Samar State

University
CONHS

RELATED LEARNING
EXPERIENCE PLAN
(Emergency Room)

{RHEAJANE AGUILAR-ROSALES}
Table of Contents

Triage--------------------------------------------------------------------4-6
Intravenous Fluid & Dosage Calculation-------------------------7-9
Emergency Room Nursing procedures -------------------------10-20

BLS & ACLS-------------------------------------------------------------21-26

Video links--------------------------------------------------------------2
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Description:
Related Learning Experience in ER Department is an actual application of the
theories, principles and concepts of clinical nursing practice to groups of clients in
varied settings to refine nursing skills in the different basic nursing services.
Emphasis is placed on integrating the multiple roles of professional nursing as a
vehicle to enhance critical thinking and communication skills.

This worksheet include five competency learning activities that will hopefully help
the student nurses assigned in the Emergency Room, under the subject Intensive
Nursing practicum to enhance their knowledge on the ER procedures, and other
nursing competency standards expected of them. Hence, application of nursing
process, critical thinking, and evidence -based practice is also integrated on the
activities in this worksheet. The author developed some of the activities found in
these worksheets, while other activities were adopted from other resources.

Learning Objectives:
At the end of these activities, student nurses will be able to;

1. Apply Nursing Process in answering the worksheets;

2. Apply evidence -based nursing interventions in the activities,

3. Analyze patient’s problem in the given scenarios;

4. Recall the competency standards for nurses in the Emergency Room;

5. and, practice problem solving approach for every questions presented in the
worksheets.

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 MEDICAL TRIAGE IN A HOSPITAL

The word triage comes from the French word trier, which means to sort or select. Its
historic roots for medical purposes go back to the days of Napoleon when triaging
large groups of wounded soldiers was necessary. Over the centuries, triage systems
have evolved into a well-defined priority process, sometimes requiring specific
training depending on the setting or organization that uses the system.
When Triage Is Used

Triage is used when the medical-care system is overloaded, meaning there are more
people who need care than there are available resources to care for them. There
may be mass casualties in a war zone, terrorist incident, or natural disaster that
results in many injuries. There may be a need for triage when a school bus accident
or a large pile-up of cars on a highway results in too many injured people for too few
ambulances or EMTs.

Triage systems run the gamut from verbal shouting in an unusual emergency to well-
defined colored tagging systems used by soldiers and EMTs when they arrive on the
scene of a mass casualty accident or a battlefield with many wounded soldiers. Each
organization has its own triage system. They all create priorities for who gets care or
is transported for care. The most common triage systems use color-coding that
works similar to this:
 Red: Needs immediate attention for a critical life-threatening
injury or illness; transport first for medical help.
 Yellow: Serious injuries needing immediate attention. In some
systems, yellow tags are transported first because they have a
better chance of recovery than red-tagged patients.
 Green: Less serious or minor injuries, non-life-threatening,
delayed transport; will eventually need help but can wait for
others.
 Black: Deceased or mortally wounded; black may not mean the
person has already died. It may mean that he or she is beyond
help and, therefore, is a lower priority than those who can be
helped.
 White: No injury or illness (not used in all systems)
In a disaster or mass casualty situation, different systems for triage have
been developed. Another system is known as START (Simple Triage
and Rapid Treatment). In START, victims are grouped into four
categories, depending on the urgency of their need for evacuation. If

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necessary, START can be implemented by persons without a high level of
training.

The categories in START are:

 the deceased, who are beyond help
 the injured who could be helped by immediate transportation
 the injured with less severe injuries whose transport can be
delayed
 those with minor injuries not requiring urgent care.

References:

Medical Triage (Color Tags, START) Terminology by MedicineNet.com. (2014, December 1). Retrieved
from https://www.medicinenet.com/medical_triage_code_tags_and_triage_terminology/views.htm

Torrey, T. (2019, November 18). What Medical Triage Is and How It Is Used to Priortize Treatment.
Retrieved from https://www.verywellhealth.com/medical-triage-and-how-it-works-2615132

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 ACTIVITY # 1:
HOSPITAL TRIAGE
Instruction: Apply hospital triage system by assigning patients to their respective
triage category by writing the patient’s number inside the color-coded boxes.

