A patient in respiratory failure becomes apneic but continues to have a strong pulse. The heart rate is dropping rapidly and now shows a sinus bradycardia at a rate of 30/min. What intervention has the highest priority?
  • 2 to 10 mcg/kg per minute
  • Simple airway manuevers and assisted ventilations.
  • Continue CPR while charging the defibrillator.
  • second dose of epinephrine 1 mg
A patient presents to the emergency department with new onset of dizziness and fatigue. On examination, the patient's heart rate is 35/min, the blood pressure is 70/50 mm Hg, the respiratory rate is 22 breaths/min, and the oxygen saturation is 95%. What is the appropriate first medication?
  • Atropine 0.5mg
  • 2 to 10 mcg/kg per minute
  • 150 mg IV push
  • Peripheral IV
What should be done to minimize interruptions in chest compressions during CPR?
  • Continue CPR while the defibrillator is charging.
  • Continuous waveform capnography
  • Hands-free pads allow for a more rapid defibrillation.
  • Suction during withdrawal but for no longer than 10 seconds.
if persistent tachycardia does not present with symptoms what do you need to consider
  • 10 to 12 breaths per minute
  • wide QRS?greater than 0.12 seconds
  • Continuous waveform capnography
  • Identifying and treating early clinical deterioration.
What is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse rate of 80/min?
  • At least 100/min
  • Determine whether pulses are present.
  • 1 breath every 5-6 seconds
  • 10 seconds or less
Which is a contraindication to nitroglycerin administration in the management of acute coronary syndromes?
  • Identifying and treating early clinical deterioration.
  • Begin CPR, starting with chest compressions.
  • Not recommended for routine use
  • Right ventricular infarction and dysfunction
The five links in the adult Chain of Survival
  • 1- Immediate activation of EMS2- Early CPR 3- Rapid defibrillation (not in peds)4- Effective advanced life support5- Integrated post-cardiac arrest care
  • Produces a small amount of blood flow to the heart
  • to the side of the left nipple, with the top edge of the pad a few inches below the armpit
  • Unstable supraventricular tachycardia
A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the following lead II ECG rhythm: What is the appropriate next intervention?
  • Synchronized cardioversion
  • Resume compressions
  • administer a second shock.
You are evaluating a 58-year-old man with chest pain. The blood pressure is 92/50 mm Hg, the heart rate is 92/min, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry reading is 97%. What assessment step is most important now?
  • Divert the patient to a hospital 15 minutes away with CT capabilities.
  • Synchronized cardioversion
  • second dose of epinephrine 1 mg
  • Obtaining a 12 lead ECG.
Which of the following is an acceptable method of selecting an appropriately sized oropharyngeal airway (OPA)?
  • PETCO2 ≥10 mm Hg
  • Measure from the corner of the mouth to the angle of the mandible.
  • Transport the patient to a facility capable of performing PCI.
  • 10 to 12 breaths per minute
what is considered a tachycardia requiring treatment
  • over 150 per minute
  • PETCO2 ≥10 mm Hg
  • given rapidly during compressions
  • Continue CPR while charging the defibrillator.
A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm: What is the appropriate next intervention?
  • Administer 1mg of epinephrine
  • Defibrillation
  • IV or IO access
After verifying unresponsiveness and abnormal breathing, you activate the emergency response team. What is your next action?
  • amiodarone 300 mg
  • Check for a pulse.
  • Safety threat to providers
  • Peripheral IV
what constitutes symptomatic bradycardia
  • maintain O2 sat at 94%treat hypotension (fluids vasopressor)12 lead EKGif in coma consider hypothermiaif not in coma and ekg shows STEMI or AMI consider re-perfusion
  • Obtain a 12-lead ECG and administer aspirin if not contraindicated.
  • if persistent tachycardia is causing:hypotensionaltered mental statussigns of shockchest painacute heart failure
  • hypotensionaltered mental statussigns of shockchest painacute heart failure
What is the recommended target temperature range for achieving therapeutic hypothermia after cardiac arrest?
  • 300 mg
  • 8-10 breaths per minute
  • 32°C to 34°C
  • Continuous waveform capnography
You have completed your first 2-minute period of CPR. You see an organized, nonshockable rhythm on the ECG monitor. What is the next action?
  • Lidocaine, epinephrine, vasopressin
  • Divert the patient to a hospital 15 minutes away with CT capabilities.
  • Have a team member attempt to palpate a carotid pulse.
  • Simple airway manuevers and assisted ventilations.
when do you consider cardioversion
  • Begin CPR, starting with chest compressions.
  • Optimizing ventilation and oxygenation.
