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Questions and Answers
What is identified by the ECG strip: Atrial Flutter?
What is identified by the ECG strip: Atrial Flutter?
Atrial Flutter
What is identified by the ECG strip: Second-degree atrioventricular block (Mobitz I Wenckebach)?
What is identified by the ECG strip: Second-degree atrioventricular block (Mobitz I Wenckebach)?
Second-degree atrioventricular block (Mobitz I Wenckebach)
What is identified by the ECG strip: Ventricular fibrillation?
What is identified by the ECG strip: Ventricular fibrillation?
Ventricular fibrillation
What is identified by the ECG strip: Monomorphic ventricular tachycardia?
What is identified by the ECG strip: Monomorphic ventricular tachycardia?
What is identified by the ECG strip: Second-degree atrioventricular block (Mobitz II block)?
What is identified by the ECG strip: Second-degree atrioventricular block (Mobitz II block)?
What is identified by the ECG strip: Atrial fibrillation?
What is identified by the ECG strip: Atrial fibrillation?
What is identified by the ECG strip: Pulseless electrical activity?
What is identified by the ECG strip: Pulseless electrical activity?
What is identified by the ECG strip: Sinus Bradycardia?
What is identified by the ECG strip: Sinus Bradycardia?
What is identified by the ECG strip: Supraventricular Tachycardia?
What is identified by the ECG strip: Supraventricular Tachycardia?
What is identified by the ECG strip: Normal Sinus Rhythm?
What is identified by the ECG strip: Normal Sinus Rhythm?
What is identified by the ECG strip: Polymorphic Ventricular Tachycardia?
What is identified by the ECG strip: Polymorphic Ventricular Tachycardia?
What is identified by the ECG strip: Agonal Rhythm/Asystole?
What is identified by the ECG strip: Agonal Rhythm/Asystole?
What is your next action for a monitored patient in the ICU with a sudden onset of narrow-complex tachycardia at a rate of 220/min?
What is your next action for a monitored patient in the ICU with a sudden onset of narrow-complex tachycardia at a rate of 220/min?
Which drug do you anticipate giving to a patient with a history of large intracerebral hemorrhage and a blood pressure of 180/100 mm Hg?
Which drug do you anticipate giving to a patient with a history of large intracerebral hemorrhage and a blood pressure of 180/100 mm Hg?
What drug should be given next for a patient in pulseless ventricular tachycardia after two shocks and one dose of epinephrine?
What drug should be given next for a patient in pulseless ventricular tachycardia after two shocks and one dose of epinephrine?
What is a contraindication to nitrate administration for a patient with ongoing chest discomfort?
What is a contraindication to nitrate administration for a patient with ongoing chest discomfort?
What is the first drug/dose to administer when a patient is in cardiac arrest with asystole?
What is the first drug/dose to administer when a patient is in cardiac arrest with asystole?
What is the appropriate medication order after one dose of epinephrine for a patient in refractory ventricular fibrillation?
What is the appropriate medication order after one dose of epinephrine for a patient in refractory ventricular fibrillation?
Which intervention is most appropriate for the treatment of a patient in asystole?
Which intervention is most appropriate for the treatment of a patient in asystole?
What is the initial dose of atropine for a patient with sinus bradycardia and a heart rate of 42/min?
What is the initial dose of atropine for a patient with sinus bradycardia and a heart rate of 42/min?
What is the next action for a patient with STEMI and ongoing chest discomfort who has a history of gastritis?
What is the next action for a patient with STEMI and ongoing chest discomfort who has a history of gastritis?
What action do you take next for a patient with palpitations, chest discomfort, and tachycardia consistent with the rhythm shown?
What action do you take next for a patient with palpitations, chest discomfort, and tachycardia consistent with the rhythm shown?
What is the recommended second dose of amiodarone for a patient who is in refractory ventricular fibrillation?
What is the recommended second dose of amiodarone for a patient who is in refractory ventricular fibrillation?
What therapy is indicated for a patient with sinus bradycardia, a heart rate of 36/min, and failed pacing?
What therapy is indicated for a patient with sinus bradycardia, a heart rate of 36/min, and failed pacing?
In a cardiac arrest scenario, which method is preferred for medication administration if no pathway is in place?
In a cardiac arrest scenario, which method is preferred for medication administration if no pathway is in place?