Patient # 1. A 14-year-old male with a broken arm walking around the scene.

Patient # 2. A responsive 34-year-old female has pale, moist skin and respirations of
32/minute.

Patient # 3. An unresponsive male patient has snoring respirations. His breathing

improves when you open his airway.

Patient # 4. A 66-year-old male patient is sitting on the ground. His eyes are open,
but he can't answer or follow directions.

Patient # 5. A 50-year-old man has bilateral fractured femurs. He has a faint radial
pulse and a respiratory rate of 24.

Patient # 6. A 57-year-old female has a deformed tibia and fibula. She is oriented
with respirations of 20 and a pulse of about 100.

Patient # 7. A 16-year-old female who is ambulatory and says she is "OK."

Patient # 8. A 42-year-old woman with no obvious injuries and without a carotid

pulse.

Patient # 9. 19-year-old male with 2nd and 3rd degree burns over about 80 percent
of his body. Respirations 24 and pulse about 120.

Patient # 10. A 36-year-old man is unresponsive with brain matter showing.

Reference:

Quiz: How accurately can you triage 10 MCI patients? (2017, January 12).
Retrieved from https://www.ems1.com/mass-casualty-incidents-
mci/articles/quiz-how-accurately-can-you-triage-10-mci-patients-
RjR0YqgEfP6uwakz/

ACTIVITY # 2:
INTRAVENOUS FLUID & DOSAGE CALCULATION

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A. Instruction: Read and understand what is asked. Show your computation and
highlight the final answer.

1. Dr. Sabio ordered to hook 1 liter of Plain LR solution to a 20 year-old boy with a
chief complaint of LBM and vomiting for 2 days. In a 1 liter Plain LR, 250 cc is FD
and regulate the remaining IV for 5 hours. The IV administration started at exactly
2 in the afternoon.

a. Compute the regulation of the remaining IV. Show your computation.

Answer:

b. What is the level of the remaining IVF and when will the administration of the
1liter PLR end?

Answer:

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2. Andrea was admitted in the Emergency Department due to hypovolemia. Upon
assessment, the patient manifested signs of dehydration and the Blood pressure is
80/50 mmHg.

As ER nurse, you are aware that doctor will order what type of IVF? Write your
answer and give the rationale.

Answer:

3. Mrs. Tan was brought to the Emergency Room because of elevated blood
pressure (170/100 mmHg). The doctor ordered Captopril 25 mg 1 tab.

a. As a nurse, you are aware that this drug can be given up to how many
doses?

Answer:_____________

b. After the first dose, the BP should be re-checked after how many minutes?

Answer:_______________

c. The route of administration of this drug is through;

Answer:________________

4. A student from SSU was admitted to the Emergency Room due to Nausea and
Vomiting 2 days prior to admission. Doctor Yulo ordered metoclopromide 5 mg
through IVTT as STAT med.

a. What is the action of this drug?

Answer:_______________________________________________

b. If Metoclopromide is 10 mg/ ampule and 1 amp contains 2 ml of this drug,

how many ml will you prepare for this patient? Show your computation.

Answer:

c. What is the common side effect of this drug?

Answer:______________________________________________________________

5. A pregnant woman was brought to the emergency room due to infection. The
patient manifested signs and symptoms of infection and the body temperature is

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39.2  C. The Doctor ordered Amoxicillin 350 mg IVTT STAT and Paracetamol 300
mg IVTT STAT.

a. If 1 vial of amoxicillin is 500 mg and the diluent is 2 ml water for injection.

How many ml of this drug will you give? Show your computation.

Answer:

B. Fill in the box the IV cannula gauges and their corresponding colors. Start from
the smallest diameter to the largest diameter.

