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201.   AHA concludes that it is reasonable to administer oxygen the first 6 hours after ACS event.   Afterwards there is no clinical benefit except in certain circumstances.   What are those circumstances? Patients with continuing/recurrent chest pain or hemodynamic instability Patients with over pulmonary congestion Patients with oxygen saturations below 90% 202.   What are the most common symptoms of myocardial ischemia? Retrosternal chest pain Chest discomfort spreading to the shoulders, neck, one or both arms, or jaw Chest discomfort that spreads to the back or between the shoulders Chest discomfort with lightheadedness, fainting, sweating, or nausea Uncomfortable pressure, fullness, squeezing or pain in the center of the chest lasting several minutes Unexplained shortness of breath which may occur with or without chest discomfort 203.   What are the AHA characteristics of high-risk unstable angina/NSTEMI? Ischemic ST-segment depression of 0.5mm or g

196.   In what circumstances would you consider changing your initial dose of Adenosine? The initial dose of Adenosine should be reduced to 3mg in patients taking dipyrimadole or carbamazepine.   Larger initial doses may be required for patients with higher blood levels of caffeine, theophylline, or theobromide.   197.   What are two initial interventions in the treatment of narrow complex tachycardias? Vagal maneuvers Adenosine 198.   After delivering a synchronized shock to a patient you notice that the patient’s heart rhythm changes to VF.   What would you do? If the patient develops VF then deliver an unsynchronized high energy shock at 200 J and follow the pulseless VF/VT algorithm. 199.   What are the cardinal rules for evaluating wide complex tachycardia? Rule No 1:   Wide complex tachycardia is VT until proven otherwise Rule No 2:   Always remember rule No 1 200.   What is the initial and subsequent dose of Lidocaine used in the treatment of sympto

191. What is the difference in the way monomorphic VT and polymorphic VT is treated? Monomorphic VT is treated with synchronized cardioversion with an initial shock of 100J.    Polymorphic VT is treated with an unsynchronized shock at 200J.   For both, if there is no response to the first shock, then increase the dose in a step wise fashion.   192.   What is the difference between synchronized cardioversion and defibrillation? With defibrillation an unsynchronized shock is delivered randomly anywhere within the cardiac cycle.   These shocks use a higher energy level beginning at 200J The shock is delivered as soon as the operator pushes the shock button on the defibrillator Synchronized cardioversion uses a sensor to mark the R wave and delivers the shock on the QRS complex.   Synchronized cardioversion uses lower energy levels than defibrillation. During synchronized cardioversion there is a slight delay in delivering the shock after the operator pushes the shock

186.   Match the following medications with the correct dosage Diltiazem                                           1-4mg/min Bicarbonate                                       20mg/min Metoprolol                                        2-10mcg/min Nitroglycerine (SL)                            0.5-1mcg/min Isoproterenol                                     0.25mg/kg Procainamide                                    1mEq/kg Epinephrine infusion                          5mg Norepinephrine                                0.4mg Lidocaine infusion                             2-10mcg/min 187.   What are five rhythms associated with unstable tachycardia? Atrial fibrillation Atrial flutter SVT Monomorphic VT Polymorphic VT Wide Complex tachycardia of uncertain type 188. What are some signs and symptoms of unstable tachycardia? Shortness of breath Chest pain Altered mental status Weakness Hypotension Ischemic ECG changes Pulmonary edema Poor per

181.   What is the recommended dose of Aspirin for a patient admitted with STEMI? The recommended dose is 160 to 325 mg 182.   Name four absolute contraindications for receiving reperfusion therapy Any prior intracranial hemorrhage Known structural cerebral vascular lesion (eg, AVM) Known malignant intracranial neoplasm (primary or metastatic) Ischemic stroke within 3 months EXCEPT acute ischemic stroke within 3 hours Suspected aortic dissection Active bleeding or bleeding diathesis (excluding menses) Significant closed head trauma or facial trauma within 3 months 183.   What is the dose of sublingual nitroglycerine for a patient who complains of chest pain? Nitroglycerine 0.3 to 0.4 mg, may repeat every 5 minutes 184.   What are two indications for giving morphine sulfate to a patient who is experiencing chest pain associated with a STEMI? Chest pain and anxiety associated with AMI or cardiac ischemia Acute cardiogenic pulmonary edema (if blood pr

