ACLS Study Guide 8/2011 Flashcards
(152 cards)
1
Q
An endotracheal intubation attempt should be accomplished in a specific amount of time. At what point does this time interval begin and end?
A
The time interval begins when ventilations are ceased; it ends when the tube has been successfully placed and the ventilations are resumed.
2
Q
According to AHA guidelines, when ventilating a patient during a cardia or respiratory arrest, the respiratory rate should be what?
A
8-10 breaths/minute
3
Q
A 78 year old female has suffered a respiratory arrest. You have intubated the patient and note there is an absence of chest wall movement with bag-valve device ventilation and you are unable to auscultate breath sounds on either side of the chest. What is the most likely cause of this situation?
A
esophageal intubation
4
Q
Which points are true about the oropharyngeal airway (OPA)? 1. Can only be used in spontaneously breathing patients 2. Is usually well tolerated in the conscious or semi conscious patient 3. should be used when possible for unconscious patients who are not intubated. 4. May result in airway obstruction if improperly inserted. 5. Should be lubricated prior to insertion.
A
- Not true. 2. Not true. 3. True. 4. True. 5. Not true.
5
Q
You are attempting to intubate an adult patient who has suffered a respiratory arrest. A capable assistant is applying cricoid pressure. At what point should cricoid pressure be released?
A
It should be maintained until the endotracheal tube cuff is inflated.
6
Q
Which is true about endotracheal intubation? 1. Is contraindicated in unresponsive patients 2. must be initially attempted by tactile methods 3. should be preceded by efforts to ventilate by another method. 4. when attempted, should be performed in 60 seconds or less.
A
- False 2. False 3. True 4. False (should be 30 seconds or less)
7
Q
Which of the following are appropriate features of the bag-valve mask device? 1. it should have an oxygen inlet at the back of the bag 2. it should not have a non-rebreathing valve 3. has a pop-off valve 4. the ability to function in all environmental conditions 5. a pliable black plastic face mask
A
- true 2. true 3. false 4. true 5. false
8
Q
When tracheal suction is performed, how/when is suction applied?
A
Only during withdrawal of the catheter
9
Q
You have intubated a 60 year old female patient in cardiac arrest. Which of the following would indicate inadvertent esophageal intubation?
A
Gurgling sounds heard over the epigastrium absent lung sounds absence of condensation in ET tube No ETCO2 reading
10
Q
What is tidal volume?
A
The volume of air exchanged in a normal breath
11
Q
True or false. An endotracheal intubation attempt should not take more than 30 seconds.
A
True
12
Q
What is the carina?
A
It is the point where the trachea bifurcates into the right and left mainstem bronchi
13
Q
With an oxygen flow rate of 1-6 liters/minute, a nasal canula can deliver an estimated oxygen concentration of:
A
24-44%
14
Q
Which are true about endotracheal intubation? 1. eliminates the risk of aspiration 2. should be accomplished in 30 seconds or less 3. permits tracheal suction 4. provides a route for the administration of atropine, lidocaine, and epinephrine.
A
- false 2. true 3. true 4. true
15
Q
What is the proper flow rate to be used with a nasal canula?
A
1-6 liters/minute
16
Q
Anatomically, where is the carina located?
A
In the arch of the aorta. Not at the level of the sternal angle, in the posterior oropharynx, or anterior to the epiglottis.
17
Q
Inadvertent esophageal intubation with an endotracheal tube is a potentially fatal complication if it is not immediately identified. True or false?
A
True.
18
Q
A 62 year old male has suffered a respiratory arrest and has just been intubated with an ET tube. When assessing the placement, you observe no chest wall movement with ventilations and are unable to auscultate breath sounds on either side of the chest. What will you do next?
A
Remove the tube and ventilate with a bag-valve device
19
Q
The average tidal volume that should be delivered when ventilating and adult with a bag-valve device is:
A
10-15 ml/kg
20
Q
When using a simple face mask, why must the oxygen flow rate be higher than 5 liters per minute?
A
To avoid the accumulation of exhaled air in the mask
21
Q
What is the minimum oxygen flow rate that should be used with a simple face mask?
A
6 liters/minute
22
Q
A 61 year old male has suffered a respiratory arrest. An ET tube has been correctly placed and you are preparing to ventilate the patient with a bag-valve device. What oxygen liter flow rate should be used when ventilating this patient?