Gauge Number Color

1.
2.
3.
4.
5.
6

C. Give examples of the Intravenous Fluids under colloids and crystalloids and give
their uses.

Colloids Uses Crystalloids Uses

ACTIVITY # 3:

EMERGENCY ROOM NURSING PROCEDURES

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A. Instruction: “Rule of Nines” method of estimating total body surface area (TBSA)
is an easy way to get a rough burn size estimate that can be used when calculating a
patients fluid resuscitation needs for adult. Using the image below, write the
corresponding percentage in each body surface area using the Rule of Nines.

Classification of Burns. Fill in the blanks. NO ERASURES.

FIRST DEGREE SECOND DEGREE THIRD DEGREE

Partial thickness
Skin reddened

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 Outer layer of skin
damaged
Painful
Heals without grafting

Test II. Matching type. NO ERASURES.

COLUMN A COLUMN B

________1. Keep dressing wet. A. Mafenide (sulfamylon)

________2. Open method. B. Silver nitrate
________3. Burn butter C. Silver sulfadiazine(Silvadene)
________4. Can leave a gray/black stain. D. Gentamycin cream
________5. Remove previously applied cream.

Multiple choice. Wite the letter of the correct answer on the space provided before
each number. NO ERASURES. USE CAPITAL LETTERS ONLY.

_____1. Carbon monoxide poisoning is treated with

a. 20% oxygen
b. 40% oxygen
c. 60 % oxygen
d. 100% oxygen
_____2. A client was admitted to the emergency room with 70% burn. The nurse
understands that the goals for this client are the following EXCEPT;
a. Prevent complications of mobility
b. Control pain
c. Promote healing
d. Correct F&E
_____3. Which of the following descriptions best define eschar?
a. Infected burned tissue
b. Edematous live tissue
c. A black crust without blood supply
d. A blood blister
_____4. A foley catheter was inserted to monitor Mr. Adams urine output. A
desirable urine output for him would be
a. 10-20 ml/hr
b. 20-25 ml/hr
c. 30-50 ml/hr
d. None of the above
_____5. Few medications are given in the ER following burn trauma; however
a. Tetanus toxoid is usually given for prophylactic reasons
b. A wide spectrum antibiotics is given for prophylactic reasons
c. ACTH is given to support body responses
d. Gamma globulin is given for prophylactic reasons

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_____6. A preschooler was admitted to the ER department with burns of the back,
right extremities, head and perineal area. Compute how many percent by using the
rule of nines;
a. 37%
b. 52%
c. 49.5%
d. 59.5%
_____7. A nurse caring for a patient with 3rd degree burn would least likely to assess
which of the following manifestation? SELECT ALL THAT APPLY.
a. Brown and leathery appearance
b. Waxy appearance
c. Blister formation
d. Epidermis and much dermis damage
e. Painless
_____8. A client with burn who will undergo debridement asked the nurse about the
maximum time the procedure will take because he still has some errands for the rest
of the day. The best response of the nurse should be’ the maximum time for
debridement is
a. 30 minutes only
b. 1 hour only
c. 2 hours only
d. 2 1/12 hours only
e. 3 and ½ hours only
_____9. Which of the following diet are appropriate for a client with burn? SELECT
ALL THAT APPLY
a. high protein diet
b. acid ash diet
c. low residue diet
d. high carbohydrate
e. high caloric diet
_____10. Definitive diagnosis of carbon monoxide poisoning can be determined by
a. arterial blood gas
b. carbon monoxide urine test
c. carboxyhemoglobin blood level
d. clinical signs and symptoms

B. URINARY CATHETERIZATION

Urinary catheterization refers to the insertion of a catheter tube through the urethra
and into the bladder to drain urine. Although not a particularly complex skill,
urethral catheterization can be difficult to master. Both male and female
catheterizations present unique challenges.

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 Having adequate lighting and visualization is helpful, but does not ensure entrance of
the catheter into the female urethra. It is not uncommon for the catheter to enter
the vagina. Leaving the catheter in the vagina can assist in the correct insertion of a
new catheter into the urethra, but you must remember to remove the one in the
vagina.
For some women, the supine lithotomy position can be very uncomfortable or even
dangerous. For example, patients in the last trimester of pregnancy may faint with
decreased blood supply to the fetus in this position. Patients with arthritis of the
knees and hips may also find this position extremely uncomfortable. Catheterization
may also be accomplished with the patient in the lateral to Sims position (three-
quarters prone).

