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    you are the code team leader and arrive to find a patient with cpr in progress. on the next rhythm check, you see the rhythm shown here. team members tell you that the patient was well but reported chest discomfort and then collapsed. she has no pulse or respirations. bag-mask ventilations are producing visible chest rise, and io access has been established. which intervention would be your next action?

    James

    Guys, does anyone know the answer?

    get you are the code team leader and arrive to find a patient with cpr in progress. on the next rhythm check, you see the rhythm shown here. team members tell you that the patient was well but reported chest discomfort and then collapsed. she has no pulse or respirations. bag-mask ventilations are producing visible chest rise, and io access has been established. which intervention would be your next action? from EN Bilgi.

    ACLS

    You arrive on the scene to find CPR in progress. Nursing staff report the patient was recovering from a pulmonary embolism and suddenly collapsed. Two

    ACLS – Practical Application

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    You arrive on the scene to find CPR in progress. Nursing staff report the patient was recovering from a pulmonary embolism and suddenly collapsed. Two shocks have been delivered, and an IV has been initiated. What do you administer now?

    A. atropine 0.5 mg IV

    B. epinephrine 1 mg IV

    C. endotracheal intubation

    D. transcutaneous pacing

    B. epinephrine 1 mg IV

    A 45-year-old woman with a history of palpitations develops light-headedness and palpitations. She has received adenosine 6 mg IV for the rhythm shown here (SVT), without conversion of the rhythm. She is n9ow extremely apprehensive. Her blood pressure is 128/70 mm Hg. What is the next appropriate intervention?

    A. administer adenosine 12 mg IV

    B. perform unsynchronized cardioversion

    C. perform vagal maneuvers

    D. perform synchronized cardioversion

    A. administer adenosine 12 mg IV

    What is the recommended depth of chest compression for an adult victim?

    A. at least 1.5 inches

    B. at least 2 inches

    C. at least 2.5 inches

    D. at least 3 inches

    B. at least 2 inches

    A patient’s 12-lead ECG is transmitted by the paramedics and shows a STEMI. When the patient arrives in the emergency department, the rhythm shown here (ST elevation) is seen on the cardiac monitor. The patient has resolution of moderate (5/10) chest pain after 3 doses of sublingual nitroglycerin. Blood pressure is 104/70 mm Hg. Which intervention is most important in reducing this patient’s in-hospital and 30-day mortality rate?

    A. application of transcutaneous pacemaker

    B. atropine administration

    C. nitroglycerin administration

    D. reperfusion therapy

    D. reperfusion therapy

    A patient has been resuscitated from cardiac arrest. During post-ROSC treatment, the patient becomes unresponsive, with the rhythm shown here (polymorphic ventricular tachycardia). which action is indicated next?

    A. give an immediate unsynchronized high-energy shock

    (defibrillation dose)

    B. give lidocaine 1 to 1.5 mg/kg IV

    C. perform synchronized cardioversion

    D. repeat amiodarone 300 mg IV

    A. give an immediate unsynchronized high-energy shock (defibrillation dose)

    A patient becomes unresponsive. You are uncertain if a faint pulse is present. The rhythm shown here is seen on the cardiac monitor. An IV is in place. Which action do you take next?

    A. begin transcutaneous pacing

    B. start high-quality CPR

    C. administer atropine 1 mg

    D. administer epinephrine 1 mg IV

    B. start high-quality CPR

    Your patient is not responsive and is not breathing. You can palpate a carotid pulse. Which action do you take next?

    A. apply an AED

    B. obtain a 12-lead ECG

    C. start an IV

    D. start rescue breathing

    D. start rescue breathing

    After initiation of CPR and 1 shock for ventricular fibrillation, this rhythm (ventricular fibrillation) is present on the next rhythm check. A second shock is given, and chest compressions are resumed immediately. An IV is in place, and no drugs have been given. Bag-mask ventilations are producing visible chest rise. What is your next intervention?