A
At least 15 liters/minute
23
Q
Which of the following is not a desirable feature of a bag-valve device? 1. Non-rebreathing valve. 2. compressible, self-refilling bag 3. pop-off (pressure release) valve 4. availability in adult and pediatric sizes
A
- Is desirable 2. Is desirable 3. Not desirable 4. Is desirable
24
Q
What is the proper method for insertion of an oropharyngeal airway (OPA) in the adult patient?
A
Inserted upside down into the mouth and rotated 180 degrees when the distal tip reaches the soft palate
25
The tip of the straight laryngoscope blade is placed where?
Under the epiglottis
26
Your patient is a 67 year old male who has suffered a cardiopulmonary arrest. The preferred technique for management of this patient's airway is what?
Insertion of an OPA and ventilating with a bag-valve device until ET intubation can be performed
27
You have just intubated a 68 year old male. You auscultate breath sounds on the right side of the chest and hear little, if any, sound on the left chest. What corrective action would you take?
Deflate the endotracheal tube cuff, pull back the tube slightly, re-inflate the endotracheal tube cuff, and reassess breath sounds.
28
Which two anatomical landmarks are used when measuring for proper OPA size?
Corner of the lips and angle of the jaw
29
Non-rebreathing oxygen masks with reservoirs can yield oxygen concentrations of what?
90-100%
30
Which of the following are possible complications of suctioning? 1. increased arterial pressure and tachycardia 2. may trigger coughing, resulting in increased intracranial pressure 3. sever hypoxia 4. bradycardia and hypotension due to vagal stimulation 5. damage to the mucosa
All are possible complications of suctioning
31
Which of the following, in regards to bag-valve devices, are true? 1. non-intubated patients are more effectively ventilated when two people work together 2. adult devices should not have pop-off valves 3. pediatric devices should have pop off valves 4. tidal volumes to be delivered via these units should be 10-15 ml/kg 5. should have the ability to perform adequately in all environmental temperatures.
1. true 2. true 3. not true 4. true 5. true
32
The approximate percentage of oxygen delivered by a simple face mask at 8-10 liters/minute is:
40-60%
33
The tip of the curved laryngoscope blade is placed where?
In the vallecula
34
When the oropharyngeal airway has been properly measured and placed, the proximal end should:
Protrude approximately 1/2 inch from the patient's lips
35
A bag-valve device WITHOUT an attached reservoir which does have supplemental oxygen flowing at 12-15 liters/minute provides what percentage of oxygen?
70-90%
36
Which is true regarding the simple face mask? 1. Provides definitive control of the airway 2. preferred device for use in COPD patients because it provides precise O2 concentrations 3. the oxygen flow rate must be greater than 5 liters/minute 4. can be used effectively to deliver high concentrations of oxygen for the apneic patient
1. Not true 2. Not true 3. True - the minimum setting must be 6 liters/minute to avoid the accumulation of exhaled air 4. Not true
37
What is the first positive deflection seen on the ECG after the P wave?
R wave
38
How would you differentiate a junctional escape rhythm at 40 beats/minute from a ventricular escape rhythm at the same rate?
The junctional escape rhythm will have a narrow QRS complex while the ventricular escape rhythm will have a wide QRS complex.
39
Where is the positive electrode placed in lead MCL1?
Right sternal border, 4th intercostal space
40
The normal pacemaker of the heart is called the what? And where is it located?
the SA node, located in the right atrium
41
The QT interval is measured how?
The beginning of the Q wave to the beginning of the T wave
42
Which of the following are true of the absolute refractory period? 1. no matter how strong a stimulus, the myocardium cannot be stimulated to depolarize 2. also known as the effective refractory period 3. extends from onset of the QRS to peak of T wave 4. extends from peak of T wave to the end of T wave a very strong stimulus can stimulate a depolarization
1. true 2. true 3. true 4. false 5. false
43
Define automaticity
The ability of cardiac cells to spontaneously initiate an electrical impulse.
44
Which of the following are possible causes of premature atrial complexes? 1. sympathomimetic 2. calcium channel blockers 3. digitalis toxicity 4. often the cause is unknown 5. beta adrenergic blockers
1. true 2. false 3. true 4. true 5. false
45
If a negative P wave is found in lead II, the impulse most likely began in or near where?
The AV junction
46
Describe Torsades de Pointes
a gradual alteration in the amplitude and direction of the QRS; atrial rate indiscernible, ventricular rate 150-200 beats/minute.