176. What is the risk of attempting cardioversion on a patient with atrial fibrillation of longer than 48 hours duration? They are at increased risk for cardioembolic events. 177.   What medications are the drugs of choice for acute rate control in most individuals with atrial fibrillation and rapid ventricular response? IV β-blockers and calcium channel blockers such as Diltiazem 178.   What is the treatment strategy for treating a patient with a long QT interval baseline that is found to be in VT that is torsades de pointes? Stop medications known to prolong the QT interval. Correct electrolyte imbalance Treat any other precipitating causes such as drug overdose or poisoning 179.   What is the immediate treatment for a patient who demonstrates rate-related cardiovascular compromise with signs and symptoms such as acute altered mental status, ischemic chest discomfort, acute heart failure, and hypotension? When a patient presents with symptoms of cardiovasc

171.  What classes of medication should be avoided for pre-excitation syndromes? AV nodal blocking drugs including adenosine, calcium blockers, β-blockers, and digoxin 172. What antiarrhythmic medication may be used in patients with pre-excited atrial arrhythmias? Amiodarone 173. For patients who are stable wide complex tachycardia, what medications should be considered?  IV antiarrhythmic drugs including procainamide, Amiodarone, or sotalol 174. What is the dose of Amiodarone in treating wide complex tachycardia or symptomatic monomorphic VT? Amiodarone is given 150 mg IV over 10 minutes and dosing should be repeated as needed to a maximum dose of 2.2 g IV per 24 hours 175.  As a second line antiarrhythmic, Lidocaine may be considered for treating monomorphic VT. What is the dosing regimen for Lidocaine? Lidocaine can be administered at a dose of 1 to 1.5 mg/kg IV bolus followed by a maintenance infusion of 1 to 4 mg/min. Reviewed 2/28/16

166.   Explain how vagal maneuvers and adenosine may aid in the correct identification of a tachyarrhythmia? The diagnostic value of vagal maneuvers and adenosine is to transiently slow ventricular rate so that the arrhythmia can accurately be identified 167. What should the health care provider do if the patient fails to respond to an initial dose of adenosine?   If the rhythm does not convert within 1 to 2 minutes, the health care provider should give 12mg of adenosine rapid IV push. 168. If a patient in symptomatic SVT fails to respond to adenosine, what are two calcium channel blockers may be considered? Diltiazem and Verapamil 169.   What is the dosing regimen for Verapamil when treating refractory SVT? Verapamil 2.5 mg to 5 mg IV bolus over 2 minutes. If there is no therapeutic response, repeated doses of 5 mg to 10 mg may be administered every 15 to 30 minutes to a total dose of 20 mg   170.   What is the dosing regimen for Diltiazem when treating r

161.   Name four rhythms that may be treated with synchronized cardioversion. Unstable SVT Unstable atrial fibrillation Unstable atrial flutter Unstable monomorphic VT 162. What is the appropriate joule setting when performing cardioversion on a patient with unstable VT, A fib, A flutter, or SVT? Monomorphic VT 100 J A fib 120-200 J A flutter 50-100 J SVT 50-100 J 163.   What are some characteristics of reentry tachycardia? A tachycardia that is caused by an abnormal rhythm circuit that allows a wave of depolarization to repeatedly travel in a circle in cardiac tissue. The QRS complex is narrow (<0.12 second) or wide (broad) if a preexisting bundle branch block is present. These arrhythmias have characteristic abrupt onset and termination. 164.   What are some characteristics of automatic tachycardias? These arrhythmias are not due to a circulating circuit but to an excited automatic focus These arrhythmias have a more gradual onset and term