    A. administer 3 sequential (stacked) shocks at 360 J

    (monophasic defibrillator)

    B. give amiodarone 300 mg IV / IO

    C. give epinephrine 1 mg IV / IO

    D. intubate and administer 100% oxygen

    C. give epinephrine 1 mg IV / IO

    What is the recommended compression rate for high-quality CPR?

    A. 50 to 60 compressions per minute

    B. 70 to 80 compressions per minute

    C. 90 to 100 compressions per minute

    D. 100 to 120 compressions per minute

    D. 100 to 120 compressions per minute

    A 35-year-old woman presents with a chief complaint of palpitations. She has no chest discomfort, shortness of breath, or light-headedness. Her blood pressure is 120/78 mm Hg. Which intervention is indicated first?

    A. adenosine 3 mg IV bolus

    B. adenosine 12 mg IV slow push (over 1 to 2 minutes)

    C. metoprolol 5 mg IV and repeat if necessary

    D. vagal maneuvers D. vagal maneuvers

    Which action should you take immediately after providing an AED shock?

    A. check the pulse rate

    B. prepare to deliver a second shock

    C. resume chest compressions

    D. start rescue breathing

    C. resume chest compressions

    Which action is likely to cause air to enter the victim’s stomach (gastric inflation) during bag-mask ventilation?

    A. giving breaths over 1 second

    B. ventilation too quickly

    C. providing a good seal between the face and the mask

    D. providing just enough volume for the chest to rise

    B. ventilation too quickly

    What is the maximum interval for pausing chest compressions?

    A. 10 seconds B. 15 seconds C. 20 seconds D. 25 seconds A. 10 seconds

    How often should you switch chest compressors to avoid fatigue?

    A. about every 2 minutes

    B. about every 3 minutes

    C. about every 4 minutes

    D. about every 5 minutes

    A. about every 2 minutes

    Your patient is a 56-year-old woman with a history of type 2 diabetes who reports feeling dizzy. She is pale ad diaphoretic. Her blood pressure is 80/60 mm Hg. The cardiac monitor documents the rhythm shown here (sinus bradycardia). she is receiving oxygen at 4 L/min by nasal cannula, and an IV has been established. What so you administer next?

    Source : subjecto.com

    Scenario Interpretation Flashcards by Anna Logan

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    1

    A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks at you for instruction. Your immediate next order is: A. Give atropine 1 mg IV B. Give epinephrine 1 mg IV C. Perform endotracheal intubation D. Give amiodarone 300 mg IV E. Resume high-quality chest compressions

    Resume high-quality chest compressions

    2

    A patient in the ED develops recurrent chest discomfort (8/10) suspicious for ischemia. His monitored rhythm becomes irregular as seen above. Oxygen is being administered by nasal cannual at 4 L/min and an intravenous line is patent. Blood pressure is 160/96 mm Hg. There are no allergies or contraindications to any medication. You would first order: A. Intravenous nitroglycerin initiated at 10 pg/min and titrated B. Lidocaine 1 mg/kg IV and infusion 2 mg/min C. Nitroglycerin 0.4 mg SL D. Morphine sulfate 2 to 4 mg IV E. Amiodarone 150 mg IV

    Nitroglycerin 0.4 mg SL

    3

    You are the code team leader and arrive finding the above rhythm with CPR in progress. Team members report that the patient was well but complained of chest pain and collapsed. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise, high-quality CPR is in progress, and an IV has been established. Your next order would be: A. Administer amiodarone 300 mg B. Perform endotracheal intubation C. Administer atropine 1 mg D. Administer epinephrine 1 mg E. Start dopamine at 10 to 20 pg/kg per minute

    Administer epinephrine 1 mg

    4

    A patient becomes unresponsive and you are uncertain if a faint pulse is present with the above rhythm. Your next action is: A. Start an IV and give atropine 1 mg B. Begin CPR with high-quality chest compressions C. Start and IV and epinephrine 1 mg IV D. Order transcutaneous pacing E. Consider causes for pulseless electrical activity