47
Which is INCORRECT in regards to a complete (third-degree) AV block? 1. in complete AV block, the atrial rate is greater than the ventricular rate 2. the atria and ventricles beat independently of each other 3. the ventricular rhythm is essentially regular although the P waves occur irregularly 4. the QRS may be either wide or narrow, depending on the origin of the escape pacemaker
The incorrect statement is #3
48
True or False? The period of time during the cardiac cycle when cells cannot respond to a stimulus, no matter how strong, is referred to as the relative refractory period.
False
49
Management of unstable patients may necessitate the use of electrical therapy. Identify the correct initial and subsequent energy settings for the management of an unstable patient who presents with PSVT. 1. 100, 200, 300, 360 joules 2. 50, 100, 150, 170, 200 joules 3. 200, 200-300, 360 joules 4. 100-200-300, 360 joules
50, 100, 150, 170, 200 joules is the correct initial and subsequent energy settings for an unstable patient with PSVT
50
Basic EMTs responded to a 73 year old man in cardiac arrest. The patient was confirmed to be pulseless and apneic and an automated external defibrillator (AED) was applied. The AED delivered 1 shock without conversion of the rhythm. The patient has now arrived in the emergency department. The AED has delivered a second shock without conversion of the rhythm. CPR has been resumed. As an ACLS rescuer, how should you proceed?
continue CPR, place endotracheal tube, IV, and administer epinephrine.
51
A 52 year old female is complaining of chest pain and begins losing consciousness. Her BP is now 50 by palpitation and respirations are 12. The cardiac monitor displays a narrow QRS tachycardia at 220 beats/minute. Oxygen therapy was initiated and an IV was established prior to the patient's collapse. You promptly deliver a synchronized countershock, however, reassessment reveals the patient to be pulseless and apneic. The cardiac monitor now reveals ventricular fibrillation. What course of action should you take at this time?
Defibrillate with 150 joules
52
Management of unstable patients may necessitate the use of electrical therapy. Identify the correct initial and subsequent energy settings for the management of ventricular tachycardia for an unstable patient who presents with a pulse. 1. 100, 150, 170, 200 joules 2. 50, 100, 150, 170, 200 joules 3. 200, 200-300, 360 joules 4. 100-200, 300, 360 joules
The correct electrical treatment for an unstable patient in V-tach, who presents with a pulse is 100, 150, 170, 200 joules
53
Emergent pacing is indicated in all of the following situations except: 1. ventricular fibrillation 2. hemodynamically compromising bradycardias 3. bradycardia with malignant escape rhythms unresponsive to pharmacologic therapy 4. overdrive pacing of tachycardia refractory to pharmacologic therapy or countershock
We do not pace ventricular fibrillation
54
A 73 year old male is found pulseless and apneic. CPR is initiated. The cardiac monitor shows ventricular fibrillation. The proper energy level for delivery of the initial shock to this patient would be what?
150 joules biphasic
55
Management of unstable patients may necessitate the use of electrical therapy. Identify the correct initial and subsequent energy settings for the management of a patient who presents with ventricular fibrillation. 1. 100, 200, 300, 360 joules 2. 50, 100, 200, 300, 360 joules 3. 150, 170, 200 joules biphasic 4. 100-200, 300, 360 joules
The correct electrical therapy for a patient who presents with ventricular fibrillation is: 150, 170, 200 joules biphasic
56
A 53 year old male is complaining of palpitations. He denies chest pain or difficulty breathing. His initial blood pressure is 128/64, his pulse is 88 and regular. You have attached the monitor leads to the patient's chest and note a wide QRS complex tachycardia. Recommended treatment guidelines for this patient include what?
O2, IV, administer an IV bolus of lidocaine and reassess the patient. This is a stable patient, so medication is tried before electrical therapy.
57
Identify the correct initial and subsequent energy settings for the management of a patient who presents with sustained unstable Torsades de Pointes. 1. 100, 200, 300, 360 joules 2. 50, 100, 200, 300, 360 joules 3. 150, 170, 200 joules biphasic 4. 100-200, 300, 360 joules
The electrical therapy settings for Torsades de Pointe are: 150, 170, 200 joules biphasic
58
Which of the following factors effect transthoracic resistance? 1. electrode (paddle) size 2. phase of patient's ventilation 3. use of interface 4. electrode (paddle) pressure
All factors listed effect transthoracic resistance
59
What is a synchronized counter shock?
