ACLS 2010 qustions http://acls-algorithms.com/acls-megacode-simulator/acls-simulator.

ACLS qustions

שאלות - BLS 1. The 2010 guidelines added a 5th link in the AHA ECC Adult Chain of Survival. This addition was: a. rapid defibrillation b. integrated post-cardiac arrest care c. effective advanced life support d. early CPR with emphasis on chest compressions

2. (True or False) Chest compressions should be stopped while the defibrillator is charging.

3. The BLS Survey focuses on:
early CPR and early defibrillation early use of advanced airways and drugs rapid access to emergency services proper rhythm interpretation

4. Success of any resuscitation attempt is built on:
A. high quality CPR B. defibrillation when required by the patients ECG rhythm C. neither A or B D. both A and B

5. The most important algorithm to know for adult resuscitation is:
A. Bradycardia B. PEA C. Tachycardia D. Cardiac Arrest

6. The systematic approach with a person in cardiac arrest should include the BLS survey and the ACLS survey? True False

7. While conducting the BLS Survey, you should do all of the following except:
A. check patient responsiveness B. active emergency response system C. open the airway D. get an AED

8. According to new 2010 Guidelines for CPR, which of the following is in the correct order for the patient with sudden cardiac arrest? A. open airway, provide ventilations, give 30 chest compressions, attach AED as soon as possible B. give 30 compressions, open airway, provide ventilation, attach AED as soon as possible C. open airway, check breathing, check pulse , attach AED as soon as possible D. none of the above

9. After providing a shock with an AED you should:
A. Start CPR, beginning with chest compressions B. check a pulse C. give a rescue breath D. let the AED reanalyze the rhythm

10. During CPR with no advanced airway in place the compression-to-ventilation ratio is:
B. 30:2 C. 10:1 D. 20:2

11. During CPR after an advanced airway is in place, which of the following is true:
A. The breaths should be synchronized with the chest compressions. B. The goal is 20 or greater breaths per minute C. Chest compressions should be stopped while giving breaths. D. One breath every 6 to 8 seconds should be given

12. The most important intervention with witnessed sudden cardiac arrest is:
A. early defibrillation B. effective chest compressions C. early activation of EMS D. rapid use of resuscitation drugs

13. Typically, suctioning attempts in ACLS situations should be:
A. ten seconds or less B. 20 seconds or less C. 5 seconds or less D. no more than 30 seconds

3. When performing BLS/ACLS you should avoid all of the following except:
prolonged rhythm analysis frequent pulse checks taking too long to give rescue breaths to the patient keeping the patients airway open

4. When checking for a carotid pulse during CPR you should take no longer than ______seconds before restarting CPR Fifteen Ten Five twenty

5. Interruptions in chest compressions should be limited to no longer than _____seconds.
Twelve Five Ten Fifteen

10. Which of the following is true about chest compressions:
push hard and fast ensure full chest recoil minimize interruptions in chest compression all of the above

3. Which of the following is performed before and/or during the BLS Survey:
a. make sure the scene is safe b. activate EMS and get an AED if available c. tap the victim's shoulder and say "Are you alright?“ d. all of the above

5. Which of the following is the correct sequence of steps for BLS according to the 2010 Guidelines?
a. chest compressions, airway, breathing, early defibrillation, if necessary b. airway, breathing, circulation, definitive care c. circulation, airway, breathing, differential diagnosis d. access care early, begin CPR, check pulse, early defibrillation, if necessary

8. Five cycles of CPR should take about __________minutes.
2 3 1 4

2010 Guidlines

3. Which is now recommended for confirming placement of the endotracheal tube after intubation?
a. exhaled carbon dioxide detector b. oxygen saturation monitor c. esophageal detector device d. continuous waveform capnography

9. During CPR with an advanced airway in place the compression rate is:
≥ 80/min ≥ 60/min ≥ 100/min ≤90/min

1. Examples of advanced airway adjuncts include all the following except:
a. oropharyngeal airway b. laryngeal tube c. laryngeal mask airway d. combitube e. endotracheal tube

2. Which is not true about the oropharyngeal airway(OPA):
a. The OPA keeps the airway open during bag-mask ventilation. b. The OPA can stimulate coughing and gagging. c. The OPA can prevent the patient from biting on an ET tube. d. The OPA should only be used on a conscious patient