The male urinary sphincter may also be difficult to pass, particularly for older men
with prostatic hypertrophy.
There are two types of urethral catheterization: intermittent and indwelling.
Intermittent catheterization (single-lumen catheter) is used for:
 Immediate relief of urinary retention
 Long-term management of incompetent bladder
 Obtaining a sterile urine specimen
 Assessing residual urine in the bladder after voiding (if a bladder scanner is
not available)
Indwelling catheterization (double- or triple-lumen catheter) is used for:
 Promoting urinary elimination
 Measuring accurate urine output
 Preventing skin breakdown
 Facilitating wound management
 Allowing surgical repair of urethra, bladder, or surrounding structures
 Instilling irrigation fluids or medications
 Assessing abdominal/pelvic pain
 Investigating conditions of the genitourinary system

The steps for inserting an intermittent or an indwelling catheter are the same, except
that the indwelling catheter requires a closed drainage system and inflation of a
balloon to keep the catheter in place. Indwelling catheters may have two or three
lumens (double or triple lumens). Double-lumen catheters comprise one lumen for
draining the urine and a second lumen for inflating a balloon that keeps the catheter
in place. Triple-lumen catheters are used for continuous bladder irrigation and for
instilling medications into the bladder; the additional lumen delivers the irrigation
fluid into the bladder.
Indwelling urinary catheters are made of latex or silicone. Intermittent catheters may
be made of rubber or polyvinyl chloride (PVC), making them softer and more flexible
than indwelling catheters (Perry et al., 2014). The size of a urinary catheter is based
on the French (Fr) scale, which reflects the internal diameter of the tube.
Recommended catheter size is 12 to 16 Fr for females, and 14 to 16 Fr for males.
Smaller sizes are used for infants and children. The balloon size also varies with
catheters: smaller for children (3 ml) and larger for continuous bladder irrigation (30
ml). The size of the catheter is usually printed on the side of the catheter port.

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An indwelling catheter is attached to a drainage bag to allow for unrestricted flow of
urine. Make sure that the urinary bag hangs below the level of the patient’s bladder
so that urine flows out of the bladder. The bag should not touch the floor, and the
patient should carry the bag below the level of the bladder when ambulating.

Instruction: Answer the questions related to the steps of inserting urinary

catheter. The questions are in red font color.

STEPS RATIONALE
Verify physician order for catheter insertion. Q: WHY DO WE NEED TO PALPATE THE
Assess for bladder fullness and pain by FULL BLADDER?
palpation or by using a bladder scanner. A:

Position patient prone to semi-upright with Assessment of perineal area allows for
knees raised; apply gloves; and inspect determination of perineal condition and
perineal region for erythema, drainage, and position of anatomical landmarks to assist
odour. Also assess perineal anatomy. with insertion.

Remove gloves and perform hand hygiene. This prevents transmission of

microorganisms.

Gather supplies: Preparation ahead of time enhances

Sterile gloves patient comfort and safety.
Catheterization kit
Cleaning solution
Lubricant (if not in kit)
Prefilled syringe for balloon inflation
as per catheter size
Urinary bag
Foley catheter

Check for size and type of catheter, and use Q: WHAT WILL HAPPEN IF YOU USE A
smallest size of catheter possible. LARGER SIZE CATHETER TO THE PATIENT?

A:

Place waterproof pad under patient. This step prevents soiling of bed linens.

7. Positioning of patient depends on gender. Patient should be comfortable, with

perineum or penis exposed, for ease and
Female patient: On back with knees flexed safety in completing procedure.
and thighs relaxed so that hips rotate to
expose perineal area. Q: WHAT CAN BE THE

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ALTERNATIVE POSITION FOR A PATIENT WHO
CANNOT ABDUCT LEG AT THE HIP?
A:

Male patient: Supine with legs extended and

slightly apart.