A shock that is delivered a few milliseconds after the highest part of the R wave, as detected by the cardiac monitor.
60
A 56 year old male has a permanent pacemaker in place. Should it be necessary to defibrillate this patient, conventional defibrillator paddles should be placed where?
at least 5 inches from the pacemaker generator
61
Identify the correct initial and subsequent energy settings for the management of ventricular tachycardia for a patient who presents without a pulse. 1. 150, 170, 200 joules biphasic 2. 50, 100, 200, 300, 360 joules 3. 200, 200-300, 360 joules 4. 100-200, 300, 360 joules
The correct electrical therapy for a patient in Ventricular tachycardia and presenting without a pulse is: 150, 170, 200 joules biphasic
62
What is the electrical therapy treatment for polymorphic VT?
unsynchronized countershock with 150, 170, 200 joules biphasic.
63
If O2 saturation is 94-99%, do you need supplemental oxygen?
94-99% is good. Don't think about supplemental O2 as the next critical step.
64
What can ETCO2 be used to measure?
It can be used as a tool to measure the quality of CPR
65
What is PETCO2 level for CPR?
PETCO2 level for CPR is greater than or equal to 10mmHg
66
What detects early critical deterioration?
MET or RPT
67
Is O2 a medication or gas?
O2 is a gas
68
What danger does blow-by O2 risk with using defib or AED?
Blow by O2 risks fire hazard during defib or AED
69
What is the BVM rate of asynchronous CPR for an intubated patient?
8-10 breaths/min
70
What is a good post-code CO2?
35-40%
71
What is the dosage for amiodarone?
300
72
What is the AHA guideline for the initial dosage of adenosine?
6mg
73
How often should you switch CPR?
Every 2 minutes
74
How much fluid should be given post-code?
2 liters
75
Is early defibrillation part of the BLS or ALS survey?
It is part of the BLS survey
76
CPR should not be interrupted for more than how many seconds?
10 seconds. This means to resume CPR during charging.
77
When using a bag-valve device, what is the proper tidal volume for an adult?
500-600ml, which is approx. half the bag
78
What can an ETCO2 of \<10 indicate?
It could indicate poor CPR being performed
79
What is the proper depth of compressions for adult CPR?
Adult CPR should be at the depth of at least 2", and at the rate of 100/min.
80
What is the rate of 5 little boxes?
10 little boxes?
15 little boxes?
1 large box?
1 large box = 5 small boxes
81
A 57 year old male is apneic and pulseless
Describe critical actions for the first 10 minutes for this patient
**Airway**: OPA/Nonreabreather @ 15LPM O2 during CCR, then intubate after 4 rounds or 800 compressions
**Breathing**: During CCR, nonrebreather is sufficient. Once intubate, 8-10 breath/minute via BVM with high flow O2. Assess lung sounds
**Circulation**: CCR for 4 rounds or 800 total compressions at 100/minute, then swith to AHA 30:2. Establish two large bore IV's of NS and provide a 500cc NS bolus as needed and 20cc flush p medications
**Drugs**: Epinepherine 1:10K / 1MG / RIVP / Q 3-5 minutes / no max dose
Lidocaine / 1-1.5mg/kg / RIVP / 1/2 initial dose q 5-10 minutes / 3mg/kg max
Successful conversion with pulse/pressure: lidocaine drip (2g in 500cc NS) / 2-4mcg/min / infusion / continuous / 4mcg/min max
**Electrical**: Rhythm is V-fib. Immediate shock is indicated @ 150 J biphasic. Resume CPR immediately after shock and assess for rhythm change after completing 2 minutes of CCR. Assess monitor for changes and shock again if found to be in V-fib still.
82
A 68 y/o F is anxious and restless. B/P is 160/90, pulse is regular/weak. Respirations are 22 and skin is W/M/P.
Describe critical actions for first 10 minutes
**Airway**: Patient is awake and breathing - airway is patent.
**Breathing**: High flow O2 via nonrebreather @ 15 LPM. Assess lung sounds. Try to calm patient and slow down respirations.
**Circulation**: Establish large bore IV of NS. 20cc bolus p any medications. Fluid bolus as needed.
**Drugs**: Consider sedation prior to Synch cardioversion with Versed / 2.5-5mg / SIVP / 1x for sedation / 5mg Max
For conversion, consider lidocaine / 1-1.5mg/kg / SIVP / repeat at 1/2 initial dose q 5-10 minutes / 3 mg Max
After conversion, lidocaine drip (2g in 500cc NS) / 2-4mcg/min / infusion / 4mcg/min Max
**Electrical:** For critical patient (ALOC), synch cardiovert without pretreatment of versed @ 100J biphasic. If successful, initiate lidocaine drip. If unsuccessful, patch.