7. During the ACLS Survey when assessing (B)breathing, which of the following is correct about supplementary oxygen delivery? a. Administer 100% oxygen for cardiac arrest patients b. Other than cardiac arrest, administer oxygen to maintain O2 saturation value o≥ 94% by pulse oximetry c. both a and b are correct d. neither a and b are correct

8. During the (C) circulation portion of the ACLS survey, the following actions are carried out:
a. look, listen, and feel b. Obtain IV access, Attach ECG leads, monitor rhythm, given medications to manage rhythm, give IV/IO fluids if needed c. Obtain IV access, give supplemental oxygen, secure the advanced airway, give IV/IO fluids if needed d. Check a pulse, monitor heart rhythm, begin CPR if indicated

10. In the Final Portion of the ACLS survey, the D stands for:
a. defibrillation b. definitive care c. differential diagonosis d. discuss options

11. Which of the following best describes how to select the proper size of an (OPA) oropharyngeal airway? a. one size fits all b. the OPA should be the length of the patients middle finger c. the OPA should be the length from the corner of the mouth to the angle of the mandible. d. the OPA should be the length from the patients nose to the ear lobe

Bradycardia

1. What is the drug of first choice for symptomatic bradycardia?
a. atropine b. lidocaine c. epinephrine . vasopressin

2. Which ECG rhythm is commonly associated with bradycardia?
a. PEA b. Mobitz II c. ventricular fibrillation d. sinus rhythm

3. What is generally considered the most important and clinically significant degree of block?
a. type I (Mobitz I) b. type II (Mobitz II) c. third-degree AV block d. first-degree AV block

4. Which drugs are involved in the Bradycardia Algorithm?
a. atropine, epinephrine, dopamine b. atropine, norepinephrine, dopamine c. atropine, lidocaine, adenosine d. atropine, epinephrine, lidocaine

5. Bradyarrhythmia is defined as:
a. any rhythm disorder with a heart rate less than 40 beats per minute b. any rhythm disorder with a heart rate less than 60 beats per minute c. any symptomatic rhythm disorder with a heart rate less than 50 beats per minute d. any rhythm disorder with a heart rate less than 50 beats per minute

6. Symptomatic bradycardia exists when_________.
a. the heart rate is slow b. the patient has symptoms c. the symptoms are due to a slow heart rate d. all of the above are needed for symptomatic bradycardia to exist.

7. Symptoms of bradycardia can include chest discomfort or pain, shortness of breath, decreased level of consciousness, weakness, fatigue, lightheadedness, dizziness, and presyncope or syncope. True False

8. Signs of symptomatic bradycardia include hypotension, orthostatic hypotension, diaphoresis, pulmonary congestion, frequent PVC's or VT. True False

. The primary decision point in the bradycardia algorithm is the determination of:
a. heart rate b. adequate perfusion c. blood pressure d. rhythm

10. After it is determined that the patient does not have adequate perfusion your first step is to:
a. prepare for transcutaneous pacing b. observe and monitor the paitent c. give atropine while awaiting transcutaneous pacer d. use defibrillator set at 200 J

Ventricular Fibrillation/Pulseless Ventricular Tachycardia

1. The primary ACLS treatment for VF and Pulseless VT is:
Lidocaine high-energy unsynchronized shocks synchronized shocks epinephrine

2. Drugs used in the VF/Pulseless VT Algorithm include:
epinephrine, vasopressin, amiodarone, lidocaine, and magnesium sulfate epinephrine, vasopressin, atropine, and magnesium sulfate epinephrine, vasopressin, adenosine, beta-blockers, magnesium sulfate epinephrine, vasopressin, amiodarone, lidocaine, and atropine

5. (True or False) According to the Guidelines, chest compressions may be continued while the defibrillator is charging. True False

6. For VF/pulseless VT how many shocks should initially be given?
3 stacked shocks none, shocks are not indicated it depends whether the rhythm is VF or VT

8. After the first shock in the Pulseless VF/VT you should:
give 1 mg epinephrine IV/IO immediately resume CPR check for a pulse check for a rhythm

10. If you do not know the effective biphasic dose range for the defibrillator that you are using, you should deliver a first shock and all subsequent shocks for VF / pulseless VT at _________. 120 200 the lowest energy does that is available the maximal energy dose that is available

1. If VF is initially terminated by a shock but recurs later in the resuscitation attempt you should: shock at the previously successful energy level increase energy level 20J for subsequent shocks increase energy level to maximum dose that defibrillator can deliver use medications to reverse VF

