if HR over 150. Usually 110-140. Amiodarone.

Question 3

PVC (premature ventricular contraction)

Answer 3

Two regular beats followed by an irregular beat. Depressed T wave and skipped P wave before QRS. Tx w/ amiodarone, lidocaine. Quinidine prevents PVCs.

Question 4

Third-degree heart block

Answer 4

Transcutaneous pacing. QRS long, P not married to QRS

Question 5

Implantable cardioverter-defibrillator (ICD)

Answer 5

Warning sound before shock is delivered so there is time to move away

Question 6

Ventricular fibrillation

Answer 6

Defibrillation. If first shock doesn’t work first vasopressor given is epinephrine or vasopressor. When resistant to tx, amiodarone used. Or lidocaine to prevent second episode

Question 7

Ventricular tachycardia

Answer 7

Saw-tooth. Cardioversion tx hemodynamically unstable tachycardias. CPR if pulse absent. Defibrillation for pulseless v-tach. Amiodarone for pulseless v-tach

Question 8

Second-degree heart block Mobitz type 1

Answer 8

Drugs that block the AV node should be avoided (BB, CCB, digoxin, and amiodarone). Symptomatic clients tx w/ atropine and transcutaneous pacing.

Question 9

Defibrillation

Answer 9

Emergency procedure. Done wherever pt found No sedation. Action- to completely depolarize all myocardial cells at once so the SA node can reestablish its role as pacemaker. Paddles- over right sternal border and apex of heart. Indication- v-fib and v-tach. 200 joules

Question 10

Cardioversion

Answer 10

Sedation used. Shock delivered at peak or R of the QRS complex. Indication- a-fib, atrial flutter, and supraventricular tach resistant to meds, unstable v-tach. SYNC

Question 11

Norepinephrine (Levophed)

Answer 11

Vasoconstrictor. Used to inc blood pressure and blood glucose levels. Often used during CPR. Should be given through a central line. Can cause extravasation (infiltration of drug into the tissue by the vein). Antidote- phentolamine (regitine).

Question 12

Phentolamine (regitine)

Answer 12

Norepinephrine antidote

Question 13

Atrial fibrillation

Answer 13

If AF occurs for more than 48 hrs anticoagulation therapy is required for 3-4 weeks before Cardioversion. Transesophageal echocardiogram should be done before Cardioversion.

Question 14

Procainamide

Answer 14

PVCs and atrial tachycardia

Question 15

Lidocaine

Answer 15

Antidysrhythmic. Dec myocardial irritability and automaticity. PVCs. Prevent second v-fib episode. SE- hypotension, tremors, double vision, tinnitus, confusion, blurred vision, drowsiness, dizziness