    Begin CPR with high-quality chest compressions

    5

    This patient has been resuscitated from cardiac arrest. During the resuscitation amiodarone 300 mg was administered. Now the patient develops severe chest discomfort, is diaphoretic, and has the above rhythm. Blood pressure is 80/60 mm Hg. What is the next indicated action? A. Give lidocaine 1 to 1.5 mg/kg IV B. Repeat amiodarone 300 mg IV C. Give immediate unsynchronized high-energy shock D. Repeat amiodarone 150 mg IV E. Perform immediate synchronized cardioversion

    Give immediate unsynchronized high-energy shock

    6

    You arrive on-scene and find a 56-year-old diabetic woman complaining of chest discomfort. She is pale and diaphoretic, complaining of lightheadedness. Her blood pressure is 80/60 mm Hg. The cardiac monitor documents the rhythm above. She is receiving oxygen at 4 L/min by nasal cannula, and an IV has been established. Transcutaneous has been requested but is not yet available. Your next order is: A. Start dopamine at 2 to 10 pg/kg per minute B. Give atropine 1 mg IV C. Give nitoroglycerin 0.4 mg SL D. Give morphine sulfate 4 mg IV E. Give atropine 0.5 mg IV

    Give atropine 0.5 mg IV

    7

    You are monitoring this patient after successful resuscitation. You note the above rhythm on the cardiac monitor and document a rhythm strip for the patient’s chart. She has no complaints and blood pressure is 110/70 mm Hg. Now you would: A. Give Atropine 1 mg IV B. Start dopamine 2 to 10 pg/kg per minute and titrate heart rate C. Administer sedation and begin immediate transcutaneous pacing at 80 per minute D. Prepare for transcutaneous pacing (place pacing pads, do not pace) E. Give Atropine 0.5 mg IV

    Prepare for transcutaneous pacing (place pacing pads, do not pace)

    8

    You are evaluating a patient with a 15-minute duration of chest pain during transportation to the emergency department. He is receiving oxygen, and 2 sublingual nitroglycerin tablets have relieved his chest discomfort. He has no complaints but appears anxious. Blood pressure is 130/70 mm Hg. You observe the above rhythm on the monitor and your next action is: A. Start epinephrine 2 to 10 pg/min and titrate B. Give atropine 0.5 mg IV C. Initiate transcutaneous pacting (TCP) D. Continue monitoring patient, prepare for TCP E. Administer nitroglycerin 0.4 mg SL

    Continue monitoring patient, prepare for TCP

    9

    Following initiation of CPR and one shock for VF, this rhythm is present on the next rhythm check. A second shock is given and chest compressions are immediately resumed. An IV is in place and no drugs no drugs have been given. Bag-mask ventilations are producing visible chest rise. What is your next order? A. Perform endotracheal intubation; administer 100% oxygen B. Prepare to give amiodarone 300 mg IV C. Administer 3 sequential (stacked) shocks at 200 Joules (biphasic defibrillator) D. Administer 3 sequential (stacked) shocks at 360 Joules (monophasic defibrillation) E. Prepare to give epinephrine 1 mg IV

    Prepare to give epinephrine 1 mg IV

    10

    You are monitoring a patient with chest discomfort who becomes suddenly unresponsive. You observe the following rhythm on the cardiac monitor. A monophasic defibrillator is present. What is your first action? �A. Begin CPR with chest compressions for 2 minutes or about 5 cycles of compressions and ventilations �B. Establish an IV and give epinephrine 1 mg IV C.� Give a single shock with 200 J �D. Intubate the patient and give epinephrine 2 to 4 mg via ET tube �E. Give a single shock with 360 J

    Source : www.brainscape.com

    Frequently Asked Questions about Chest

    Frequently Asked Questions about Chest-Compression-Only CPR

    Frequently Asked Questions about Chest-Compression-Only CPR

    How do you know if it’s primary cardiac arrest?

    The person is fine one moment and you suddenly see or hear them collapse.

    You then check for responsiveness by “shaking and shouting” (are you alright?) and rub the sternum with your knuckles. This helps to determine whether the person had some other reason for the event or if they are indeed in cardiac arrest. If you have no response you should assume that the person has experienced cardiac arrest.