2. Select the sequence that is in the correct order?
give 3 stacked shocks, 5 cycles CPR, check rhythm, give 1 shock, 5 cycles CPR, after 2nd shock give 1mg epinephrine IV push give 1 shock, 3 cycles CPR, check rhythm, give 1 shock, 3 cycles CPR, after 2nd shock give 1mg epinephrine IV push give 1 shock, 5 cycles CPR, check rhythm, give 1 shock, 5 cycles CPR, check rhythm after 2nd shock give 1mg epinephrine IV push give 1 shock, check rhythm, 5 cycles CPR, give 1 shock, check rhythm, 5 cycles CPR, after 2nd shock give 1mg epinephrine IV push

3. You have given a patient the 1st shock and CPR for 5 cycles, your next step is to __________.
check breathing give the patient epinephrine 1 mg IV check rhythm give a second shock

4. You have given a patient the 1st shock, CPR for 5 cycles, and now they have an organized rhythm. Your next step is to ___________. place the patient in rescue position start the patient on an antiarrhythmic drug search for possible causes of the VF/VT palpate for a pulse

5. The drug ___________ can be used as a substitute for epinephrine for the first or second dose during resuscitation. Vasopressin Adenosine Atropine Lidocaine

6. If during VF/VT after a shock, the rhythm check reveals a __________ rhythm and _______, you then should proceed with the asystole/PEA pathway of the ACLS Pulseless Arrest. ventricular, no pulse slow, weak pulse shockable, strong pulse nonshockable, no pulse

9. You have shocked the patient, given 5 cycles of CPR and have done a rhythm check. Now, the patient remains in VT with no pulse. What should you do next: give the patient a second shock give the patient 1 mg epinephrine continue CPR for 5 cycles consider giving antiarrhythmics

1. The initial energy dose used during defibrillation is dependent upon ____________.
whether the patient has an internal pacemaker whether the arrest was witness or unwitnessed whether the defibrillator is monophasic or biphasic none of the above

2. Prior to defibrillation which of the following should be done?
ensure all team members are clear charge the defibrillator minimize time delay between chest compressions and shock delivery all of the above

3. Epinephrine hydrochloride is used during resuscitation primarily for its alpha-adrenergic effects. Alpha-adrenergic effects include: increase in coronary blood flow resulting from vasoconstriction increased cerebral blood flow resulting from vasodilation increased oxygenation resulting from bronchoconstriction increased renal blood flow resulting from vasoconstruction

4. (True or False) Overall vasopressin effects have not been shown to differ from epinephrine with regard to ROSC (return of spontaneous circulation), 24 hour survival, or survival to hospital discharge. True False

5. When treating pulseless VF/VT remember to __________.
ensure full chest recoil push hard and fast (100/min) search for treatable contributing factors (H and T's) all of the above

6. The H's of treatable contributing factors are:
hypovolemia, hypoxia, hydrogen ion, hypo-/hyperkalemia, hypothermia hypovolemia, hydrogen ion, hypo-/hyperkalemia, hyperglycemia, hypothermia hypovolemia, hypoxia, hydrogen ion, hypo-/hypercalcemia, hypoglycemia, hypothermia hemophilia, hypoxia, hydrogen ion, hypo-/hyperkalemia, hypoglycemia

7. After the third shock in the pulseless VF/VT algorithm with no change in rhythm/pulse, you should __________. get a different defibrillator check for a pulse consider giving antiarrhythmic drugs consider giving a beta-blocker

8. Four important aspects to the Pulseless VF/VT algorithm are:
early defibrillation, effective CPR(hard and fast), secure the airway, establish IV/IO access stacked shocks with defibrillation, minimize delay in CPR, establish IV/IO access, avoid hyperventilation use only biphasic defibrillator, avoid hyperventilation, establish IV/IO access, CPR immediately after shock early defibrillation, atropine after first shock, consider antiarrhythmic use, establish IV/IO access

9. For the pulseless VF/VT algorithm, the proper first dose of IV Amiodarone is ________.
150 mg 300 mg 200 mg 100 mg

10. A second dose of ________IV Amiodarone can be given.
150 mg 300 mg 200 mg 100 mg

Tachycardia

1. A tachyarrhythmia is defined as "any rhythm other than sinus tachycardia with a rate greater than ______.“ 60 100 80 150

2. (True or False) Unstable tachycardia exists when the heart rate is too fast for the patient’s clinical condition and the excessive heart rate causes symptoms. True False