156. What is the advantage of performing CPR prior to defibrillating a patient in VF/VT? A brief period of chest compressions can deliver oxygen and energy substrates to the myocardium, thus increasing the likelihood that a perfusing rhythm will return after shock delivery. 157. What is the meaning of the term end tidal CO2?  End-tidal CO2 is the concentration of carbon dioxide in exhaled air at the end of expiration. 158.  What should the health care provider do for a patient that remains in refractory VF/VT after giving an initial dose of Lidocaine? If pulseless VF/ VT persists, an additional doses of 0.5 to 0.75 mg/kg IV push may be administered at 5- to 10-minute intervals to a maximum dose of 3 mg/kg. 159.  What is the difference between unstable bradycardia and symptomatic bradycardia? Unstable bradycardia implies that the patient is acutely impaired and cardiac arrest imminent. Symptomatic bradycardia implies the patient the patient is more stable and the bradycardia is exper

151.   What is synchronized cardioversion?   It is a shock delivery that is timed (synchronized) with the QRS complex. This synchronization avoids shock delivery during the relative refractory portion of the cardiac cycle, when a shock could produce VF. 152.   When is it acceptable to use a precordial thump on a patient? The precordial thump may be considered for patients with witnessed, monitored, unstable ventricular tachycardia including pulseless VT if a defibrillator is not immediately ready for use. 153. When the health care provider uses bag-mask ventilation with an adult (1 to 2 L) bag, what should the provider approximately tidal volume be when delivering ventilations?   The rescuer should deliver approximately 600 mL of tidal volume sufficient to produce chest rise over 1 second. 154. What are some advantages of placing an endotracheal tube? Keeps the airway patent Permits suctioning of airway secretions Enables delivery of a high concentration of

146. What should a lone provider do to aid an adult drowning victim? The healthcare provider may give about 5 cycles (approximately 2 minutes) of CPR then activate the emergency response system. 147.   As the health care provider checks the victim of cardiac arrest for responsiveness what else should be assessed? The health care provider should also check for absence of breathing or abnormal breathing (agonal or gasping respirations). 148.   Describe the correct hand placement when performing chest compressions. The health care provider should place the heel of one hand on the center of the victim's chest and the heel of the other hand on top of the first so that the hands are overlapped. 149.   If an adult victim has a strong pulse but is not breathing, how often should the health care provider provide rescue breaths?   The healthcare provider should give rescue breaths at a rate of about 1 breath every 5 to 6 seconds, or about 10 to 12 breaths per minute.

141.   List the criteria for high quality CPR. Providing chest compressions of adequate rate (at least 100/minute) Providing a compression depth of at least 2 inches (5 cm) Allowing complete chest recoil after each compression Minimizing interruptions in compressions Avoiding excessive ventilation 142.   If multiple rescuers are available how often should they rotate the task of compressions? Every 2 minutes. 143.   Once chest compressions have been started, how should a trained rescuer deliver rescue breaths to the victim of a cardiac arrest? Deliver each rescue breath over 1 second. Give a sufficient tidal volume to produce visible chest rise. Use a compression to ventilation ratio of 30 chest compressions to 2 ventilations. 144. If a bystander is not trained in CPR, what is an acceptable technique for performing CPR? The bystander should provide Hands-Only (chest compression only) CPR, with an emphasis on "push hard and fast," or follow th

136.   What is the difference between a monophasic and a biphasic defibrillator? Monophasic defibrillators deliver current in one direction of current flow and require a higher joule setting.   Whereas biphasic defibrillators deliver current in two directions of current flow and require a lower joule setting. 137.   Cardioversion has been shown to be ineffective in the treatment of what two rhythms? Cardioversion is not effective for treatment of junctional tachycardia or multifocal atrial tachycardia. 138. What is the next medication that may be considered when VF/VT is unresponsive to CPR, defibrillation, and vasopressor therapy? Amiodarone 300mg push IV/IO   139. If tension pneumothorax is clinically suspected as the cause of PEA what might the initial management include? Needle decompression 140. If an advanced airway is in place, the provider should ventilation the patient at what rate?      The provider delivering ventilations should give 1 br

