Post-ACLS Megacode Flashcards - Quizlet
Post-ACLS Megacode Flashcards - Quizlet
Post-ACLS Megacode Flashcards - Quizlet
Post-ACLS Megacode
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SCENARIO 1: You witness a middle-aged, obese Move the man out of the way of pedestrian traffic on the escalator
male pedestrian collapse on an escalator in an
airport. He is clutching his chest and slumps over
on the person behind him. The bystander places
him on the floor at the end of the down-moving
escalator track. As a first responder certified in
ACLS, which of the following is your first course
of action?
1: You have moved the man to a seating area near send someone to get AED
the bottom of the escalator. The man is gasping
for breath but does not appear to be effectively
breathing. You yell at him "Are you alright?" but he
does not respond. What is your next action?
1: After sending for EMS and waiting for an AED to check for a pulse
pulse. You cannot feel a definite pulse after 10 Since there is no pulse, the man is now in cardiac arrest. He needs CPR,
seconds of trying. What is your next action? including chest compressions.
Post-ACLS Megacode
1: You start high-quality CPR at a rate of 100-120 Rip the pads off the man's chest and apply new pads in the same locations
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compressions per minute. The AED arrives
moments later. You open the man's shirt to find a Chest hair can interfere with electrical contact through the AED pads. The
copious amount of thick hair covering his chest adhesive on the pads can act as a rapid depilatory (i.e. it rips the chest hair out).
and he is damp with sweat. The AED cannot get a New pads can then be used on the bare skin.
good signal through the pads because of the hair,
even though you have pressed them down very
hard. What is your next action?
1: With hair removed and new pads placed, the resume CPR ASAP
2: You believe the woman is having an acute finger stick blood glucose
should be ordered emergently for this patient and A CT scan of the brain without contrast should be obtained as quickly as
is the most important for determining further possible. The goal is to determine if there is blood visible in the brain
treatment? parenchyma (indicates hemorrhage).
for a CT scan. A qualified physician states that the Evidence points to an ischemic stroke in evolution. Fibrinolytic therapy may
head CT shows no sign of bleeding (hemorrhage). help, but the patient must be screened to determine if tPA is appropriate in this
There is radiological evidence to suggest early case.
ischemic stroke. The patient's symptoms have not
resolved. True or false: the patient should be
evaluated for fibrinolytic therapy?
2: The hospital's stroke team has been called to pt had heart attack 4 yrs ago
2: You are in the room with her two hours after tPA acute hemorrhagic stroke
treatment. She complains of a terrible headache Blood is irritating to brain tissue and can cause abnormal electrical activity,
and then becomes unresponsive. The patient has leading to seizures. One of the risks of tPA is that the ischemic stroke may
no history of epilepsy, but begins to convulse. Her undergo hemorrhagic conversion. That said, hemorrhagic conversion of
eyes are pointed toward the left side of her face. ischemic stroke can occur with or without tPA treatment. Acute hemorrhagic
You suspect which of the following? stroke is the most likely result in this case.
give supplemental O2
3: You apply supplemental oxygen via nasal atropine 0.5 mg bolus IV once
3: Another staff member is applying the ECG atropine 0.5 mg bolus IV once
sensation of fluttering in her chest. You perform + Check for signs of heart failure
an initial assessment and find that the 22-year-old
woman is communicative and in no acute distress.
The rhythm monitor on the defibrillator reveals a
regular, narrow complex heart rate of 150 beats
per minute. Your initial evaluation should include
which of the following?
Post-ACLS Megacode
4: She denies chest pain or shortness of breath. CAROTID MASSAGE
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start CPR
4: You administer a defibrillation dose (200 J
biphasic) to the patient. What is your next action? Provide chest compressions as part of CPR immediately after providing a shock.
This should continue for two minutes without interruption.
4: After two minutes of CPR, the patient still has For biphasic energy, 200 J is already the maximum dosage level. Subsequent
no pulse and the rhythm is now ventricular shocks should be delivered at this same energy. It is too soon to abort the
fibrillation. What is your next action? resuscitation in this woman (and probably too soon for any patient). She is a
young and otherwise healthy woman who has a relatively high likelihood of
regaining spontaneous circulation.
start CPR
5: Which of the following is your first management CPR with immediate chest compressions is the first action. Epinephrine through
action? a peripheral IV is worthless without some sort of circulation, such as that
obtained through chest compressions.
5: Given the patient's history, which probable treat hypoxia and hypothermia at the same time
cause of PEA should be treated immediately?
5: You administer a defibrillation dose (200 J Administer atropine 0.5 mg bolus IV once
PEA
This patient should be treated for cardiac arrest, specifically with epinephrine.
6: Assuming that CPR is continuing, how do you
Amiodarone is recommended in pulseless ventricular tachycardia and
first manage pulseless electrical activity?
ventricular fibrillation after epinephrine and unsynchronized cardioversion
(shock). Non-synchronized cardioversion has no place in cardiac arrest.
Atropine in asystole/PEA is unlikely to positively influence outcomes.
What is the best first step in managing this This patient is stable and most likely has supraventricular tachycardia, a common
patient's tachycardia?
form of tachycardia typically caused by a reentry circuit in the conduction
1) Synchronized cardioversion
system. This condition most commonly presents with a narrow QRS, however the
2) Procainamide infusion at 60 mg/min until QRS interval can be >120 ms in cases associated with aberrant conduction or a
arrhythmia is suppressed
fixed bundle branch block. Vagal maneuvers such as Valsalva or carotid sinus
3) Vagal maneuvers
massage block conduction at the AV node, disrupting the reentry system,
4) Sedation and Intubation making them an appropriate initial intervention in these patients. .
Post-ACLS Megacode Tree Removal Service Experts
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pt is still not better. What is the next best step in 6mg IV adenosine rapid push followed by NS flush
management?
1) 6 mg rapid IV push of Adenosine, followed by SVT that is refractive to vagal maneuvers should be treated with adenosine.
NS flush
Adenosine has an extremely short half-life of less than 10 seconds. It should be
2) 12 mg rapid IV push of Adenosine, followed by administered via rapid injection into a large proximal vein, followed by a normal
NS flush
saline flush of 20 mL and extremity elevation. Patients should be on continuous
3) IV infusion of 6 mg Adenosine over 1 hour
EKG monitoring during administration.
4) IV infusion of 12 mg Adenosine over 1 hour
patient now develops wide monomorphic VT but Immediately perform synchronized cardioversion at 100J
1) Start a beta-blocker
This patient has become acutely unstable, with conversion of his rhythm to a
2) Immediately perform defibrillation at 200J
ventricular tachycardia (VT). Patients with regular, wide complex monomorphic
3) Give third dose of 12 mg rapid IV push of VT and a palpable pulse should be immediately treated with 100J synchronized
Adenosine
cardioversion.
4) Immediately perform synchronized
cardioversion at 100J