3. Symptoms that may be due to tachycardia include all the following except:
shortness of air facial droop altered mental status chest pain

4. Serious signs or symptoms of tachycardia can include which of the following:
Hypotension poor peripheral perfusion acutely altered mental status acute heart failure all of the above

5. Heart rates from _____to_____ (per minute) usually are the result of an underlying process (fever, anemia, blood loss, etc.) and are generally sinus tachycardia. 90-150 none of the above

7. The decision point for performing immediate synchronized cardioversion is:
The patient is unstable and no other reversible causes are identified The patient's heart rate is greater than 150 Advised by expert consultation Adenosine does not convert the patient's rhythm

8. Tachyarrhythmias respond to cardioversion
8. Tachyarrhythmias respond to cardioversion. Sinus tachycardia will not respond to cardioversion. What will often occur if a shock is delivered with sinus tachycardia? heart rate decreases Asystole heart rate increases ventricular fibrillation

9. Which of the following would be considered a tachyarrhythmia if the ventricular rate is greater than 100 ? atrial flutter atrial fibrillation supraventricular tachycardia all of the above

10. (True or False) When performing synchronized electrical cardioversion on a patient, the shock will occur at the exact time that you press the "deliver shock button.“ True False

1. Which of the following is not an appropriate initial intervention when addressing tachycardia with a pulse? give oxygen (if hypoxemic) monitor ECG, blood pressure, and oximetry identify and treat reversible causes attempt vagal maneuvers

2. True or False Tachycardia rates less than 150 per minute usually do not cause serious signs or symptoms. True False

3. Which of the following are key questions that should be addressed during the assessment and management of a patient with tachycardia? Are symptoms present or absent? Is the patient stable? Is the QRS narrow or wide? Is the rhythm regular or irregular? All of the above

4. True or False With tachycardia, if a patient is seriously ill or has significant underlying heart disease or other conditions, symptoms may be present at a lower heart rate? True False

5. If a tachyarrhythmia is causing a patient to become unstable what is the most important intervention? Cardioversion IV fluids expert consultation antiarrhythmic medications

6. True or False Unstable Monomorphic VT and Polymorphic VT (with a pulse) are treated with the same interventions? True False Synchronized cardioversion is recommended to treat supraventricular tachycardia due to reentry, atrial fibrillation, atrial flutter, and atrial tachycardia. Synchronized cardioversion is also recommended to treat monomorphic VT with pulses. Cardioversion is not effective for treatment of junctional tachycardia or multifocal atrial tachycardia. Synchronized cardioversion must not be used for treatment of VF as the device may not sense a QRS wave and thus a shock may not be delivered. Synchronized cardioversion should also not be used for pulseless VT or polymorphic (irregular VT). These rhythms require delivery of high-energy unsynchronized shocks (ie, defibrillation doses). Electric therapy for VT is discussed further below. For additional information see Part 8.2: “Management of Cardiac Arrest.”

7. Which is the correct treatment for unstable polymorphic VT?
treat as VF with high-energy unsynchronized shocks treat with 3 stacked shocks treat with medications only treat with synchronized cardioversion and an initial shock of 100 J

8. Which is the correct treatment of unstable monomorphic VT with a pulse ?
treat as VF with high-energy unsynchronized shocks treat with 3 stacked shocks treat with medications only treat with synchronized cardioversion and an initial shock of 100 J

9. If there is any doubt about whether an unstable patient has monomorphic or polymorphic VT what should you do? treat with high-energy unsynchronized shocks treat with 3 stacked shocks treat with medications only treat with synchronized cardioversion and an initial shock of 100 J

10. If the patient is unstable with a narrow-complex SVT what IV medication can be given as you prepare for immediate synchronized cardioversion? (not shown in unstable pathway but can be given) amiodarone 150 mg IV adenosine 6 mg rapid IV push atropine 1 mg IV epinephrine 1 mg IV

1. Which is the correct definition of unsynchronized shock ?
The electrical shock is delivered as soon as the operator pushes the SHOCK button to discharge the machine. The shock can fall randomly anywhere within the cardiac cycle. The electrical shock is delivered with a peak of the R wave in the QRS Complex thus avoiding the delivery of a shock during cardiac repolarization (t-wave)

2. (True or False) Synchronized cardioversion uses a higher energy level than used with unsynchronized cardioversion (defibrillation). True False