83
A 21 year old male is unresponsive and apneic. He has overdosed on heroin. The blood pressure is 118/80, the pulse is regular, and the skin is cool/moist/cyanotic.
Describe critical actions for the first 10 minutes.
**Airway:** Suction if necessary. OPA if no gag reflex, NPA if gag reflex.
**Breathing**: BVM with 15LPM O2 at 8-10 BPM. Assess lung sounds/rise/fall of chest.
**Circulation:** Obtain large bore IV with NS. Provide bolus as needed. 20cc flush p medications.
**Drugs:** narcan / 2mg / IM-IV-Nasal (2mg each) / q 2 minutes / 6mg max (8mg is used nasally)
**Electrical:** Monitor rhythm for changes
84
A 67 year old female is apneic and pulseless. She has suffered three strokes in the last six months.
Describe critical actions for first 10 minutes.
**Airway**
**Breathing**
**Circulation**
**Drugs**
**Electricity**
85
Peripheral vasoconstriction occurs with the simulation of:
Alpha-1 receptors
86
Dopamine may be of value in the management of:
1. symptomatic bradycardia.
2. cardiogenic shock.
3. hypovolemic shock.
4. hypotension after the return of spontaneous pulses.
5. hypertension
(1, 2 & 4)
87
What is the maximum recommended dose of procainamide?
100 mg
88
Which of the following are common side effects associated with the use of nitrates.
1. reflex tachycardia.
2. nausea.
3. hypertension.
4. headache.
5. tinnitues
1, 2, & 4
89
Verapamil is classified as a :
calcium channel blocker
90
Which of the following pharmacological actions can be attributed to calcium channel blocker administration?
1. bronchial dilation.
2. relaxation of vascular smooth muscle.
3. decrease in myocardial oxygen consumption.
4. dilation of the coronary arteries.
5. increase in afterload.
2, 3, & 4
91
Adenosine should be administered:
fast push
92
Adenosine is useful in converting:
Paroxysmal supraventricular tachycardia
93
Magnesium sulfate is useful in treating:
Torsades de Pointes
94
Verapamil, when administered IV, should be given:
over 2 minutes.
95
What is the initial dosage of lidocaine when used in ventricular fibrillation?
1 mg/kg or 100mg
| (actual dosage is 1-1.5mg/kg)
96
Common side effects of NTG include:
hypotension and headache
97
The initial IV dose for adult adenosine administration is:
6 mg per AHA (PFD uses 12mg)
98
Which of the following statements regarding the administration of nitroglycerin to patients with acute pulmonary
edema are true?
1. it reduces pre-load.
2. it promotes venous pooling.
3. it increases afterload.
4. it increases venous capacitance.
1, 2, & 4
99
Lidocaine is recommended for:
1. wide-complex tachycardia of uncertain origin.
2. complete AV block with new wide-QRS complexes.
3. control of significant PVC’s in the setting of ischemia or infarction.
4. ventricular escape beats.
5. ventricular fibrillation that persists after defibrillation and the administration of epinephrine.
1& 3 & 5
100
Dopamine:
1. may cause tissue sloughing or necrosis if extravasation occurs during administration.
2. is useful in the management of hypertension.
3. should not be administered simultaneously with sodium bicarbonate.
4. may produce a paradoxical intracellular acidosis.
1 & 3
101
The half-life of adenosine is:
seconds
102
Calcium chloride is useful during a resuscitation when:
1. hypocalcemia is documented.
2. hyperkalemia is documented.
3. hypokalemia is documented.
4. pulseless electrical activity is observed.
1 & 2
103
Magnesium sulfate is useful in treating:
refractory ventricular fibrillation
104
Advanced cardiac life support medications that may be administered via the endotracheal tube include:
lidocaine, epinephrine and atropine
105
Which of the following drugs are used in the treatment of ventricular dysrhythmias?
1. lidocaine.
2. magnesium sulfate.
3. verapamil.
4. dopamine.
5. procainamide.
1, 2, & 5
106
Propranolol, atenolol and metoprolol are examples of:
beta-adrenergic blockers.
