1. You find an unresponsive pt who is not breathing. After activating the ERS, you determine there is not pulse. What is your next action?
a. Start chest compressions of at least 100/min
2. You are evaluating a 58M w/ chest pain. BP 92/50, HR 92, non-labored RR 14, O2 97. What assessment step is ...
1. You find an unresponsive pt who is not breathing. After activating the ERS,
you determine there is not pulse. What is your next action?
a. Start chest compressions of at least 100/min
2. You are evaluating a 58M w/ chest pain. BP 92/50, HR 92, non-labored RR 14, O2
97. What assessment step is most important now?
a. Obtaining 12 lead ECG
3. What is the most preferred method of access for epinephrine administration during
cardiac arrest in most patients?
a. Peripheral IV
4. An AED does not promptly analyze a rhythm. What is your next step?
a. Begin chest compressions
5. You have completed 2 min of CPR. The ECG monitor displays the lead below (PEA)
and the pt has no pulse. Your partner resumes chest compressions and an IV is in place.
What management step is your next priority?
a. Administer 1mg epinephrine
6. During a pause in CPR, you see a narrow complex rhythm on the monitor. The pt has
no pulse. What is the next action?
a. Resume compressions
7. What is a common but sometimes fatal mistake in cardiac arrest managmemt?
a. Prolonged interruption in chest compression
8. Which action is a component of high-quality chest compressions?
a. Allowing complete chest recoil
9. Which action inc. the change of successful converstion of VF?
a. Providing quality compressions immediately before defibrillation attempt
10. Which situation best described PEA?
a. Sinus rhythm without a pulse
11. What is the best strategy for performing high quality CPR on a pt with an
advanced airway in place?
a. Provide continuous chest compressions w/o pauses and 10 ventilations per min
12. 3 min after witnessing a cardiac arrest, one member of your team inserts an ET tube
while another performs continuous chest compressions. During subsequent ventilation,
you notice the presence of a waveform on the capnography screen and a PETCO2 of 8
mmHg. What is the significance of this finding?
a. Chest compressions may not be effective
13. The use of quantitative waveform capnography in intubated pt’s does what?
a. Allows for monitoring CPR wuality
14. For the past 25 min, EMS crews have attempted resuscitation of a pt who originally
presented w/ VF. After the 1st shock, the ECG screen displayed asystole which has
persisted despite 2 doses of epi, a fluid bolus, and high quality CPR. What is your
next treatment?
a. Consider terminating resuscitation efforts after consulting medical control
15. Which is a safe and effective practice within the defibrillation sequence?
a. Be sure O2 is NOT blowing over the pt’s chest during shock
16. During your assessment, your pt suddenly loses consciousness. After calling for help
and determining that the pt is not breathing, you are unsure whether the pt has a pulse.
What is your next action?
, a. Begin chest compressions
17. What is an advantage of using hands-free defibrillation pads intead of paddles?
a. Hands free allows for more rapid defibrillation
18. What action is recommended to help minimize interruptions in chest compressions during
CPR?
a. Continue CPR while charging the defibrillator
19. Which action is included in the BLS survey?
a. Early defibrillation
20. Which drug and dose are recommended for the management of a pt in refractory VF?
a. Amiodarone 300 mg
21. What is the appropriate interval for an interruption in chest compressions?
a. 10 sec or less
22. Which of the following is a sign of effective CPR?
a. PETCO2 >/= 10 mmHg
23. What is the primary purpose of a medical emergency team or rapid response team?
a. Identifying and treating early clinical deterioration
24. Which action improved the quality of chest compressions delivered during resuscitative
attempts?
a. Switch providers about every 2 min or every 5 compression cycles
25. What is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse
of 80 bpm?
a. 1 breath q5-6 sec
26. A pt presents to the ED with a new onset of dizziness and fatigue. On examination, the
pt’s HR 35, BP 70/50, RR22, O295. What ist he appropriate 1st medication?
a. Atropine 0.5 mg
27. A pt presents to the ER with dizziness and SOC with a sinus brady of 40. The
initial atropine does was ineffective and your monitor does not provide TCP. What
is the appropriate dose of dopamine for this pt?
a. 2-10 mcg/kg/min
28. A pt has a new onset of dizziness. HR 180, BP 110/70, RR 18, O2 98. This is a regular
narrow complex tachycardia rhythm. What is the next intervention?
a. Vagal maneuver
29. A monitored pt in the ICU developed a suddent onset of narrow complex tachycardia at
a rate of 220/min. BP 128/58, PETCO2 38 mmHg, O2 98. There is an EJ established for
vascular access. The pt denies taking any vasodilators. A 12 lead shows no ischemia or
infarction. Vagal maneuvers are ineffective. What is the next intervention/
a. Adenosine 12 mg IV
30. You are receiving a radio report from an EMS team enroute with a pt who may be
having a stroke. The hospital CT scanner is broken. What should you do?
a. Divert the pt to a hospital 15 min away with CT capabilities
31. Choose an appropriate indication to stop or withhold resuscitative efforts?
a. Evidence of rigor mortis
32. A 49F arrives in the ER with persistent epigastric pain. She has been taking antacids PO
for the past 6hr b/c she has heartburn. BP 118/72 HR 92, RR 14 non-labored, O2 96.