3. Low-energy shocks are always delivered synchronized due to the fact that low energy shocks have the potential to produce which rhythm if delivered unsynchronized? VT Asystole VF atrial flutter

4. Which of the following cases is unsynchronized shock NOT advised?
for the patient who is pulseless for a patient who is unstable with polymorphic VT for a patient who has unstable tachycardia with a pulse for the patient who is unstable and you are unsure what type of VT exists

5. According to the new 2010 ACLS Guidelines, how many doses of adenosine rapid IV push can be give with the tachycardia algorithm? 2 3 4 5

6. (True or False) Two interventions that can be performed for a regular narrow-complex tachyarrhythmias are vagal maneuvers and adenosine administration? True False

7. Adenosine can be given 2 times to attempt conversion of tachyarrhythmia. What is the recommended dosing schedule? 12 mg, if no conversion 6 mg 12 mg, if no conversion 12 mg 6 mg, if no conversion 12 mg 6 mg, if no conversion 6 mg

8. (True or False) Cardioversion is contraindicated for SINUS tachycardia because the increased heart rate is being caused by an external influence such as fever, blood loss, or exercise. True False

9. (True or False) With sinus tachycardia the goal is to identify and treat the underlying systemic causes. True False

Adenosine can now be considered for the diagnosis and treatment of stable undifferentiated wide-complex tachycardia when the rhythm is regular and the QRS waveform is monomorphic. True False

Acute Coronary Syndrome (ACS)

1. Immediate assessments and actions for a patient presenting with symptoms suggestive of ACS include: a. oxygen b. aspirin c. nitroglycerin d. morphine e. 12-lead ECG f. all of the above

3. What is the primary focus of treatment of a patient with ACS?
a. Early reperfusion of the STEMI patient b. Early hospital arrival c. Early use of medications to prevent plaque formation d. Assessing family history of coronary artery disease

4. Which rhythms is most commonly caused by acute myocardial ischemia and is the leading cause of sudden cardiac death? a. VT b. Bradycardia c. SVT d. VF

5. Reperfusion therapy may involve which of the following:
a. PCI (percutaneous coronary intervention) b. fibrinolytic therapy c. heparin d. both a and b e. all of the above

6. Which of the following drugs are used in the initial treatment of ACS (acute coronary syndrome)?
a. aspirin, morphine, nitroglycerine b. heparin, metoprolol, aspirin c. aspirin, fibrinolytics, ACE inhibitors d. simvastatin, labetalol, oxygen

8. What is the most common symptom of myocardial ischemia and infarction?
a. discomfort in the retrosternal chest b. radiating left arm pain c. jaw pain d. discomfort in the upper back between the shoulder blades

9. Other life-threatening conditions that may cause acute chest discomfort are:
a. aortic dissection, acute PE b. acute pericardial effusion with tamponade c. tension pneumothroax d. all of the above

2. What rhythm is most likely to develop in the first 4 hours after onset of acute coronary syndrome? a. VT b. VF c. atrial flutter d. PEA

3. Nitroglycerine should be administered if the patient's systolic blood pressure remains >(greater than) ________ and the heart rate is /min. a. 100 b. 80 c. 90 d. 120

4. Which pain medication is indicated in STEMI when chest discomfort is unresponsive to nitrates?
a. Motrin b. morphine c. dilaudid d. hydrocodone

5. (True or False) For the patient with acute coronary syndrome, use of Non-steroidal anti-inflammatory drugs (NSAIDs) is contraindicated (excpet for aspirin) and should be discontinued. True False

7. One of the goals of reperfusion therapy is to perform PCI (percutaneous coronary intervention) within ________ minutes of arrival in the ED. a. 30 minutes b. 60 minutes c. 90 minutes d. 120 minutes

8. What is the major contraindication to aspirin administration?
a. true aspirin allergy b. recent GI bleed c. hypotension d. fever >100 F (37.7 C) e. all of the above f. both a and b

What is the recommended dosage of oral aspirin to be given within the ACS protocol?
300 mg mg mg mg

1. Which item(s) below can be used to identify a STEMI?
a. retrosternal chest pain b. 12-lead EKG c. troponin d. all of the above

2. One goal of reperfusion therapy is to give fibrinolytics within _______minutes of arrival.
d. 90

3. (True or False) Morphine is recommended for patients suspected of having ischemic chest discomfort that does not respond to nitrates. True False

4. (True or False) Consultation with a cardiologist should take place before treatment of STEMI.