107
How might the initial dose of furosemide be adjusted if a patient is already taking the drug orally?
the initial dose would be twice the daily oral dose
108
A 63 year old male is complaining of shortness of breath and chest pain. The cardiac monitor shows a sinus
rhythm at 80 beats/minute with frequent, “R on T” PVC’s occurring at a rate of 8-10/minute and runs of
ventricular tachycardia. A total of 2 mg/kg of lidocaine was administered in bolus doses and the ectopy appears
to be resolved. At what rate should the continuous lidocaine drip be infused?
3 mg/minutes
109
Sodium nitroprusside:
1. decreases myocardial oxygen requirements.
2. decreases cardiac output.
3. decreases preload.
4. decreases afterload.
5. is administered IV slow bolus.
1, 3, & 4
110
Norepinephrine is used to treat what?
may be used in the management of severe hypotension associated with sepsis
111
Lidocaine is not indicated in which of the following situations?
a. significant PVC’s in the setting of suspected AMI.
b. wide-complex tachycardia of uncertain origin.
c. routine prophylactic use in any patient with a suspected AMI.
d. ventricular tachycardia that persists after defibrillation and the administration of epinephrine
c. routine prophylactic use in any patient with a suspected AMI.
112
Verapamil decreases myocardial contractility.
a. true b. false
a. true
113
Which one of the following is an indication for administration of beta-blockers?
acute MI with hypertension.
114
Sublingual nitroglycerin frequently relives anginal attacks within:
3-5 minutes.
115
Side effects of beta blocker administration include:
1. hypotension.
2. hypertension.
3. bradycardia.
4. tachycardia.
5. AV conduction delay.
1 & 3
116
The drug of choice in the management of Torsdades de Pointes is:
magnesium sulfate
117
Isoproterenol is primarily a (an):
beta stimulating agent
118
The recommended initial furosemide dosage is:
0.5 to 1 mg/kg IV slowly
119
Which of the following pharmacological actions are associated with the IV administration of furosemide?
1. venodilation.
2. decreased reabsorption of sodium at the renal loop of Henle.
3. decreased venous capitance.
4. relief of pulmonary congestion.
5. increased reabsorption of sodium at the distal renal tubule.
1, 2, & 4
120
Adenosine depresses the activity in the:
1. SA node.
2. AV node.
3. Purkinje fibers.
4. bundle branches.
2. AV node.
121
The initial recommended adult IV dose of epinephrine administered in cardiac arrest is:
1.0 mg IV bolus
122
Which of the following are possible causes of pulseless electrical activity?
1. hyperthermia.
2. acidosis.
3. hypoxia.
4. massive cerebral embolism.
5. sympathomimetic use.
2. acidosis.
3. hypoxia.
123
A 46 year old male is complaining of chest pain radiating to his jaw. His blood pressure is 136/72 and the
respiratory rate is 16. The cardiac monitor displays a sinus tachycardia with frequent “R on T” PVC’s.
Interventions to consider in the management of this patient would include, aspirin and:
O², IV, nitroglycerin, morphine if no relief from the nitroglycerin, a lidocaine bolus and maintenance infusion.
124
A 57 year old male is complaining of chest pain and difficulty breathing. He is disoriented and extremely anxious.
Examination reveals bibasilar crackles, a weak and irregular carotid pulse and a blood pressure of 60/30. The
cardiac monitor displays a narrow QRS tachycardia a rate of 210 beats/minute. Management of this patient
should include:
administration of a sedative, performing synchronized countershock at 50J and reassess
125
A 50 year old female is complaining of chest pain, dizziness and nausea. Her blood pressure is 62/38, and
respiration’s are 18. The cardiac monitor shows a sinus bradycardia at 48/minute with frequent, multiformed
PVC’s. Your first choice of drug and dosage will be:
atropine 0.5 mg IV bolus.
126
A 65 year old female is complaining of difficulty breathing. She is awake, extremely anxious and laboring to
breathe. Examination reveals a BP of 166/94, irregular pulse rate of 90-120 beats/minute and respiratory rate of 32.
The skin is cool and moist. Auscultation of the chest reveals bilateral crackles. Pitting edema of the ankles is noted.
The cardiac monitor shows atrial fibrillation. The patient has a history of hypertension for which she takes
Catapres. How will you manage this patient?
1. place the patient in the supine position for comfort.
2. administer oxygen.