    Tell someone to call 911 or make the call yourself. You need to get emergency responders on their way as soon as possible.

    Start chest compressions.

    Just do your best. If you do nothing, the person is likely to die. Studies have shown that there is almost no chance that you will hurt the person. While it is rare that a rib will be broken during CPR, doctors are able to repair broken ribs, but they cannot repair death.

    Is this the same as a heart attack?

    No. In the case of a heart attack, blood flow through one of the coronary arteries becomes blocked. Remember, time is heart muscle. To preserve heart muscle, it's important to understand early heart attack symptoms:

    Chest discomfort. The discomfort lasts for more than a few minutes or it may go away and come back. The discomfort may feel like pressure, squeezing, fullness, or pain.

    Discomfort in other areas of the upper body. This may include pain or discomfort in one or both arms, the back, neck, jaw, or upper stomach.

    Shortness of breath may occur with or before chest discomfort.

    Other symptoms may include breaking out in a cold sweat, nausea, dizziness or light-headedness, “feeling of impending doom,” weakness/fatigue.

    Women are different than men and not all symptoms of a heart attack are universal. Please check the following for more information:

    https://heart.arizona.edu/heart-health/heart-attacks/women-symptoms

    https://heart.arizona.edu/heart-health/heart-attacks/do-you-know-what-heart-attack-looks

    If this happens to you or you witness someone who exhibits these signs: call 911.

    Should I stop compressions if the victim gasps?

    No! Gasping is a sign of cardiac arrest and often occurs for a while soon after the arrest and will continue when effective compressions are being delivered. It is NOT an indication of recovery. Continue chest compressions until paramedics arrive; gasping is a sign you are doing a good job.

    What if I get tired during chest compressions?

    Chest compressions are hard work and after 100 chest compressions or if you become fatigued, it is recommended that you switch chest comrpessions with someone nearby. To transfer chest compressions effectively, there must be less than a 10 second delay when trading off.

    Can you damage someone’s heart if you perform CPR while it is beating?

    The physicians and scientists at the Sarver Heart Center, have found that the old saying "Never perform CPR on beating heart" is not valid. According to these professionals, the chances that a bystander could harm a person by pressing on their chest are slim to none, even if the heart is working normally. Therefore, they recommend following the "Better safe than sorry" approach and begin chest compressions. It is better to perform a few unnecessary chest compressions for someone with a beating heart, rather than withhold chest compressions and circulation from someone in cardiac arrest.

    Why don’t you check for a pulse?

    We do NOT recommend that lay public rescuers waste time trying to assess for a palpable pulse. During Dr. Kern’s tenure as AHA National ACLS Chairman, the AHA came to the same conclusion. Public lay rescuers cannot reliably detect the absence of a pulse in a timely fashion, hence in the 2000 and 2005 AHA CPR Guidelines (Circulation 2005; 112(24): IV-3), this requirement was removed.

    Studies have also shown that even if a person manages to locate the correct spot for detecting a pulse, there is a high chance that the pulse they may detect is their own, especially considering heightened stress levels in such situations. Rather than wasting time trying to detect a pulse that may or may not be the victim's own pulse, it is better to get perfusion to the brain by continuous chest compressions.

    The correct response to a witnessed cardiac arrest is to:

    Check for responsiveness (shake and shout).

    IF NO RESPONSE, call for help ("911") or ask someone else to call.

    Begin uninterrupted forceful continuous chest compressions immediately.

    Call for an AED if one is nearby and available.

    Don’t you need to check the airway first?

    If you see or hear someone suddenly collapse and they did not show any sign of choking, you don’t have to worry about checking the airway. Assume it’s a sudden cardiac arrest and follow the 3 Cs: Check for responsiveness (shake and shout), Call 911 and Compress at a rate of 100 per minute, about 2 inches deep. If by some chance an object is lodged in the throat, effective compressions likely will dislodge the object, similarly to the way abdominal thrusts (the Heimlich Maneuver) dislodges objects.

    Do I have to remove a person’s clothes to do Chest-Compression-Only CPR or only when using an AED?

    Source : heart.arizona.edu

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