Place a blanket or sheet to cover patient and

expose only required anatomical areas. This step helps protect patient dignity.

Apply clean gloves and wash perineal area Cleaning removes any secretions, urine,
with warm water and soap or perineal and feces, and reduces risk of CAUTI.
cleanser according to agency policy.
Ensure adequate lighting.

Add supplies and cleaning solution This step ensures preparation and
to catheterization kit, and according organization for procedure
to agency policy.

If using indwelling catheter and closed Urinary bag should be closed to prevent
drainage system, attach urinary bag to the urine drainage leaving bag.
bed and ensure that the clamp is closed.

Apply sterile gloves using sterile technique. This reduces the transmission of

microorganisms.

Drape patient with drape found in Q: HOW MANY CM OUTSIDE THE EDGES IS
catheterization kit, either using sterile gloves CONSIDERED NON-STERILE ON A
or using ungloved hands and only touching STERILE DRAPE?
the outer edges of the drape. Ensure that any
sterile supplies touch only the middle of the
sterile drape (not the edges), and that sterile
gloves do not touch non-sterile surfaces.
Drape patient to expose perineum or penis.

Lubricate tip of catheter using sterile Q: WHY DO WE NEED TO LUBRICATE THE

lubricant included in tray, or add lubricant CATHETER?
using sterile technique.

Check balloon inflation using a sterile syringe. This maintains sterility of catheter.

Place sterile tray with catheter between Sterile tray will collect urine once catheter
patient’s legs. tip is inserted into bladder.

Clean perineal area. This process helps visualize urethral

meatus and relax external urinary

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Q: HOW DO YOU CLEAN THE PERINEAL AREA sphincter.
AND MALE GENITALS? WRITE THE CORRECT
PROCEDURE
Female patient:

Male patient:

Pick up catheter with sterile dominant hand Holding catheter closer to the tip will help
7.5 to 10 cm below the tip of the catheter. to control and manipulate catheter during
insertion.

 Insert catheter as follows. FILL IN THE This process helps visualize urethral
BLANKS meatus and relax external urinary
Female patient: sphincter.
Ask patient to bear down gently (as if
to void) to help expose urethral meatus.
Advance catheter ___to ___ cm until
urine flows from catheter, then advance an
additional ____ cm.

Male patient:
Hold penis perpendicular to body
and pull up slightly on shaft.
Ask patient to bear down gently (as if
to void) and slowly insert catheter through
urethral meatus.

 Advance catheter ____ to ___ cm or

until urine flows from catheter.

Note: If urine does not appear in a female

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patient, the catheter may be in the patient’s
vagina. You may leave catheter in vagina as a
landmark, and insert another sterile catheter.

Note: If catheter does not advance in a male

patient, do not use force. Ask patient to take
deep breaths and try again. If catheter still
does not advance, stop procedure and
inform physician. Patient may have an
enlarged prostate or urethral obstruction.

Place catheter in sterile tray and collect urine Urine specimen may be required for
specimen if required. analysis. Collect as per agency policy.

Slowly inflate balloon for indwelling The size of balloon is marked on the catheter
catheters according to catheter size, port.
using prefilled syringe.
Q: HOW MANY ML OF FLUID WILL BE
INJECTED TO INFLATE THE BALLOON?

Note: If patient experiences pain on balloon

inflation, deflate balloon, allow urine to
drain, advance catheter slightly, and reinflate
balloon.

After balloon is inflated, pull gently on Moving catheter back into bladder will
catheter until resistance is felt and then avoid placing pressure on bladder neck.
advance the catheter again.

Connect urinary bag to catheter using sterile Keep urinary bag _________level of
technique. patient’s bladder.

Secure catheter to patient’s leg using Securing catheter reduces risk of CAUTI,
securement device at tubing just above urethral erosion, and accidental catheter
catheter bifurcation. removal.

Female patient: Secure catheter to

______________________, allowing enough
slack to prevent tension.

Male patient: Secure catheter to upper thigh

(with penis directed downward) or abdomen
(with penis directed toward chest), allowing
enough slack to prevent tension. Ensure
foreskin is not retracted.