3. Administer sublingual nitroglycerin.
4. start an isoproterenol infusion at a low dosage.
5. consider the administration of morphine.
2. administer oxygen.
3. Administer sublingual nitroglycerin.
5. consider the administration of morphine
127
A 70 year old male has suffered a cardiac arrest. The cardiac monitor displays ventricular tachycardia.
Examination confirms the patient is pulseless and apneic. Which of the following medications may be utilized in
the resuscitation of this patient?
1. adenosine.
2. procainamide.
3. magnesium sulfate.
4. verapamil.
5. epinephrine.
2. procainamide.
3. magnesium sulfate.
5. epinephrine
128
A 65 year old male is complaining of “chest pressure”. His past medical history is significant for an MI 4 years ago
and hypertension. Medications include nitroglycerin, Cardizem and Lasix. The patient states his pain began
approximately 30 minutes ago and has not been relived by rest or the three nitroglycerin tablets he has taken thus
far. His blood pressure is 144/78, and the respiratory rate is 18. He is awake, oriented and extremely anxious. The
cardiac monitor displays a sinus rhythm with a run of ventricular tachycardia. How will you manage this patient?
oxygen, IV, morphine, a lidocaine bolus and maintenance infusion
129
Medications which may be used in the management of ventricular fibrillation include:
1. atropine.
2. epinephrine.
3. adenosine.
4. lidocaine.
5. magnesium sulfate.
2. epinephrine
4. lidocaine.
5. magnesium sulfate
130
A 72 year old female is complaining of severe chest pain radiating to both arms. The patient states the pain began
20 minutes ago during a meeting. On a 1-10 scale, she ranks her pain a 9 and states her arms are numb. The
cardiac monitor displays sinus rhythm with frequent “R on T” PVC’s. Her blood pressure is 142/84, and
respiratory rate is 24. Breath sounds are clear. The patient has a history of a CVA 4 years ago and takes Lanoxin
and Tenormin. Which of the following may be used in the management of this patient?
1. lidocaine
2. oxygen
3. aspirin
4. nitroglycerin
5. atropine
6. external pacing
1. lidocaine
2. oxygen
3. aspirin
4. nitroglycerin
131
When an IV lifeline is established during CPR:
a. 5% dextrose in water is the preferred solution for use during cardiac arrest.
b. It is preferable to administer some drugs by intracardiac injection rather than IV.
c. IV medications administered by bolus injection should be followed with a 20 ml bolus of IV fluid and elevation of the extremity.
d. Sites of first choice should include the external jugular or subclavian veins
c. IV medications administered by bolus injection should be followed with a 20 ml bolus of IV fluid and elevation of the extremity
132
Management of the unresponsive, severely hypothermic patient with vital signs should include:
1. gentle handling and cardiac monitoring.
2. initiation of CPR, withholding of IV medications and limiting shocks for VF/VT to a maximum of three.
3. endotracheal intubation to provide effective ventilation and reduce the risk of aspiration.
4. administration of warm, humidified oxygen and warm intravenous fluids
1. gentle handling and cardiac monitoring
3. endotracheal intubation to provide effective ventilation and reduce the risk of aspiration.
4. administration of warm, humidified oxygen and warm intravenous fluids
133
An electrical shock is capable of producing respiratory arrest by:
a. paralysis of the respiratory muscles.
b. disrupting the medullary respiratory center in the brain.
c. tetanic contraction of the diaphram
d. all of the above
d. all of the above
134
A 38 year old female is in labor. She becomes suddenly short of breath, markedly diaphoretic and complains of a
sharp pain in her chest. The cardiac monitor shows a sinus tachycardia at 138/minute. You suspect this patient
may be experiencing:
b. a pulmonary embolism.
135
Which of the following factors influence a drowning victim’s chances for survival?
1. ability to swim.
2. age of the victim.
3. length of submersion.
4. cleanliness of the water.
5. temperature of the water.
6. pre-existing medical conditions.
all of the above
136
External re-warming of the hypothermic patient may:
lead to core temperature after drop
137
A 65 year old male is suffering from hypothermia. He is unconscious and breathing shallowly at a rate of 4-6
breaths per minute. His carotid pulse is barely palpable at 40 beats per minute. How will you manage this
patient’s airway?
ventilate with 100% oxygen with a bag-valve mask and prepare to intubate
138
Stroke is an (an):
illness of sudden onset caused by occlusion or rupture of a blood vessel in the brain
139
A 28 year old female is complaining that her heart is racing. She denies chest pain or difficulty breathing although
she is anxious and feels lightheaded. Her blood pressure is 148/88, with a respiratory rate of 18. The cardiac
monitor displays a supraventricular tachycardia (narrow-QRS tachycardia) at 176 beats/minute. Breath sounds
are clear. How will you manage her?