Which drug should be administered first after a patient is in cardiac arrest with refractory ventricular fibrillation?
Which drug should be administered first after a patient is in cardiac arrest with refractory ventricular fibrillation?
What action is recommended next for a patient with a rapid irregular wide-complex tachycardia and a history of angina?
What action is recommended next for a patient with a rapid irregular wide-complex tachycardia and a history of angina?
In which situation does bradycardia require treatment?
In which situation does bradycardia require treatment?
What is the indication for the use of magnesium in cardiac arrest?
What is the indication for the use of magnesium in cardiac arrest?
After finding asystole, which action do you take next?
After finding asystole, which action do you take next?
What is the first action for a patient with unresponsive status and faint pulse presence?
What is the first action for a patient with unresponsive status and faint pulse presence?
What is the maximum interval for pausing chest compressions?
What is the maximum interval for pausing chest compressions?
What should you do immediately after providing an AED shock?
What should you do immediately after providing an AED shock?
What is the recommended compression rate for high-quality CPR?
What is the recommended compression rate for high-quality CPR?
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Study Notes
ECG Identifications
- Atrial Flutter: Characterized by rapid, organized atrial contractions.
- Second-degree AV Block (Mobitz I - Wenckebach): Progressive lengthening of the PR interval leading to dropped beats.
- Ventricular Fibrillation: Chaotic electrical activity with no effective heartbeat.
- Monomorphic Ventricular Tachycardia: Consistent, regular QRS complexes indicating a rapid heart rate.
- Second-degree AV Block (Mobitz II): Intermittent dropped beats without progressive lengthening of the PR interval.
- Atrial Fibrillation: Irregularly irregular rhythm with no discernible P waves.
- Pulseless Electrical Activity (PEA): Organized electrical activity without a palpable pulse.
- Sinus Bradycardia: Heart rate less than 60 bpm with normal sinus rhythm.
- Supraventricular Tachycardia (SVT): Rapid heart rate originating above the ventricles.
Emergency Treatment Protocols
- Administer Adenosine (6 mg IV Push): Indicated for stable SVT unresponsive to vagal maneuvers.
- Aspirin for Stroke Assessment: Administer to patients with a history of intracerebral hemorrhage under appropriate conditions.
- Amiodarone (300 mg IV): Used during pulseless VT, especially after unsuccessful defibrillation.
- Use of Nitrates: Contraindicated in patients who have taken phosphodiesterase inhibitors within 24 hours.
- Epinephrine (1 mg IV/IO): First drug to give in cases of asystole and during cardiac arrest scenarios.
- Synchronized Cardioversion: Recommended for unstable tachycardia cases presenting with low blood pressure or symptoms.
Advanced Cardiac Life Support (ACLS) Details
- Magnesium Use: Indicated in cases of pulseless VT associated with torsades de pointes.
- High-quality CPR: Maintains a compression rate of 100 to 120 compressions per minute; pause for no longer than 10 seconds.
- Rescue Breathing: Administered every 6 seconds in patients with respiratory arrest.
- Compression Depth: At least 2 inches is recommended for adult victims during CPR.
- Cardiac Arrest Response: Resume compressions immediately following any AED shock.
Patient Management and Drug Administration
- Initial Dose of Atropine: 1 mg IV recommended for symptomatic bradycardia.
- Epinephrine Dosing in Resuscitation: Continue to administer 1 mg doses for patients in refractory cardiac fibrillation.
- Aspirin Administration: Should be provided to patients in STEMI with appropriate history, while avoiding in certain GI conditions.
Special Situations and Considerations
- Wide-complex Tachycardia: Seek expert consultation for asymptomatic patients with adequate blood pressure.
- Rescue Breathing After Carotid Pulse: Initiate if patient is unresponsive but has a detectable pulse.
- Ventilation Techniques: Ensure proper seal and minimize air entering the stomach during bag-mask ventilation by delivering enough volume to achieve chest rise.
Follow-up Actions
- Compressions Switch: Team members should alternate every 2 minutes to prevent fatigue.
- Recovery Procedures: In case of ventricular fibrillation, continue CPR and prepare for medication administration or further shocks.
- Anticipate Patient Needs: Always establish IV or IO access for rapid medication delivery in emergencies.
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