Dispose of supplies following agency policy.

Remove gloves and perform hand hygiene.

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Document procedure according to agency
policy, including patient tolerance of
procedure, any unexpected outcomes, and
urine output.

Data source: BCIT, 2015c; Perry et al., 2014

C. REMOVAL OF FOREIGN OBJECT INSIDE THE EAR.

1. A client arrives at the emergency department and reports, “An insect has
somehow made its way into my ear” the client reports buzzing sound in the ear.”
What interventions would the nurse anticipate to be prescribed initially?

Answer:

2. A little girl was brought to the Emergency Room due to a small seed inserted
inside the ear. Explain how this object will be removed from the kid’s ear.

Answer:

D. WOUND DRESSING

Dressings for wounds come in direct contact with wounds, and aid in preventing
infection. They are meant to stop bleeding and absorb excess secretions so the
wound can begin to heal. There are several types of wound dressings.

Instruction: Give the uses or indications of the following types of wound dressing.

 Hydrocolloid —

 Hydrogel —

 Alginate —

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  Collagen —

E. ECG

1. Instruction: Draw and color ECG electrodes on the patient’s chest below to
show the correct placement of 12 Lead ECG electrodes. Make sure to label the
electrodes from V1-V6 and observe the correct color -coding of each electrodes.

2. Explain the nursing responsibilities before, during, and after performing ECG
procedure to a patient.

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References:

Doyle, G. R., & McCutcheon, J. A. (2015, November 23). 10.4 Urinary Catheters. Retrieved from
https://opentextbc.ca/clinicalskills/chapter/10-3-urinary-catheters/

Team, F.-T. H. L. (n.d.). Types of Wound Care for Wound Healing. Retrieved from
https://www.fishertitus.org/health/wound-care-for-wound-healing

ACTIVITY # 4:
BASIC LIFE SUPPORT AND ADVANCED CARDIAC LIFE SUPPORT

Instruction:

Multiple choice. Wite the letter of the correct answer on the space provided before
each number. NO ERASURES. USE CAPITAL LETTERS ONLY.

1. Which of the following is the most important factor in surviving an out-of-

hospital cardiac arrest?
a. Immediate airway control with intubation.
b. Rapid transport to appropriate facility.
c. Early defibrillation.
d. Aggressive management of hypotension.

2. One of the critical activities a Bystander Lay rescuer should do in an Out of

Hospital Cardiac Arrest ?
a. Check pulse and Breathing for 10 seconds
b. Do Head tilt Chin lift and give 2 full breaths
c. Rapid Defibrillation using AED
d. Call for Help (EMS) after doing immediate CPR

3. A 50-year-old man who has been eating steak in a restaurant abruptly stands
up and immediately collapses to the floor. The rescuer determines that the victim is
cyanotic. The best response is to:
a. Do nothing; wait until the victim becomes responsive
b. Use back blows
c. Use abdominal thrusts
d. Use upward chest thrusts

4. Your patient in the ER has a strong pulse and regular heart rate of 182 beats
per minute with a normal QRS on the cardiac monitor. Her blood pressure is 112/56.
She is awake and denies any pain. What is the next best intervention:
a. Attempt vagal maneuvers

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 b. Administer adenosine 6 mg IV
c. Normal Saline 1 L bolus
d. Perform synchronized cardioversion

5. How often should a patient be ventilated if they are experiencing respiratory

arrest?
a. Once every 7 to 8 seconds or 10 to 12 times per minute
b. Once every 8 to 9 seconds or 8 to 10 times per minute
c. Once every 5 to 6 seconds or 10 to 12 times per minute
d. Once every 2 to 3 seconds or 15 to 17 times per minute

6. The recommended Depth of Chest Compressions during CPR

a. 2 to 2 1⁄2 inches over lower half of sternum
b. 2 to 2.4 inches over the lower half of sternum
c. 4 to 5cm over the lower half of sternum
d. 5 to 5.5 cm over the lower half of sternum

7. Which of the following is correct regarding Airway management during CPR?

a. Deliver synchronous 15:2 compression ventilation ratio
b. Deliver asynchronous compression/ventilation rates at 30:2
c. When the airway is protected, the compression/ventilation ratio should be 100-
120/minutes and 1 breath every 6 seconds.
d. The rescuer can hear an air leak around the mask

8. What is the most immediate sign confirming ET tube placement?

a. Chest Xray is the fastest way to confirm tube placement
b. Auscultation
c. Decreased cyanosis
d. Seeing the chest rise during ventilation.