5. Patients with suspected ACS should have oxygen administered if the patient is ___________.
a. dyspenic b. hypoxemic c. oxyhemaglobin saturation is < 94% d. any of the above

6. The 4 agents that are routinely recommended for consideration in patients with ischemic-type chest discomfort are: a. aspirin, nitroglycerin, morphine, and oxygen if hypoxemic (o2<94%) b. motrin, morphine, nitroglycerine, and oxygen if hypoxemic (o2<94%) c. aspirin, nitroglycerin, dilaudid, and metoprolol d. epinephrine, dopamine, morphine, and oxygen if hypoxemic (o2<94%)

7. What is the major contraindication to the administration of nitroglycerine and morphine?
a. recent bleeding b. changes in level of consciousness c. chest pain d. hypotension

8. For cases in which fibrinolytics are contraindicated, what intervention should be performed?
a. heparin therapy b. PCI (percutaneous coronary intervention) c. bypass surgery d. observation

9. (True or False) routine use of IV nitroglycerine is not indicated for STEMI and has not been shown to significantly reduce mortality in STEMI. True False

Which is a contraindication for the use of nitroglycerin in the ACS protocol?
a. right ventricular infarction b. hypotension c. recent phosphodiesterase inhibitor use d. all of the above

PEA / Asystole

The H’s include: The T’s include:
Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper-/hypokalemia, Hypoglycemia, Hypothermia. The T’s include: Toxins, Tamponade(cardiac),Tension pneumothorax, Thrombosis (coronary and pulmonary), andTrauma. Hypovolemia Hypovolemia or the loss of fluid volume in the circulatory system can be a major contributing cause to cardiac arrest. Looking for obvious blood loss in the patient with pusleless arrest is the first step in determining if the arrest is related to hypovolemia. After CPR, the most import intervention is obtaining intravenous access/IO access. A fluid challenge or fluid bolus may also help determine if the arrest is related to hypovolemia. Hypoxia Hypoxia or deprivation of adequate oxygen supply can be a significant contributing cause to cardiac arrest. You must ensure that the patient’s airway is open, and that the patient has chest rise and fall and bilateral breath sounds with ventilation. Also ensure that your oxygen source is connected properly. Hydrogen ion (acidosis) To determine if the patient is in respiratory acidosis, an arterial blood gas evaluation must be performed. Prevent respiratory acidosis by providing adequate ventilation. Prevent metabolic acidosis by giving the patient sodium bicarbonate. Hyper-/hypokalemia Both a high potassium level and a low potassium level can contribute to cardiac arrest. The major sign of hyperkalemia or high serum potassium is taller and peaked T-waves. Also, a widening of the QRS-wave may be seen. This can be treated in a number of ways which include sodium bicarbonate (IV), glucose+insulin, calcium chloride (IV), Kayexalate, dialysis, and possibly albuterol. All of these will help reduce serum potassium levels. The major signs of hypokalemia or low serum potassium are flattened T-waves, prominent U-waves, and possibly a widened QRS complex. Treatment of hypokalemia involves rapid but controlled infusion of potassium. Giving IV potassium has risks. Always follow the appropriate infusion standards. Never give undiluted intravenous potassium. Hypoglycemia Hypoglycemia or low serum blood glucose can have many negative effects on the body, and it can be associated with cardiac arrest. Treat hypoglycemia with IV dextrose to reverse a low blood glucose. Hypoglycemia was removed from the H’s but is still to be considered important during the assessment of any person in cardiac arrest. Hypothermia If a patient has been exposed to the cold, warming measures should be taken. The hypothermic patient may be unresponsive to drug therapy and electrical therapy (defibrillation or pacing). Core temperature should be raised above 86 F (30 C) as soon as possible. The T’s include: Toxins Accidental overdose of a number of different kinds of medications can cause pulseless arrest. Some of the most common include: tricyclics, digoxin, betablockers, and calcium channel blockers). Street drugs and other chemicals can precipitate pulseless arrest. Cocaine is the most common street drug that increases incidence of pulseless arrest. ECG signs of toxicity include prolongation of the QT interval. Physical signs include bradycardia, pupil symptoms, and other neurological changes. Support of circulation while an antidote or reversing agent is obtained is of primary importance. Poison control can be utilized to obtain information about toxins and reversing agents. Tamponade Cardiac tamponade is an emergency condition in which fluid accumulates in the pericardium (sac in which the heart is enclosed). The buildup of fluid results in ineffective pumping of the blood which can lead to pulseless arrest. ECG symptoms include narrow QRS complex and rapid heart rate. Physical signs include jugular vein distention (JVD), no pulse or difficulty palpating a pulse, and muffled heart sounds due to fluid inside the pericardium. The recommended treatment for cardiac tamponade is pericardiocentesis. Tension Pneumothorax Tension pneumothorax occurs when air is allowed to enter the plural space and is prevented from escaping naturally. This leads to a build up of tension that causes shifts in the intrathroacic structure that can rapidly lead to cardiovascular collapse and death. ECG signs include narrow QRS complexes andslow heart rate. Physical signs include JVD, tracheal deviation, unequal breath sounds, difficulty with ventilation, and no pulse felt with CPR. Treatment of tension pneumothorax is needle decompression. Thrombosis (heart: acute, massive MI) Coronary thrombosis is an occlusion or blockage of blood flow within a coronary artery caused by blood that has clotted within the vessel. The clotted blood causes an acute myocardial infarction which destroys heart muscle and can lead to sudden death depending on the location of the blockage. ECG signs during PEA indicating coronary thrombosis include ST-segment changes, T-wave inversions, and/or Q waves. Physical signs include: elevated cardiac markers on lab test. For patients with cardiac arrest and without known pulmonary embolism (PE), routine fibrinolytic treatment given during CPR has shown no benefit and is not recommended. Treatments for coronary thrombosis before cardiac arrest include use of fibrinolytic therapy, PCI (percutaneous coronary intervention). The most common PCI procedure is coronary angioplasty with or without stent placement. Thrombosis (lungs: massive pulmonary embolism) Pulmonary thrombus or pulmonary embolism (PE) is a blockage of the main artery of the lung which can rapidly lead to respiratory collapse and sudden death. ECG signs of PE include narrow QRS Complex and rapid heart rate. Physical signs include no pulse felt with CPR. distended neck veins, positive d-dimer test, prior positive test for DVT or PE. Treatment includes surgical intervention (pulmonary thrombectomy) and fibrinolytic therapy. Trauma The final differential diagnosis of the H’s and T’s is trauma. Trauma can be a cause of pulseless arrest, and a proper evaluation of the patients physical condition and history should reveal any traumatic injuries. Treat each traumatic injury as needed to correct any reversible cause or contributing factor to the pulseless arrest. Trauma was removed from the T’s but is still to be considered important during the assessment of any person in cardiac arrest.