O², IV, vagal maneuver and adenosine
140
A 75 year old male is complaining of severe chest pain. On a scale of 1-10, he ranks his pain an 8. His blood
pressure is 74/50. Breath sounds are clear. Respiratory rate is 14/minute. The cardiac monitor displays an
idioventricular rhythm at 38 beats/minute. How will you manage him?
O², IV and transcutaneous pacing
141
A 55 year old male complains of “severe crushing chest pain and difficulty breathing.” The blood pressure is 142/96, the pulse is irregular, respirations are 30 per minute/labored, and the skin is cool/wet/pale.
Describe critical treatment for first 10 minutes
Airway
Breathing
Circulation
Drugs
Electricity
142
A 48 year old female complains of “fluttering in my chest” and being “short of breath”. The blood pressure is 156/90, the pulse is regular, respirations are 24 per minute/shallow, and the skin is warm/moist/pink.
Describe critical actions for first 10 minutes.
Airway
Breathing
Circulation
Drugs
Electricity
143
An 82 year old female is conscious, has spontaneous eye opening, and makes incomprehensible sounds. Her legs and feet have become edematous in the last two days. The blood pressure is 82/40, the pulse is regular, respirations are 24 per minute/shallow, and the skin is cool/moist/pale.
Describe critical actions for first 10 minutes.
Airway
Breathing
Circulation
Drugs
Electricity
144
A 36 year old male suffered a submersion accident when he fell through the ice cover of a lake. The blood pressure is 80/40, the pulse is regular/weak, respirations are 6 per minute/agonal, and the skin is cold/dry/cyanotic.
Describe critical actions for first 10 minutes.
Airway
Breathing
Circulation
Drugs
Electricity
145
A 66 year old female is apneic and pulseless. She was the driver of an automobile which ran against a red light at a high rate of speed striking another vehicle head-on. The front ends of both vehicles are severely damaged. Her steering wheel is grossly deformed.
Describe critical actions for first 10 minutes.
Airway
Breathing
Circulation
Drugs
Electricity
146
A 29 year old male is unresponsive and apneic after suffering an electrocution at a construction site. The blood pressure is 72/44, the pulse is regular, and the skin is warm/moist/pale. Full-thickness burns are present on both hands.
Describe 10 minutes of critical actions.
Airway
Breathing
Circulation
Drugs
Electrical
147
A 60 year old female is apneic and pulseless.
Describe 10 minutes of critical actions.
Airway
Breathing
Circulation
Drugs
Electical
148
A 73 year old male complains of being “dizzy” and “weak”. He was attempting a bowl movement and experienced a syncopal episode lasting several minutes. The blood pressure is 94/70, the pulse is regular/weak, respirations are 24 per minute, and the skin is cool/moist/pale.
Describe 10 minutes of critical actions.
Airway
Breathing
Circulation
Drugs
Electrical
149
A 37 year old female complains of being “extremely short of breath”. Her medical history includes “rapid heart rate”. She is prescribed Calan® (verapamil). The blood pressure is 92/66, the pulse is regular/weak, respirations are 36 per minute/labored, and the skin is cool/wet/pale.
Describe 10 minutes of critical actions.
Airway
Breathing
Circulation
Drugs
Electrical
150
A 75 year old male cannot move his right arm or leg. He presents with a facial droop and abnormal speech. His medical history includes hypertension. The blood pressure is 236/120, the pulse is regular, respirations are 20 per minute, and the skin is warm/dry/pink.
Describe 10 minutes of critical actions.
Airway
Breathing
Circulation
Drugs
Electrical
151
A 57 year old female is apneic and pulseless. She has purposefully overdosed on Elavil® (amitriptyline), a tricyclic antidepressant and alcohol.
Describe 10 minutes of critical actions.
Airway
Breathing
Circulation
Drugs
Electrical
152
A 97 year old male is apneic and pulseless. His medical history includes lung and esophageal cancer. An advance directive (“do not resuscitate”) form is complete and available.
Describe 10 minutes of critical actions.
Airway
Breathing
Circulation
Drugs
Electrical