131.   For an adult victim receiving two person CPR, what is the ratio of compressions to ventilations?   30 compressions:   2 ventilations for and adult for both one and two rescuer CPR 132.    Compare the amount of oxygen a patient receives from a BVM devise that it not hooked to an oxygen source to one that is hooked to an oxygen source at 15L/min.    A BVM that is not hooked to an oxygen source delivers 21% oxygen to the patient while one that is hooked to an oxygen source at 15L/min will deliver 40-60% oxygen to the patient. 133.   What is meant by the term functional or relative bradycardia? A heart rate that is too slow relative to a low blood pressure or the patient’s condition, eg a heart rate of 66 with a blood pressure of 84/40 and symptoms of shock. 134.   What is the most frequent initial rhythm seen in out-of-hospital witnessed sudden cardiac arrest? Ventricular fibrillation 135. If no CPR is provided, by what percentage do the survival rates fro

126.   What are the therapeutic effects of Nitroglycerine? Decreases pain of ischemia Increases venous dilation Decreases venous blood return to heart Decreases preload and cardiac oxygen consumption Dilates coronary arteries 127.   What are some precautions to observe during the administration of Nitroglycerine? Use extreme caution if systolic BP <90 mm Hg Use extreme caution in RV infarction Suspect RV infarction with inferior ST changes Limit BP drop to 10% if patient is normotensive Limit BP drop to 30% if patient is hypertensive Watch for headache, a drop in BP, syncope, and tachycardia 128.   What are the ECG characteristics of atrial fibrillation? Rate:   Atrial rate may be 200-400, ventricular rate will vary Rhythm:   ventricular rhythm is irregular P waves:   No identifiable P waves, fibrillatory waves are present PR interval is not measurable QRS complex will usually be less than .10 seconds 130.   What are some factors that af

121.  You come upon an unconscious victim who is not breathing but has a carotid pulse.  What actions should you take? Assess responsiveness and breathing Activate EMS system and get and AED Feel for carotid pulse for 5-10 seconds If a pulse is present but the victim is not breathing then ventilate the patient every 5-6 seconds (10-12 breaths per minute) and reassess the pulse every couple of minutes. 122.  Describe the technique for determining the correct size of an OPA for a patient. Place the OPA on the side of the face with one end at the corner of the mouth and the other end at the angle of the jaw 123.  Question has been removed. 124.  What is the maintenance dose of Lidocaine that can be given to a patient after returning to spontaneous circulation? Maintenance dose of Lidocaine 1-4mg/min Reduce maintenance dose (not loading dose) in presence of impaired liver function or left ventricular dysfunction Discontinue infusion immediately if signs of to

116.  What is meant by the term pulseless electrical activity? Describes a condition in which electrical activity or rhythm is displayed on the cardiac monitor but the patient has lost the contractile function of the heart. 117.  Give some examples of slow PEA rhythms. Idioventricular rhythms Ventricular escape rhythms Bradyasystolic rhythms 118.   The 6H’s and the 6T’s describe some of the possible causes that may lead to PEA.  Name the 6H’s. Hydrogen ion (acidosis) Hyper-/Hypokalemia Hypoglycemia Hypothermia Hypovolemia Hypoxia 119.  Fibrinolytic therapy for a patient presenting with an acute MI is most beneficial if given within ___ hours of the onset of symptoms? 12 hours.  In general, the shorter the time to reperfusion, the greater the benefit. 120.  What are the ECG characteristics for ST-segment elevation myocardial infarction (STEMI)? STEMI is characterized by ST segment elevation greater than 1mm in 2 or more contiguous precordial lea

110.   Explain how to technique for performing a Valsalva maneuverer Document the dysrhythmia before treating Explain the procedure to the patient Instruct the patient to inhale and hold their breath and Bear down as if to have a bowel movement, and to hold this position for 20-30 seconds Document any rhythm changes on the monitor. 111.   During CPR how long should the rescuer check the carotid pulse? The pulse check should be checked for a least 5 seconds but no more than 10 seconds. 112.   What are some complications that can occur from using bag-mouth ventilation? Gastric inflation Regurgitation Aspiration Pneumonia 113.   What are some contraindications for performing carotid sinus massage? Avoid in elderly Carotid bruits History of CVA Recent MI or myocardial ischemia 114.   When are the acceptable times for interrupting chest compressions during a pulseless arrest? During pauses for ventilations During rhythm checks During delivery of actual shocks 115.   What is the mainten