  • if persistent tachycardia is causing:hypotensionaltered mental statussigns of shockchest painacute heart failure
  • give 0.5mg atropine every 3-5 mins to max of 3mgif that doesn't work try one of the following:transcutaneous pacing2-10mcg/kg / minute dopamine infusion2-10mcg per minute epinephrine infusion
What is the potential danger of using ties that pass circumferentially around the patient's neck when securing an advanced airway?
  • Identifying and treating early clinical deterioration.
  • Begin CPR, starting with chest compressions.
  • Administration of IV or IO fluid bolus
  • Obstruction of venous return from the brain
What is the appropriate interval for an interruption in chest compressions?
  • 10 seconds or less
  • At least 100/min
  • 10 to 12 breaths per minute
  • Continuous waveform capnography
What is the primary purpose of a medical emergency team (MET) or rapid response team (RRT)?
  • 8-10 breaths per minute
  • Identifying and treating early clinical deterioration.
  • 0.1 to 0.5 mcg/kg per minute IV infusion
  • Peripheral IV
A 49-year-old man has retrosternal chest pain radiating into the left arm. The patient is diaphoretic, with associated shortness of breath. The blood pressure is 130/88 mm Hg, the heart rate is 110/min, the respiratory rate is 22 breaths/min, and the pulse oximetry value is 95%. The patient's 12-lead ECG shows ST-segment elevation in the anterior leads. First responders administered 160 mg of aspirin, and there is a patent peripheral IV. The pain is described as an 8 on a scale of 1 to 10 and is unrelieved after 3 doses of nitroglycerin. What is the next action?
  • Administer the shock immediately and continue as directed by the AED.
  • Administration of IV or IO fluid bolus
  • Obtain a 12 lead ECG.
  • Administer 2 to 4 mg of morphine by slow IV bolus.
What is the recommended second dose of adenosine for patients in refractory but stable narrow-complex tachycardia?
  • 12mg
  • 12 to 24 hours
  • 10 to 12 breaths per minute
  • 120to200J
What is the recommended duration of therapeutic hypothermia after reaching the target temperature?
  • Peripheral IV
  • 32°C to 34°C
  • 8-10 breaths per minute
  • 12 to 24 hours
What is the recommended energy dose for biphasic synchronized cardioversion of atrial fibrillation?
  • 10 to 12 breaths per minute
  • 120to200J
  • 35-40mm Hg
  • Peripheral IV
What is the minimum depth of chest compressions for an adult in cardiac arrest?
  • 32°C to 34°C
  • 2 inches
  • Determine whether pulses are present.
  • 90mm Hg
What is the recommended assisted ventilation rate for patients in respiratory arrest with a perfusing rhythm?
  • 10 to 12 breaths per minute
  • Continuous waveform capnography
  • 0.1 to 0.5 mcg/kg per minute IV infusion
  • Not recommended for routine use
A 62-year-old man in the emergency department says that his heart is beating fast. He says he has no chest pain or shortness of breath. The blood pressure is 142/98 mm Hg, the pulse is 200/min, the respiratory rate is 14 breaths/min, and pulse oximetry is 95% on room air. What intervention should you perform next?
  • 150 mg IV push
  • second dose of epinephrine 1 mg
  • Obtain a 12 lead ECG.
  • Obtaining a 12 lead ECG.
A 68-year-old woman experienced a sudden onset of right arm weakness. EMS personnel measure a blood pressure of 140/90 mm Hg, a heart rate of 78/min, a nonlabored respiratory rate of 14 breaths/min, and a pulse oximetry reading of 97%. The lead II ECG displays sinus rhythm. What is the most appropriate action for the EMS team to perform next?
  • Performing a head tilt-chin lift maneuver
  • second dose of epinephrine 1 mg
  • Chest compressions may not be effective.
  • Cincinnati Prehospital Stroke Scale assessment
What action is recommended to help minimize interruptions in chest compressions during CPR?
  • Continuous waveform capnography
  • Switch providers about every 2 minutes or every 5 compression cycles.
  • Prolonged interruptions in chest compressions.
  • Continue CPR while charging the defibrillator.
What survival advantages does CPR provide to a patient in ventricular fibrillation?
  • Measure from the corner of the mouth to the angle of the mandible.
  • Produces a small amount of blood flow to the heart
  • Be sure oxygen is not blowing over the patient's chest during the shock.
  • Providing quality compressions immediately before a defibrillation attempt.
Choose an appropriate indication to stop or withhold resuscitative efforts.
  • 1 breath every 5-6 seconds
  • Prolonged interruptions in chest compressions.
  • 10 seconds or less
  • Evidence of rigor mortis.
