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Questions and Answers
Which drug do you anticipate giving to the patient with a blood pressure of 180/100 mm Hg?
Which drug do you anticipate giving to the patient with a blood pressure of 180/100 mm Hg?
If no pathway for medication administration is in place, which method is preferred for a patient in cardiac arrest?
If no pathway for medication administration is in place, which method is preferred for a patient in cardiac arrest?
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 indication for the use of magnesium in cardiac arrest?
What is the indication for the use of magnesium in cardiac arrest?
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What is your next action for a monitored patient in the ICU with narrow-complex tachycardia?
What is your next action for a monitored patient in the ICU with narrow-complex tachycardia?
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What is the maximum interval for pausing chest compressions?
What is the maximum interval for pausing chest compressions?
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What is the recommended depth of chest compressions for an adult victim?
What is the recommended depth of chest compressions for an adult victim?
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What do you administer for a patient who collapsed after recovering from a pulmonary embolism?
What do you administer for a patient who collapsed after recovering from a pulmonary embolism?
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What is the recommended compression rate for high-quality CPR?
What is the recommended compression rate for high-quality CPR?
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How often should you switch chest compressors to avoid fatigue?
How often should you switch chest compressors to avoid fatigue?
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What do you administer next for a patient presenting with dizziness and a blood pressure of 80/60 mm Hg?
What do you administer next for a patient presenting with dizziness and a blood pressure of 80/60 mm Hg?
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How does complete chest recoil contribute to effective CPR?
How does complete chest recoil contribute to effective CPR?
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Which action is likely to cause air to enter the victim's stomach during bag-mask ventilation?
Which action is likely to cause air to enter the victim's stomach during bag-mask ventilation?
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What action minimizes the risk of air entering the victim's stomach during bag-mask ventilation?
What action minimizes the risk of air entering the victim's stomach during bag-mask ventilation?
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Which action should you take immediately after providing an AED shock?
Which action should you take immediately after providing an AED shock?
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How often should you provide ventilations for a patient in respiratory arrest?
How often should you provide ventilations for a patient in respiratory arrest?
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Which intervention would be your next action for a patient with no pulse or respiration?
Which intervention would be your next action for a patient with no pulse or respiration?
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What rhythm is identified by the term Sinus Bradycardia?
What rhythm is identified by the term Sinus Bradycardia?
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What rhythm is identified by the term Reentry Supraventricular Tachycardia?
What rhythm is identified by the term Reentry Supraventricular Tachycardia?
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What rhythm corresponds to the term Second-degree AV block (Mobitz II block)?
What rhythm corresponds to the term Second-degree AV block (Mobitz II block)?
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What rhythm is identified by the term Agonal Rhythm/Asystole?
What rhythm is identified by the term Agonal Rhythm/Asystole?
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What rhythm should be identified as Third-Degree AV Block?
What rhythm should be identified as Third-Degree AV Block?
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Identify the rhythm associated with Monomorphic Ventricular Tachycardia.
Identify the rhythm associated with Monomorphic Ventricular Tachycardia.
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What rhythm is referred by the term Sinus Tachycardia?
What rhythm is referred by the term Sinus Tachycardia?
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What rhythm corresponds to Atrial Fibrillation?
What rhythm corresponds to Atrial Fibrillation?
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What is identified by Course Ventricular Fibrillation?
What is identified by Course Ventricular Fibrillation?
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Which treatment is appropriate for a patient with a regular wide-complex QRS at a rate of 180/min?
Which treatment is appropriate for a patient with a regular wide-complex QRS at a rate of 180/min?
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What is the appropriate action for a patient with ongoing chest discomfort unresponsive to nitroglycerin?
What is the appropriate action for a patient with ongoing chest discomfort unresponsive to nitroglycerin?
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What drug should be administered after two shocks in pulseless ventricular tachycardia?
What drug should be administered after two shocks in pulseless ventricular tachycardia?
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What describes the recommended second dose of Amiodarone for refractory ventricular fibrillation?
What describes the recommended second dose of Amiodarone for refractory ventricular fibrillation?
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What medication should be administered for a patient with stable tachycardia after ineffective vagal maneuvers?
What medication should be administered for a patient with stable tachycardia after ineffective vagal maneuvers?
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What action is recommended for a patient with rapid irregular wide-complex tachycardia?
What action is recommended for a patient with rapid irregular wide-complex tachycardia?
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What is the indicated therapy for a patient with sinus bradycardia, confusion, and low blood pressure?
What is the indicated therapy for a patient with sinus bradycardia, confusion, and low blood pressure?