106.   Describe the ECG characteristic of 2 nd degree heart block type II Atrial rate is greater than the ventricular rate Presence of extra or non-conducted P waves not followed by QRS complexes PR interval is normal or prolonged but remains the same on conducted beats QRS complex is usually narrow < .12 sec Atrial rate is regular, Ventricular rate is irregular. 107. How do you perform a “quick look” with the defibrillator paddles? Change the lead selector to paddles mode Apply conduction gel or gel pads to the paddles Apply the paddles to the patient’s bear chest with one paddle over the apex of the heart and the other over the right sternal border Observe the rhythm on the monitor 108.    Name 5 causes common causes of bradycardia. Hypoxia, hypothermia, heart blocks, head injury, heart medications, high vagal tone 109.    How do you differentiate between sinus tachycardia and SVT? ST is a nonspecific clinical sign.   The causes include hypoxemia, hypovolemia, hyperthermia, me

101.   During two person CPR how often should the one providing compressions switch positions? The provider giving chest compressions should switch at every 2-minute cycle to minimize fatigue 102.   What is the liter flow and oxygen concentration that can be delivered by nasal cannula? The nasal cannula has a liter flow of 1-6L/min and delivers a concentration of oxygen from 24-44%. 103. What the clinical signs and symptoms that transvenous pacing is effective in an adult victim with unstable bradycardia? Improved BP Palpable pulse Improved level of consciousness Improved respiratory status Cessation of chest pain Improvement in skin color 104. What signs and symptoms may be observed in an unstable patient requiring synchronized cardioversion? Chest pain Syncope Shortness of breath Cold and clammy skin Decreased level of consciousness Hypotension Pulmonary congestion 105.   Name  three rhythms may be suspected in irregular, narrow co

96. When assessing the effectiveness of transcutaneous pacing, the rescuer observes for electrical capture.   What is meant by the term electrical capture?   Electrical capture is observed when a pacer spike is immediately followed by a QRS complex 97.   How often can Atropine be administered to a patient in unstable bradycardia? Atropine 0.5mg IV/IO every 3-5 minutes up to a total dose of 3mg (0.04mg/kg) 98. What three drugs may be used in the treatment of wide complex tachycardia? Amiodarone 150mg infused over 10-20 minutes Lidocaine 1-1.5mg/kg IV push.   May repeat at 0.5-.75mg/kg in 5-10 minutes Procainamide 20mg/kg infused over 30-60 minutes 99. A patient with stable SVT fails to respond to an initial dose of 6mg adenosine. What would be the next appropriate step in treating this patient? Administer a second dose of adenosine at 12mg IV using the fast flush technique 100.   Can Polymorphic VT be cardioverted?   No.   Arrhythmias with a polymorphic Q

91. During adult CPR describe technique for administering compressions.   The person performing the compressions should push hard and fast and compress the chest at least 2 inches and allow for full chest recoil.   92. What is the correct way of sizing the patient for a nasopharyngeal airway (NPA) prior to inserting it into the patient? The length of the nasal airway can be estimated as the distance from the nares to the patient’s ear lobes.   The diameter of the NPA should not be larger than the diameter of the patient’s nostril. 93. What is the first antiarrhythmic and dosage that can be administered during a VF arrest? Amiodarone 300mg IV/IO push.   If necessary, may be repeated in 3-5 minutes at 150mg IV push. 94.   What are the ECG characteristics of ventricular tachycardia? P Wave: Not usually visible. PRI: None QRS: The QRS is wide and bizarre, usually 0.12 or greater. Rhythm: The rhythm is usually regular. Rate: The ventricular rate is 150 - 25