A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. The patient's blood pressure is 128/58 mm Hg, the PETCO2 is 38 mm Hg, and the pulse oximetry reading is 98%. There is vascular access at the left internal jugular vein, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirms a supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal maneuvers. What is the next recommended intervention?
  • second dose of epinephrine 1 mg
  • 2 to 10 mcg/kg per minute
  • Adenosine 6mg IV push
  • Intraosseous (IO)
What is the recommended dose of epinephrine for the treatment of hypotension in a post- cardiac arrest patient who achieves ROSC?
  • 0.1 to 0.5 mcg/kg per minute IV infusion
  • Obstruction of venous return from the brain
  • Begin CPR, starting with chest compressions.
  • 160 to 325 mg
What is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation?
  • 300 mg
  • 10 seconds or less
  • Antecubital vein
  • Begin CPR, starting with chest compressions.
What is the appropriate procedure for endotracheal tube suctioning after the appropriate catheter is selected?
  • Measure from the corner of the mouth to the angle of the mandible.
  • Begin CPR, starting with chest compressions.
  • Continuous waveform capnography
  • Suction during withdrawal but for no longer than 10 seconds.
What is the immediate danger of excessive ventilation during the post-cardiac arrest period for patients who achieve ROSC?
  • Decreased cerebral blood flow
  • 10 seconds or less
  • At least 100 per minute
  • Not recommended for routine use
What is a common but sometimes fatal mistake in cardiac arrest management?
  • Provide continuous chest compressions without pauses and 10 ventilations per minute.
  • Prolonged interruptions in chest compressions.
  • Optimizing ventilation and oxygenation.
  • Suction during withdrawal but for no longer than 10 seconds.
A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient's lead II ECG is displayed below.
  • Vagal maneuvers
  • administer a second shock.
  • stable supraventricular tachycardia
You find an unresponsive pt. who is not breathing. After activating the emergency response system, you determine there is no pulse. What is your next action?
  • Cincinnati Prehospital Stroke Scale assessment
  • Divert the patient to a hospital 15 minutes away with CT capabilities.
  • Start chest compressions of at least 100 per min.
  • Have a team member attempt to palpate a carotid pulse.
How long should it take to perform a pulse check during the BLS Survey?
  • 5 to 10 seconds
  • PETCO2 ≥10 mm Hg
  • 10 seconds or less
  • Agonal gasps
A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine has been given. Which is the next drug to anticipate to administer?
  • amiodarone 300 mg
  • 2 to 10 mcg/kg per minute
  • Intraosseous (IO)
  • Amioderone 300mg
What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube?
  • Not recommended for routine use
  • Potential oxygen toxicity
  • Continuous waveform capnography
  • Identifying and treating early clinical deterioration.
What is the most appropriate intervention for a rapidly deteriorating patient who has this lead II ECG?
  • Synchronized cardioversion
  • Resume compressions
  • Administer 1mg of epinephrine
  • Give a single shock
An 80-year-old woman presents to the emergency department with dizziness. She now states she is asymptomatic after walking around. Her blood pressure is 102/72 mm Hg. She is alert and oriented. Her lead II ECG is below. After you start an IV, what is the next action?
  • Cincinnati Prehospital Stroke Scale assessment
  • Seeking expert consultation
  • Closed-loop communication
  • Conduct a problem-focused history and physical examination.
Bradycardia require treatment when?
  • given rapidly during compressions
  • chest pain or shortness of breath is present
  • Identifying and treating early clinical deterioration.
  • Unstable supraventricular tachycardia
IV/IO drug administration during CPR should be
  • ROSC return of spontaneous circulation
  • Allowing complete chest recoil
  • monitor and observe
  • given rapidly during compressions
Which action is included in the BLS survey?
  • Unstable supraventricular tachycardia
  • Providing quality compressions immediately before a defibrillation attempt.
  • Epinephrine
  • Early defibrillation
What is the recommended compression rate for performing CPR?
  • PETCO2 ≥10 mm Hg
  • At least 100 per minute
  • over 150 per minute
  • Peripheral IV
What is the recommended initial intervention for managing hypotension in the immediate period after return of spontaneous circulation (ROSC)?
  • At least 100 per minute
  • Administration of IV or IO fluid bolus
  • Potential oxygen toxicity
  • Provide continuous chest compressions without pauses and 10 ventilations per minute.
EMS is transporting a patient with a positive prehospital stroke assessment. Upon arrival in the emergency department, the initial blood pressure is 138/78 mm Hg, the pulse rate is 80/min, the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95% on room air. The lead II ECG displays sinus rhythm. The blood glucose level is within normal limits. What intervention should you perform next?
