Questions and Answers
What rhythm is indicated by 3˚ AV block?
p and qrs completely separate
What rhythm is indicated by pulseless electrical activity (PEA)?
Identify the rhythm.
What rhythm is indicated by coarse ventricular fibrillation?
Identify the rhythm.
What rhythm is indicated by reentry supraventricular tachycardia (SVT)?
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What rhythm is indicated by sinus bradycardia?
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What rhythm is indicated by polymorphic ventricular tachycardia?
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What rhythm is indicated by 2˚ AV block (Mobitz type II)?
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What rhythm is indicated by atrial flutter?
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What is indicated for 2˚ AV block (Mobitz type I Wenckebach)?
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What is indicated for normal sinus rhythm?
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What rhythm is indicated by sinus tachycardia?
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What rhythm is indicated by atrial fibrillation?
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What rhythm is indicated by fine ventricular fibrillation?
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What is indicated for agonal rhythm/asystole?
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Which of the following statements about the use of magnesium in cardiac arrest is most accurate?
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What should be done for a patient with ST-segment elevation MI and ongoing chest discomfort with a history of gastritis?
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For a patient with sinus bradycardia and a heart rate of 36/min who is confused, which of the following is now indicated?
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What are the guidelines for antiplatelet and fibrinolytic therapy following rtPA administration?
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What would be a contraindication to the administration of nitrates?
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What is the first drug and dose to be administered in a cardiac arrest patient after refractory ventricular fibrillation?
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What drug should be administered IV for a stable tachycardia patient with a persistent narrow-complex QRS at a rate of 180/min?
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What is the initial dose of atropine for a patient with sinus bradycardia and heart rate of 42/min?
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Study Notes
Cardiac Rhythms and Interventions
- 3˚ AV Block: P waves and QRS complexes are completely separate; indicates severe conduction disturbance.
- Pulseless Electrical Activity (PEA): Heart rhythm is present, but there is no pulse; usually requires immediate assessment of reversible causes.
- Coarse Ventricular Fibrillation: Irregular, chaotic electrical activity in the heart; requires defibrillation and advanced life support.
- Reentry Supraventricular Tachycardia (SVT): Characterized by a rapid heart rate due to a reentrant circuit; may need maneuvers or adenosine for termination.
- Sinus Bradycardia: Heart rate less than 60 bpm; may require atropine if symptomatic.
- Polymorphic Ventricular Tachycardia: Rapid heart rate with varying shapes; associated with QT prolongation; may require magnesium.
- 2˚ AV Block (Mobitz Type II): Random dropping of QRS complexes without prior PR prolongation; poses risk for complete heart block.
- Sinus Tachycardia: Heart rate over 100 bpm originating from the sinus node; often a response to stress or other physiological stimuli.
- Atrial Flutter: Regular, sawtooth pattern of flutter waves; may require anticoagulation and rate control.
- Atrial Fibrillation: Irregularly irregular rhythm; often requires anticoagulation and rate control.
- Fine Ventricular Fibrillation: Subtle chaotic activity requiring immediate defibrillation.
- Agonal Rhythm/Asystole: Absence of heart rhythm; indicates a critical state needing immediate CPR and epinephrine.
Medications and Dosages
- Magnesium: Indicated for VF/pulseless VT associated with torsades de pointes; contraindicated in normal QT VT.
- Aspirin: Administer 160 to 325 mg chewable for suspected ST-elevation MI.
- Epinephrine: Start at 2 to 10 mcg/min for severe bradycardia unresponsive to atropine or when cardiac arrest occurs; 1 mg IV for cardiac arrest.
- Amiodarone: Administer 300 mg IV push for pulseless VT; second dose is 150 mg.
- Atropine: First-line treatment for symptomatic bradycardia; initial doses typically start at 0.5 mg IV.
- Adenosine: Dose of 6 mg IV for stable SVT; can repeat with a higher dose if necessary.
- Nitroglycerin: Administer 0.4 mg sublingually for chest pain; contraindicated with phosphodiesterase inhibitors within 12 hours.
- Normal Saline: Administer 250 to 500 mL fluid bolus for hypotension unresponsive to analgesics.
Algorithm Steps for Cardiac Arrest
- Begin high-quality CPR immediately for unresponsive patients with suspected cardiac arrest.
- Administer epinephrine or vasopressin for asystole or PEA.
- Consider defibrillation for VF/pulseless VT after each shock.
- Assess and manage reversible causes of cardiac arrest continuously.
- Use synchronized cardioversion for unstable tachyarrhythmias with a pulse.
Clinical Decision Making
- Monitor patients with a history of MI and irregular rhythms for stability before intervention.
- Seek expert consultation for complex arrhythmias or persistent symptoms.
- Repeat antiarrhythmic medications only after reassessing the patient's rhythm and stability.
General Guidelines
- Avoid aspirin within 24 hours of rtPA administration for stroke patients.
- Recognize symptoms prompting treatment for bradycardia, including chest pain or shortness of breath.
- Always establish IV or IO access promptly in emergency settings for medication administration.### Resuscitation and Cardiac Interventions
- A third shock has been delivered to the patient; initial next step is essential, choices include performing intubation, resuming compressions, checking pulse, administering atropine, or giving amiodarone.
- Evaluate patient with 15-minute chest discomfort, now stable and anxious, with blood pressure 130/70 mm Hg and normal rhythm after two nitroglycerin doses; seek expert consultation.
- Post-resuscitation with CPR and a shock, a stable patient with blood pressure 120/80 mm Hg shows rhythm; expert consultation is advised rather than medication.
- In an unresponsive patient with chest discomfort and available defibrillator, immediate action should be delivering a single shock.
- Following successful resuscitation from cardiac arrest, patient shows a concerning rhythm on monitor; in cases of hypotension (80/60 mm Hg), administer 1 to 2 L of normal saline.
Medications and Dosages
- Atropine doses vary widely; initial dose is critical and can influence treatment direction.
- Amiodarone is a key agent used for various cardiac dysrhythmias, with initial doses often recommended at 300 mg IV.
- Epinephrine is administered as part of advanced cardiac life support protocols, generally starting at 1 mg IV.
- Lidocaine can be utilized in certain arrhythmias, often given at doses of 1 to 1.5 mg IV with follow-up infusion as needed.
- Normal saline administration may play a crucial role in volume resuscitation following cardiac arrest.
Monitoring and Expert Consult
- Continuous evaluation of rhythm stability post-resuscitation is vital; any abnormality indicates the necessity for further action or consultation.
- Anxiety in patients is commonly observed but should not overshadow physiological assessment and intervention plans.
- Expert consultations are recommended when patient conditions appear stable but require specialized assessment or intervention for abnormal rhythms.
Important Considerations
- Prioritize high-quality chest compressions during resuscitation regardless of advanced interventions being employed.
- Always assess for responsiveness and vital signs before proceeding with further interventions in a critical care scenario.
- Understanding the rhythm on the monitor and correlating it with intervention protocols is essential for effective resuscitation efforts.
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Description
Test your knowledge of key ACLS rhythms with this quiz. Identify various heart conditions such as 3˚ AV block, pulseless electrical activity, and more. Perfect for those preparing for ACLS certification or reviewing important concepts.