1. Some clues for PEA caused by acidosis (hydrogen ion) would be all of the below except:
recent trauma history of diabetes renal failure smaller-amplitude QRS complexes

2. Recommended treatment to reverse PEA caused by acidosis is:
a. adequate ventilation b. sodium bicarbonate c. normal saline bolus d. both a and b

3. PEA caused by HYPERkalemia may present with which of the following rhythm changes?
narrow QRS complex, smaller P-waves, and T- waves taller and peaked wide QRS complex, taller P-waves, and T-waves taller and peaked wide QRS complex, smaller P-waves, and T-waves taller and peaked narrow QRS complex, smaller P-waves, and T-waves smaller and rounded

Hyperkalemia ecg

4. Patients that you might more commonly see with PEA caused by HYPERkalemia are all the followingexcept which one? renal failure Diabetes Elderly dialysis recipient

5. Reversing HYPERkalemia is done using which of the following medications?
sodium bicarbonate glucose and insulin Albuterol any of the above

6. PEA caused by HYPOkalemia may present with which if the following symptoms?
flattened T-waves, prominent U waves, wide QRS, prolonged QT peaked T-waves, prominent U waves, narrow QRS, prolonged QT flattened T-waves, prominent U waves, narrow QRS, shortened QT peaked T-waves, non-visible U waves, wide QRS, prolonged QT

7. Patients that you might more commonly see with PEA caused by HYPOkalemia are:
diabetic patients patients using diuretics patients with chest pain all of the above

8. Life threatening hypokalemia is uncommon but can occur in the setting of gastrointestinal and renal losses and is associated with hypomagnesemia. Treatment with magnesium may help during cardiac arrest. True False

9. The “T” that represents drug overdose and chemical exposure among frequent causes of PEA stands for: Thrombosis tension pneumothroax Tamponade toxins

10. A clue that PEA could be caused by drug overdose “Toxins” is:
narrow QRS complex prolonged QT interval Tachycardia tracheal deviation

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