9. Immediate endotracheal intubation would be indicated for which of the following

patients?
a. An elderly woman with severe chest pain and shallow respirations at 30
breaths/min
b. A 55-year-old insulin-dependent diabetic with ST-segment elevation and runs
of VT
c. An apneic patient whose chest does not rise with bag-mask ventilations
d. A subdued, alcohol-intoxicated college student with a reduced gag reflex

10. Proper sequence of events indicated for the performance of CPR and the
operation of an AED.
a. Send someone to call EMS, attach AED electrode pads, open the airway, turn
on the AED, provide 2 breaths, check for a pulse
b. Wait for the AED and barrier device to arrive, open the airway, provide 2
breaths, check
for a pulse,if no pulse attach AED electrode pads, follow AED prompts
c. Check scene safety, check the patient for responsiveness, send someone to call

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EMS, check for a pulse, if no pulse start compressions until the AED arrives then
attach the AED, follow AED prompts
d. Provide 2 breaths, check for a pulse, if no pulse perform chest compressions
for 1 minute, call for the AED, when the AED arrives attach electrode pads

11. The technique used to clear the victim's airway is:

a. Push chin down, tilt head forward.
b. Lift chin up, tilt head back.
c. Lift chin up, turn head sideways.
d. None of the above.

12. You are a lay bystander first time doing CPR on a man who is unresponsive,
pulseless and apneic. Nearest AED has just arrived . The AED advises you to press the
shock button and you give a shock. What do you do next?
a. Reanalyze the victim's rhythm
b. Perform CPR until EMS personnel arrive
c. Start 30 chest compressions then give 2 breaths
d. Leave the AED attached and start transport to the nearest ED, stopping every 3
minutes for the AED to reanalyze

13. During cardiopulmonary resuscitation, deliver oxygen at:

a. Titrated  to  keep  oxygen  saturation  ≥  94%
b. Titrated  to  keep  oxygen  saturation  ≥  85%
c. 100%
d. 2 Liters per minute via nasal cannula

14. A 65 year old man in the ER reports 30 minutes of severe crushing substernal
chest pain. BP 110/70 mm Hg , HR 58/min. The patient has received Aspirin 325 mg
orally, O2 at 4L/min nasal cannula, 3 SL Nitroglycerin tabs 5 mins apart, but
continues to have severe chest pain. Which should be given next if there are no
contraindications?
a. Atropine 0.5 to 1mg IV
b. Furosemide 20 to 40 mg IV
c. Lidocaine 1 to 1.5 mg/kg IV
d. Morphine 2 to 4 mg IV

15. A 49 year old man has crushing chest pain. He is pale, diaphoretic, drowsy and
slow to respond to questions. His BP is 60/40 mm Hg, HR 190/min, RR 18/min. What
should be the next best intervention?
a. Do12LECG
b. Give Amiodarone 300mg IV.
c. Procedural sedation
d. Perform synchronized cardioversion

16. The medication that should NOT be given via endotracheal tube is:
a. Lidocaine
b. Amiodarone

22
c. Vasopressin
d. Epinephrine

17. Which cause of PEA is most likely to respond to immediate treatment ?

a. Massive Pulmonary embolism
b. Hypovolemia
c. Massive Acute Myocardial Infarction
d. Myocardial rupture

18. . For which of the following rhythms would transcutaneous cardiac pacing be
indicated?
a. Sinus bradycardia with no symptoms
b. Normal sinus rhythm with hypotension and shock
c. Complete heart block with pulmonary edema
d. Asystole that follows 6 or more defibrillation shocks