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What is the first medication to administer in cardiac arrest after ventricular fibrillation is refractory to shock?
What is the first medication to administer in cardiac arrest after ventricular fibrillation is refractory to shock?
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What is the immediate action following administration of CPR and rhythm check finds asystole?
What is the immediate action following administration of CPR and rhythm check finds asystole?
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What is the next action for a patient with STEMI, ongoing chest discomfort, and aspirin history of gastritis?
What is the next action for a patient with STEMI, ongoing chest discomfort, and aspirin history of gastritis?
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Bradycardia requires treatment when: ____________.
Bradycardia requires treatment when: ____________.
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What is the first drug/dose to administer for a patient in cardiac arrest with asystole?
What is the first drug/dose to administer for a patient in cardiac arrest with asystole?
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What is the initial dose of atropine for a patient with sinus bradycardia, diaphoresis, and low blood pressure?
What is the initial dose of atropine for a patient with sinus bradycardia, diaphoresis, and low blood pressure?
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What medication should be given next after a dose of epinephrine in refractory ventricular fibrillation?
What medication should be given next after a dose of epinephrine in refractory ventricular fibrillation?
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What is the guideline for antiplatelet and fibrinolytic therapy in the case of rtPA?
What is the guideline for antiplatelet and fibrinolytic therapy in the case of rtPA?
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What is the correct statement regarding the administration of vasopressin during cardiac arrest?
What is the correct statement regarding the administration of vasopressin during cardiac arrest?
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What combination of drugs can be administered by the endotracheal route?
What combination of drugs can be administered by the endotracheal route?
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What would you do next with a patient who becomes unconscious, has a weak carotid pulse, and has initiated cardiac monitoring?
What would you do next with a patient who becomes unconscious, has a weak carotid pulse, and has initiated cardiac monitoring?
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What is the next action when you find a patient with CPR ongoing, a pulse, and a rhythm indicative of ventricular fibrillation?
What is the next action when you find a patient with CPR ongoing, a pulse, and a rhythm indicative of ventricular fibrillation?
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What is indicated next for a patient with chest discomfort lasting 15 minutes in transportation with anxiety?
What is indicated next for a patient with chest discomfort lasting 15 minutes in transportation with anxiety?
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What is the appropriate initial action after observing a patient become unresponsive with a rhythm signifying potential arrest?
What is the appropriate initial action after observing a patient become unresponsive with a rhythm signifying potential arrest?
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What should you order for a resuscitated patient from cardiac arrest with low blood pressure and increasing rhythm abnormalities?
What should you order for a resuscitated patient from cardiac arrest with low blood pressure and increasing rhythm abnormalities?
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What medication should you order for a patient with a baseline QT interval that is high normal to slightly prolonged?
What medication should you order for a patient with a baseline QT interval that is high normal to slightly prolonged?
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What action should be taken for a patient with dizziness and low blood pressure when a specific rhythm is noted?
What action should be taken for a patient with dizziness and low blood pressure when a specific rhythm is noted?
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What should be performed for a patient not breathing with carotid pulse present?
What should be performed for a patient not breathing with carotid pulse present?
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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?
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In which situation does bradycardia require treatment?
In which situation does bradycardia require treatment?
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Study Notes
Cardiac Rhythms and Treatments
- Sinus Bradycardia: Characterized by a slow heart rate (typically less than 60 bpm), may require intervention if symptomatic.
- Reentry Supraventricular Tachycardia (SVT): Rapid heart rate originating above the ventricles, can cause palpitations and may require medications or cardioversion.
- Second-Degree AV Block (Mobitz II): Intermittent failure of conduction from atria to ventricles, higher risk of complete heart block.
- Agonal Rhythm/Asystole: Indicates no effective heart contractions; often associated with cardiac arrest requiring immediate CPR.
- Third-Degree AV Block: Complete heart block; atria and ventricles beat independently, potentially requiring pacemaker intervention.
- Monomorphic Ventricular Tachycardia: Stable form of tachycardia with a consistent QRS complex; can degenerate to ventricular fibrillation.
- Sinus Tachycardia: Elevated heart rate (over 100 bpm) with normal sinus rhythm; often transient in response to exercise or anxiety.
- Atrial Fibrillation: Irregular and often rapid heart rate that can increase risk of stroke; may require anticoagulation.
- Course Ventricular Fibrillation: Life-threatening arrhythmia requiring immediate defibrillation.
- Polymorphic Ventricular Tachycardia (Torsades de Pointes): Variable QRS complexes; associated with QT interval prolongation.