86.   An adult patient in unstable SVT does not respond to an initial cardioversion attempt at 50 J.   What would the next step be in the treatment of this patient? Activate synchronized button on the monitor Increase the joule setting to 100 J and cardiovert the patient again 87.   What are three precautions to keep in mind before giving Atropine in unstable bradycardia? Doses of atropine sulfate of <0.5 mg may paradoxically result in further slowing of the heart rate Atropine will not work on denervated hearts (heart transplants).  Atropine may be considered, but if 2nd degree type II or 3rd degree block present, it may extend the block to 3rd degree or asystole 88. Give 5 examples of narrow complex tachycardia. Sinus tachycardia, SVT, atrial fibrillation, atrial flutter, junctional tachycardia 89. What is the role of cricoid pressure during intubation?   Cricoid pressure may reduce the risk if aspiration during intubation but it is no longer recomm

81. List the steps for performing CPR on a victim of an unwitnessed cardiac arrest. Assess responsiveness and breathing Feel for a pulse for up to 10 seconds If no pulse then begin CPR beginning with chest compressions After 2 minutes or 5 cycles of CPR activate the EMS system 82. How is an esophageal detector device used? Attach the detector device to the ETT while maintaining ETT placement Squeeze the bulb and allow the bulb to self- expand; if the bulb expands in < 5 sec, then the ETT is in the trachea.     Ventilate the patient and clinically check placement: check for symmertical chest rise and auscultate over the stomach and lungs. If bulb expands slowly (over 5 sec) tracheal intubation is questionable If bulb remains collapsed or gastric contents obtained, the ETT is in the esophagus.   Remove the ETT immediately and ventilate with BVM device 83. What are the therapeutic endpoints for the administration of Procainamide for VT with a pulse? The patient receives

76. What devise has been shown to be the most effective at monitoring on going correct ET tube placement? Continuous waveform capnography 77. What is the recommended method for administering medications through a peripheral IV during a cardiac arrest? The medication should be given by bolus injection followed with a 20ml bolus of saline or IV fluids. 78. What are the recommended drug dosages when giving medications through the ET tube? Typically the drug dose given by the ET tube route is 2-2.5 times the recommended IV dose. 79. Name 5 medications that may be used in the treatment of pulseless VT? Epinephrine Vasopressin Amiodarone Lidocaine Magnesium 80. What is the recommended dosage of isoproterenol in treating unstable bradycardia? Isoproterenol 2-10ug/min by IV infusion titrated to the patient’s response

71.   You observe a victim fall to the ground in cardiac arrest.   What should you do?   Activate EMS and obtain the AED Begin CPR beginning with chest compressions while AED is set up Analyze the rhythm and defibrillate if needed 72. What are 5 ways of verifying endotracheal tube placement in an adult? Direct cord visualization End tidal CO2 monitoring Bilateral breath sounds Continuous capnography CXR 73. Where is the J point on an ECG waveform? The J point is used to measure ST elevation in an acute MI. Locate where the S wave meets the T wave then measure 0.4 sec to the right. ST elevation or depression over 1mm is significant for AMI 74. What is the recommended rate setting when preparing to pace an adult with unstable bradycardia? 60-80 bpm Reviewed 2/28/16

66. What is the difference in the way Amiodarone is administered in pulseless VT and stable VT? In pulseless arrest, Amiodarone is given IV push at 300mg.   In stable VT Amiodarone 150mg IV infusion is given as an infusion over 10 minutes. 67.   Sodium bicarbonate is indicated in the treatment of what cardiac arrest situations? Preexisting hyperkalemia Preexisting metabolic acidosis Tricyclic antidepressant OD Aspirin overdose Prolonged arrest interval after return of spontaneous circulation 68. Name three antiarrhythmics that can be used to treat stable VT? Procainamide Amiodarone Lidocaine 69. You are a lone rescuer and come upon an unresponsive adult victim who is pulseless and apneic.   What should you do?    Provide 2 minutes of CPR then activate the EMS system. 70. What is the initial dose of Lidocaine when administered to an adult through an ET tube during pulseless VT/VF? Lidocaine 2-3mg/kg via ET tube Reviewed 2/28/16