What concentration of Lidocaine would result from 1 gram being mixed with
250 ml saline?
a. 2.5 mg/ml
b. 4.0 mg/ml
c. 25. mg/ml
d. 40.0 mg/ml ---------CORRECT ANSWER-----------------ANSWER b. 4.0
mg/ml. Here you simply plug in the numbers and change grams into mg.
(1000 mg = 1 gm). Using: Conc. = Amt./Vol.
= 1 gm/250 ml = 1000 mg/250 ml
Concentration by unit cancellation:
1 gm 1000 mg ==1000 250 ml 1 gm == 250
= 4 mg/ml.
== 4 mg ml
See: Craig, Clinical Calculations Made Easy, Chapter on "Solving
Problems Using Dimensional Analysis"
Which vitamin is necessary for the formation of clotting factors?
a. Vitamin A
b. Vitamin C
c. Vitamin D
d. Vitamin K ---------CORRECT ANSWER-----------------ANSWER d. Vitamin
K. Guyton says, " Vitamin K is required . . . for normal formation of
prothrombin as well as four other clotting factors . . . Therefore, the lack of
vitamin K can decrease the prothrombin level so low that a bleeding
tendency results." An important long term anticoagulant coumadin
functions by inhibiting vitamin K. Administration of vitamin K reverses this
anticoagulant effect.
See: Guyton, chapter on "Hemostasis and Blood Coagulation" Keywords:
vitamin K, coumadin
,At the beginning of a diagnostic coronary arteriogram procedure a patient
was given 5000 units of IV heparin. Before you pull the sheath the
physician wants you to neutralize 4000 units of heparin. What medication
and dosage should be given to reverse 4000 units of heparin?
a. 2 cc of Protamine (100 micrograms/cc) IV push
b. 4 cc of Protamine (10 mg/cc) slowly over 5 minutes
c. 2 cc of Amicar (100 micrograms/cc) IV push
d. 4 cc of Amicar (10 mg/cc) slowly over 5 minutes ---------CORRECT
ANSWER-----------------ANSWER b. 4 cc of Protamine 10 mg/cc slowly over
5 minutes. Grossman recommends 10 mg (1.0 cc) of Protamine to
counteract every 1000 units of heparin. It's easy to remember because they
react 1:1 by volume, or 1000μ:10 mg. by dosage. If the concentrations are
standard (1000 units heparin = 1 cc and 10 mg. Protamine = 1 cc), then
each 1 cc of protamine counteracts each 1 cc of heparin.
Grossman says: "If systemic heparinization is used, its effects must be
reversed at the termination of the left heart catheterization and associated
angiography. This is usually accomplished by the administration of
protamine (1 mL = 10 mg of protamine for every 1,000 IU of heparin) . . . .
When giving protamine, administer it slowly (over 5 minutes), since more
rapid administration can provoke severe back pain of unknown etiology."
See: Grossman, Chapter on "Percutaneous Approach."
To mix an epinephrine drip at a concentration of 4 micrograms/ml put ____
mg. of epinephrine into 250 ml. (Use Concentration = amount/volume) a. 1
b. 2
c. 4 d. 8 ---------CORRECT ANSWER-----------------ANSWER a. 1 mg. X/250
ml = 4 micro gm/ml
X =(250 ml) (4 micro gm/ml) =1000 microgram
=1 mg
In the unit drug dosing system 1 mg of epi comes in the "unit" vial (E.g.: 1
mg/10 ml
syringe). When the entire vial is added to 250 ml a standard concentration
results. See: ACLS Manual
Keywords: epinephrine concentration
,You are doing CPR on a patient with an implanted ICD near the ICD
generator. When the patient's ICD defibrillates, you would feel:
a. Nothing
b. Tingling
c. A distinct shock
d. A shock which could send you into cardiac arrest ---------CORRECT
ANSWER-----------------ANSWER b. Tingling. Watson says: "During
emergency situations, however, care of the patient should be based on
BCLS and ACLS protocols. Standard treatment should not be delayed.
Persons touching the patient during device discharge may feel a slight
tingling sensation, but will not be harmed. The use of rubber gloves by
persons touching the patient during device discharge will minimize the
effect. "
See: Watson, Chapter on "Implantable Cardioverter Defibrillator"
With ICDs the lowest energy that achieves successful defibrillation is
termed:
a. Minimum Defibrillation Level (MDL)
b. Pre-Defibrillation Force (PDF)
c. Cardioversion Threshold (C-T)
d. Defibrillation Threshold (DFT) ---------CORRECT ANSWER-----------------
ANSWER d. Defibrillation threshold testing (DFT) is performed to assure
adequate detection of ventricular fibrillation and efficacy of device therapy.
The defibrillation threshold can be defined as the lowest energy at which
successful defibrillation occurs at least two times.
See: Watson, Chapter on "Implantable Cardioverter Defibrillator"
Most current ICD sensing electrodes are:
a. BP and motion sensors in the ICD can
b. Unipolar transvenous RV electrodes
c. Bipolar transvenous RV electrodes
d. Epicardial active-fixation ventricular electrodes ---------CORRECT
ANSWER-----------------ANSWER c. Bipolar transvenous RV electrodes.
, These electrodes are currently implanted transvenous, much like
pacemaker leads. Bipolar leads are better, because they are less sensitive
to muscle tremor and EMI noise, which can be mistaken by the ICD for VF.
Some systems use the coils around the electrode both for sensing and
shocking. These are termed "integrated" electrodes, because they serve a
dual function - both sensing and shocking.
See: Watson, Chapter on "Implantable Cardioverter Defibrillator"
Current ICDs use high efficiency cardioversion and defibrillation. The most
efficient shock waveforms are:
a. Monophasic
b. Biphasic
c. Sinusoidal
d. Square waves ---------CORRECT ANSWER-----------------ANSWER b.
Biphasic waveforms convert patients with less energy then the traditional
monophasic waveform. In the biphasic defibrillation current goes for
cathode to anode then reverses and returns in a push-pull manner. Watson
says: "Much investigation has gone into developing the optimal shock
waveform. As a result, the shape of the defibrillation waveform has
changed and become more efficient. The biphasic or bidirectional
waveform has proven to be more efficient
than the unidirectional or monophasic waveform, thus providing lower
defibrillation thresholds."
See: Watson, Chapter on "Implantable Cardioverter Defibrillator
When cardioverting or defibrillating most modern ICDs utilize _______ as
the positive electrode.
a. RA coil
b. RV distal tip electrode and RV coil
c. RV coil and RA coil electrodes
d. RA coil and Left pectoral generator can ---------CORRECT ANSWER------
-----------ANSWER d. RA coil and Left pectoral generator can. The RV coil
is usually the negative electrode, similar to pacemakers. This sends current
through the entire LV up to the generator metal can and RA. This is termed
a hot can because it acts as one of the electrodes, similar to a unipolar
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