- Second-Degree AV Block (Mobitz I/Wenckebach): Progressive lengthening of PR interval until a beat is dropped; typically less serious.
- Normal Sinus Rhythm: Indicates heart functioning properly with a rate of 60-100 bpm.
- Pulseless Electrical Activity (PEA): Electrical activity observed but no pulse detected; requires immediate CPR and advanced life support.
- Fine Ventricular Fibrillation: A variation of VF characterized by low amplitude waves; still requires defibrillation.
- Atrial Flutter: Rapid atrial rate with a characteristic "sawtooth" pattern; can often be controlled with medication or cardioversion.
Emergency Interventions
- Electrical Cardioversion: Recommended for hemodynamically unstable patients with wide-complex tachycardia (e.g., regular wide QRS at 180/min).
- Fluid Bolus: Administer normal saline (250-500 ml) for hypotension, especially post-nitroglycerin.
- Amiodarone Administration: Administer 300 mg for pulseless ventricular tachycardia after defibrillation attempts.
- Second Dose of Amiodarone: 150 mg IV push for refractory ventricular fibrillation after initial doses.
- Adenosine: 6 mg IV for stable narrow-complex tachycardia after vagal maneuvers fail; may repeat with 12 mg if ineffective.
- Synchronized Cardioversion: Indicated for unstable tachycardia, adjusting shock timing to coincide with QRS complex.
- Epinephrine: First drug in cardiac arrest scenarios, typically administered at 1 mg IV/IO for asystole or VF.
- Atropine: 0.5 mg IV indicated for symptomatic bradycardia, relaxing vagal tone to increase heart rate.
- Hypovolemia Management: Administering 1-2 L normal saline post-cardio-resuscitation to maintain blood pressure.
- Antiplatelet Therapy: Aspirin (162-325 mg) to chew for STEMI patients, monitoring for contraindications like recent intracerebral hemorrhage.
Special Considerations
- Contradictions for Nitrates: Avoid in patients who have taken phosphodiesterase inhibitors within the prior 24 hours.
- Magnesium Usage: Indicated in cases like pulseless ventricular tachycardia associated with torsades de pointes.
- Vagal Maneuvers: First-line intervention in stable SVT to attempt a rhythm change without medication.
- Clinical Assessment: Regular evaluation and consideration of patient presentation, including blood pressure and symptoms, guide treatment decisions.
Resuscitation Protocols
- Start High-Quality CPR: Immediate action for unresponsive patients at risk for cardiac arrest; ensure continuous chest compressions.
- Defibrillation Protocol: Use high-energy shocks for unstable rhythms observed post-cardiac arrest; essential for patient survival.
- Monitoring and Consultation: Constant assessment of patient responses during rhythm checks and stabilization efforts; seeking expert consultation as necessary.
This structured approach emphasizes rhythm identification, appropriate intervention protocols, and continuous evaluation during acute cardiac events.### Supraventricular Tachycardia Management
- Confirmed diagnosis of supraventricular tachycardia (SVT) with no ischemia or infarction.
- If the heart rate does not respond to vagal maneuvers, the next step is to administer adenosine 6 mg IV push.
CPR Guidelines
- Maximum interval for pausing chest compressions is 10 seconds.
- Recommended depth for chest compressions in adults is at least 2 inches.
Emergency Response During Collapse
- Administer epinephrine 1 mg IV after two shocks in a patient who collapsed while recovering from a pulmonary embolism.
- High-quality CPR should be performed at a rate of 100-120 compressions per minute.
- Switch chest compressors to avoid fatigue approximately every 2 minutes.
Pharmacological Interventions
- In hypotensive patients with dizziness and signs of shock, administer atropine 1 mg IV.
Importance of Chest Recoil
- Complete chest recoil during CPR is crucial as it allows maximum blood return to the heart.
Bag-Mask Ventilation Techniques
- Ventilating too quickly can lead to gastric inflation.
- Minimize air entering the stomach by ventilating until you see the chest rise.
Post-AED Shock Protocol
- Immediately after providing an AED shock, resume chest compressions without delay.
Ventilation Rhythm During Respiratory Arrest
- Provide bag-mask ventilations every 6 seconds for a patient in respiratory arrest.
Code Team Protocol
- As the code team leader, after confirming no pulse or respiration, the next action is to administer epinephrine 1 mg.
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Description
Test your knowledge of ACLS rhythms with these flashcards. Each card challenges you to identify crucial cardiac rhythms, ensuring you are prepared for emergencies. Perfect for both beginners and seasoned healthcare professionals.