  • Head CT scan
  • Peripheral IV
  • 150 mg IV push
  • Adenosine 6mg IV push
If the heart muscle resets and initiates an organized rhythm this is called
  • Not recommended for routine use
  • Continuous waveform capnography
  • ROSC return of spontaneous circulation
  • Prolonged interruptions in chest compressions.
Which of the following is a sign of effective CPR?
  • Peripheral IV
  • PETCO2 ≥10 mm Hg
  • Early defibrillation
  • over 150 per minute
What is an advantage of using hands-free defibrillation pads instead of defibrillation paddles?
  • 0.1 to 0.5 mcg/kg per minute IV infusion
  • Improving patient outcomes by identifying and treating early clinical deterioration
  • Begin CPR, starting with chest compressions.
  • Hands-free pads allow for a more rapid defibrillation.
What is the purpose of a medical emergency team (MET) or rapid response team (RRT)?
  • Determine whether pulses are present.
  • Suction during withdrawal but for no longer than 10 seconds.
  • Improving patient outcomes by identifying and treating early clinical deterioration
  • Providing quality compressions immediately before a defibrillation attempt.
What is the danger of routinely administering high concentrations of oxygen during the post- cardiac arrest period for patients who achieve ROSC?
  • 8-10 breaths per minute
  • Obstruction of venous return from the brain
  • Potential oxygen toxicity
  • Administration of IV or IO fluid bolus
An AED does not promptly analyze a rythm. What is your next step?
  • Begin chest compressions.
  • Begin CPR, starting with chest compressions.
  • Administer the shock immediately and continue as directed by the AED.
  • Sinus rythm without a pulse
Three minutes after witnessing a cardiac arrest, one member of your team inserts an endotracheal tube while another performs continuous chest compressions. During subsequent ventilation, you notice the presence of a waveform on the capnography screen and a PETCO2 level of 8 mm Hg. What is the significance of this finding?
  • Chest compressions may not be effective.
  • Not recommended for routine use
  • Continuous waveform capnography
  • Responding to verbal commands
Which drug and dose are recommended for the management of a patient in refractory ventricular fibrillation?
  • amiodarone 300 mg
  • Amioderone 300mg
  • 5 to 10 seconds
  • Peripheral IV
Which of the following is the recommended first choice for establishing intravenous access during the attempted resuscitation of a patient in cardiac arrest?
  • Antecubital vein
  • 1 to 2 Liters
  • 8-10 breaths per minute
  • Potential oxygen toxicity
Your patient has been intubated. IV/IVO access is not available. Which combination of drugs can be administered by endotracheal route?
  • amiodarone 300 mg
  • Lidocaine, epinephrine, vasopressin
  • Decreased cerebral blood flow
  • Administration of IV or IO fluid bolus
A patient is in refractory ventricular fibrillation. High CPR is in progress and shocks have been given. One dose of epinephrine was given after the second shock. An anti arrhythmic drug was given immediately after the the third shock. What drug should the team leader request to be prepared for administration next?
  • second dose of epinephrine 1 mg
  • 150 mg IV push
  • Simple airway manuevers and assisted ventilations.
  • amiodarone 300 mg
A 53-year-old man has shortness of breath, chest discomfort, and weakness. The patient's blood pressure is 102/59 mm Hg, the heart rate is 230/min, the respiratory rate is 16 breaths/min, and the pulse oximetry reading is 96%. The lead II ECG is displayed below. A patent peripheral IV is in place. What is the next action?
  • Vagal maneuvers
  • Vagal manuever.
  • administer a second shock.
  • Defibrillation
Which action improves the quality of chest compressions delivered during a resuscitation attempt?
  • Measure from the corner of the mouth to the angle of the mandible.
  • Switch providers about every 2 minutes or every 5 compression cycles.
  • Continue CPR while charging the defibrillator.
  • Be sure oxygen is not blowing over the patient's chest during the shock.
How often should the team leader switch chest compressors during a resuscitation attempt?
  • 8-10 breaths per minute
  • . Every 2 minutes
  • Obtain a 12 lead ECG.
  • Start chest compressions of at least 100 per min.
You are monitoring a patient with chest discomfort who suddenly becomes unresponsive. You observe the following rhythm on the cardiac monitor. A defibrillator is present. What is your first action?
  • administer a second shock.
  • Administer 1mg of epinephrine
  • Give a single shock
  • Synchronized cardioversion
What is the BEST strategy for performing high-quality CPR on a patient with an advanced airway in place?
  • Improving patient outcomes by identifying and treating early clinical deterioration
  • Not recommended for routine use
  • Identifying and treating early clinical deterioration.
  • Provide continuous chest compressions without pauses and 10 ventilations per minute.
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