What is the most appropriate next action?
a. Obtain a 12 lead ECG
,33. A pt in respiratory failure becomes apneaic but continues to have a strong pulse. The HR
is dropping rapidly and now shows sinus brady rate at HR 30. What intervention has the
highest priority?
a. Simple airway maneuvers and assisted ventilations
34. What is the appropriate procedure for ET suctioning after the catheter is selected?
a. Suction during withdrawl, but no longer than 10 sec
35. While treating a stable pt for dizziness, BP 68/30, cool and clammy, you see a
brady rhythm on the ECG. How do you treat this?
a. Atropine 0.5 mg
36. A 68F pt experienced a sudden onset of right arm weakness. BP 140/90, HR 78, RR
non- labored 14, O2 97. Lead II in ECG shows sinus rhythm. What is your next action?
a. Cincinnati Stroke Scale
37. You are transporting a pt with a positive stroke assessment. BP 138/?, HR 80, RR 12,
O2 95 RA. BG level normal and ECG shows sinus rhythm. What is next?
a. Head CT scan
38. What is the proper ventilation rate for a pt in cardiac arrest who has an advanced airway
in place?
a. 8-10 breaths/min
39. A 62M pt in the ER says his heart is beating fast. No chest pain or SOB. BP 142/98,
HR 200, RR 14, O2 95 RA. What should be the next evaluation?
a. Obtain a 12-lead ECG
40. You are evaluating a 48M with crushing sub-sternal pain. He is cool, pale, diaphoretic,
and slow to respond to your questions. BP 58/32, HR 190, RR 18, unable to obtain O2
d/t no radial pulse. The ECG shows a wide complex tachycardia rhythm. What
intervention should be next?
a. Synchronized cardioversion
41. What is the initial priority for an unconscious pt with any tachycardia on the monitor?
a. Determine if a pulse is present
42. Which rhythm requires synchronized cardioversion?
a. Unstable SVT
43. What is the recommended dose for adenosine for pt’s in refractory, but stable
narrow complex tachycardia?
a. 12 mg
44. What is the usual post-cardiac arrest target ran for PETCO2 who achieves ROSC?
a. 34-40 mmHg
45. Which condition is CI to therapeutic hypothermia during the post-cardiac arrest period
for pt’s who achieve ROSC?
a. Responding to verbal commands
46. What is the potential danger to using ties that pass circumferentially around the pt’s
neck when securing an advanced airway?
a. Obstruction of venous return from the brain
47. What is the most reliable method of confirming and monitoring correct placement of an
ET tube?
a. Continuous waveform capnography
48. What is the recommended IV fluid (NS or LR) bolus dose for a pt who achieves
ROSC but is hypotensive during the post-cardiac arrest period?
, a. 1-2 L
49. What is the minimum SBP one should attempt to achieve with fluid, inotropic, or
vasopressure administration in a hypotensive post-cardiac arrest who achieves ROSC?
a. 90 mmHg
50. What is the 1st treatment priority for a pt who achieves ROSC?
a. Optimizing ventilation and oxygenation
51. Ventilations during cardiac arrest?
a. 2:30 with bag mask
b. 1:6-8 sec w/ advanced airway (8-10 breaths/min)
52. Ventilations during respiratory arrest?
a. 1:5-6 sec
b. 10-12 breaths/min
53. Tidal volume delivered w/ bag mask
a. 600 mL
54. What does PETCO2 <10 mmHg indicated in intubated pt
a. Their CO2 is inadequate to achieve ROSC
55. Which drugs can be given with ET route?
a. Only epi, vasopressin and lidocaine; will need to double the dose
56. Why do we give a saline bolus after infusion of a drug via peripheral IV?
a. To hasten the time for peak response
57. Steps for treating hypotension
a. IV bolus 1-2L NS
b. Pressor; 0.1-0.5 mcg/kg/min for epinephrine or norepinephrine or 5-10
mcg/kg/min of dopamine
c. Treatable causes? H’s and T’s
d. Obtain ECG
58. Do you shock PEA?
a. DO NOT SHOCK ASYSTOLE OR PEA TREAT W VASOPRESSOR ONLY
59. Reperfusion goal: door to balloon (PCI)
a. 90 min
60. Reperfusion goal: door to needle (fibrinolysis)
a. 30 min
61. If pt is hemodynamically unstable, do you give NTG?
a. NO, must have SBP >90
62. When it NTG CI?
a. Inferior wall MI or right ventricular infarction
b. Hypotension, bradycardia or tachycardia
c. Recent phosphodiesterase use (Viagra)
63. 4 D’s of in-hospital therapy
a. Door to Data to Decision to Drug (or PCI)
64. Treatment of bradyarrythmia
a. 0.5 mg atropine q3-5 min; max 3 doses
i. if ineffective: transcutaneous pacing or dopamine 2-10 mcg/kg/min or
epi 2-10 mcg/min
65. When do you use synchronized shocks>
a. Unstable SVT
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