Exam Review

Question 1

A fib tx

Answer 1

Rate control/cardioversion

Question 2

Atrial Flutter tx

Answer 2

Rate control or cardioversion

Question 3

SVT tx

Answer 3

Rate control or cardioversion

Adenosine

Question 4

Monomorphic V tach tx

Answer 4

Antiarrhythmias or cardioversion

Amiodarone if they have a pulse

Question 5

Polymorphic V tach tx

Answer 5

Antiarrhythmics or cardioversion (unsynchronized)

Question 6

Torsades tx

Answer 6

Antiarrhythmics or cardioversion (unsynchronized)

plus magnesium

Question 7

First Degree Heart Block tx

Answer 7

12 lead and consult

Question 8

Second Degree Heart Block tx

Answer 8

Treat all symptomatic bradycardia with atropine 0.5 mg

Question 9

Third Degree Heart Block

Answer 9

Treat all symptomatic bradycardia with atropine 0.5 mg

Question 10

V fib tx

Answer 10

Defibrillator, CPR

Question 11

PEA

Answer 11

Any unorganized electrical activity that is not v fib, v tach or asystole

Question 12

unsynchronized cardioversion

Answer 12

a fib

v tach

Question 13

If pt is in cardiac arrest w/ shockable rhythm (VF or pVT)

Answer 13

start CPR, give O2 and attach defib

if rhythm shockable→ shock then CPR 2 min, IV/IO access→
shock → CPR 2 min → epi q3-5 min →
shock → CPR 2 min → amiodarone

Question 14

If pt is in cardiac arrest w/ NO shockable rhythm (asystole or PEA)

Answer 14

start CPR, give O2 and attach defib

if rhythm NOT shockable→ CPR 2 min, IV/IO access →
epi q3-5 min →
consider adv airway →
CPR 2 min and repeat

Question 15

What indicates ROSC?

Answer 15

pulse and BP

abrupt sustained inc in PETCO2

spontaneous arterial pressure waves with intra-arterial monitoring

Question 16

What are reversible causes of cardiac arrest?

Answer 16

hypovolemia

hypoxia

hydrogen ion (acidosis)

hypo/hyperkalemia

hypothermia

tension pmneumo

tamponade, cardiac

toxins

thrombosis, pulmonary or coronary

Question 17

Pt is in cardiac arrest of VF/VT, what do you do?

Answer 17

start cpr, give O2, attach defib

shockable rhythm → shock → cpr 2 min →
shockable rhythm → shock →
CPR 2 min → epi q3-5 min→
shockable rhythm → shock → CPR 2 min → amiodarone and repeat

Question 18

Epi IV/IO dose for cardiac arrest

Answer 18

1mg q3-5 min

Question 19

Amiodarone IV/IO dose for cardiac arrest

Answer 19

first dose: 300 mg bolus

second dose: 150 mg

Question 20

Pt is in cardiac arrest of asystole/PEA, what do you do?

Answer 20

start cpr, give O2, attach defib

non-shockable rhythm → CPR 2 min, IV/IO access →
epi q3-5 min→
consider adv airway→

non-shockable → CPR 2 min and repeat

Question 21

Pt ROSC what do you do?

Answer 21

maintain O2 dat, consider adv airway

treat hypotension <90 via IV/IO bolus, or vasopressor infusion→

12 lead ekg (if STEMI then reperfuse) → if can follow commands → adv critical care

if NOT → initiate targeted temp mgmt

Question 22

IV bolus for post cardiac care hypotension

Answer 22

1-2 L NS or LR

Question 23

epi IV dose for ROSC

Answer 23

0.1-0.5 mcg/kg/min

70-35 mcg in 70 kg adult

Question 24

dopamine IV dose for ROSC

Answer 24

5-10 mcg/kg/min

Question 25

norepinephrine IV dose for ROSC

Answer 25

0.1-0.5 mcg/kg/min 70-35 mcg in 70 kg adult

Question 26

If stable brady arrhythmia <50 bpm w/ pulse what is tx

Answer 26

monitor and observe

Question 27

What makes pt unstable?

Answer 27

hypotension acutely altered mental status signs of shock ischemic chest discomfort acute heart failure

Question 28

If unstable brady arrhythmia <50 bpm w/ pulse what is tx

Answer 28

Atropine If uneffective → transcutaneous pacing or dopamine infusion or epi infusion Consider: expert consult or transvenous pacing

Question 29

atropine IV dose for brady arrhythmia

Answer 29

first dose: 0.5 mg bolus q3-5 min MAX 3 mg

Question 30

Dopamine IV dose for brady arrhythmia

Answer 30

2-20 mcg/kg/min titrate pt response taper slowly

Question 31

Epinephrine IV dose for brady arrhythmia

Answer 31

2-10 mcg/min | titrate pt response taper slowly

Question 32

Unstable tachy arrhythmia w/ pulse

Answer 32

synchronized cardioversion consider sedation if narrow complex consider adenosine

Question 33

Synchronized cardioversion doses

Answer 33

narrow and reg: 50-100 Wide and reg: 100 Narrow and irreg biphasic: 120-200 Narrow and irreg monophasic: 200 Wide and irreg: defibrillation

Question 34

Stable tachy arrhythmia w/ pulse and wide QRS

Answer 34

IV access, 12 lead EKG Consider adenosine if regular and monophasic consider antiarrhythmic consider expert consult

Question 35

Stable tachy arrhythmia w/ pulse and narrow QRS

Answer 35

IV access, 12 lead vagal maneuvers adenosine (IF REGULAR) beta blocker or calcium channel blocker consider expert consult

Question 36

Adenosine IV dose for tachy arrhythmia

Answer 36

first dose 6 mg rapid IV push follow w/ NS flush second dose 12 mg

Question 37

Amiodarone IV dose for tachy arrhythmia stable w/ wide QRS

Answer 37

first does 150 mg over 10 min repeat as needed if VT recurs follow by maintenance of 1 mg/min for first 6 hrs

Question 38

Narrow and reg rhythms

Answer 38

SVT and A flutter

Question 39

Narrow and irregular

Answer 39

A fib

Question 40

Wide and regular

Answer 40

SVT and V tach

Question 41

Wide and irregular

Answer 41

Wide a fib polymorphic v tach and monomorphic v tach

Question 42

Tachy Narrow and reg rhythms (SVT or A flutter) tx

Answer 42

vagal adenosine 6 mg then 12 mg

Question 43

Tachy Narrow and irregular (a fib) tx

Answer 43

vagal calcium channel blockers or beta blockers

Question 44

Tachy Wide and regular

Answer 44

if SVT adeonsine If Vtach amiodarone

Question 45

Tachy Wide and irregular

Answer 45

Amiodarone 150 mg over 10 min If polymorphic torsades add magnesium