19. Which cause of Out of Hospital Arrest in Asystole is most likely to respond to
treatment ?
a. Prolonged cardiac arrest
b. Prolonged submersion in warm water
c. Drug overdose
d. Blunt multisystem Trauma

20. Synchronized cardioversion is indicated for which of the following patients?

a. A 78-year-old woman with fever, pneumonia, chronic congestive heart failure,
and sinus
tachycardia at 125 bpm
b. A 55-year-old man with multifocal atrial tachycardia at 125 bpm, respiratory
rate of 12 breaths/minute, and BP of 134/86 mm Hg
c. A 69-year-old woman with a history of coronary artery disease, chest pain, a 2-
mm ST
elevation, and sinus tachycardia at 130 bpm
d. A 62-year-old man with a history of rheumatic mitral valve disease, obvious
shortness of breath, HR of 160 bpm, and BP of 80/50 mm Hg

21. Energy ( joules) for defibrillation in Ventricular fibrillation?

a. 200 joules (monophasic)
b. 300 joules (monophasic)
c. 360 joules (monophasic)
d. 400 joules (monophasic)

22. After initiation of CPR and 1 shock, ventricular fibrillation is present. A second
shock is given, and chest compressions and bag mask ventilations are resumed.
What should be the next order?
a. 3 sequential shocks at 360 joules
b. Amiodarone 300 mg IV
c. Epinephrine 1 mg IV

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d. Endotracheal intubation. Give 100% Oxygen.

23. Vasopressin is recommended for which of the following :

a. Supraventricular tachycardia with a pulse
b. Pulseless Electrical Activity
c. Monomorphic wide complex Tachycardia with pulse
d. None of the above

24. Your patient presents with PEA. When would sodium bicarbonate therapy (1
mEq/kg) be most effective?
a. A patient with hypercarbic acidosis due to a tension pneumothorax
b. A patient with a brief arrest interval
c. A patient with documented severe hyperkalemia
d. A patient with documented severe hypokalemia

25. Which of the following treatments is included in the definitive therapy for a 62-
year-old man with >3mm ST-segment elevation within 30 minutes of the onset of
symptoms of acute myocardial infarction?
a. Fibrinolytics or PCI, aspirin, ß-blockers, heparin
b. Heparin, aspirin, glycoprotein Ilb/Illa inhibitors, IV ß-blockers, nitrates
c. Serum cardiac markers, serial ECGs, perfusion scan or stress test
d. Prophylactic lidocaine, fluid bolus, vasopressor infusion

26. In which of the scenario's below would you not cardiovert a patient with stable
tachycardia
a. A 25-year-old wheezing asthmatic woman who has pneumonia on chest x-ray,
who is taking albuterol, and who has the following vital signs: temp = 101.2'F, HR =
140 bpm,resp = 20 breaths/min
b. A 55-year-old man with diaphoresis, bilateral rales, and the following vital
signs: HR =140 bpm,BP = 90/55 mrn Hg, resp = 18 breaths/min, rhythm = rapid atrial
flutter
c. A 62-year-old man with a wide-complex tachycardia at a rate of 140 bpm,
chestpain, shortness of breath, and palpitations
d. A 55-year-old woman with chest pain, shortness of breath, extreme weakness
and dizziness, BP of 88/54 mm Hg, and a narrow-complex tachycardia at a rate of
145 bpm

27. A 49-year-old female came to the ER complaining of sudden onset of palpitations

and lightheadedness. She had a BP of 110/70. She otherwise denies other signs and
symptoms. Her ECG showed :

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Which of the following interventions are not acceptable for this patient :
a. carotid sinus massage
b. cardiovert at 100 joules
c. verapamil 2.5 mg IV
d. adenosine 6 mg IV bolus

28. The  patient’s  rhythm  persisted  despite  your  initial  intervention. After a few
minutes, the patient became hypotensive with 60 mmHg palpatory with cold sweats.
You would give or do:
a. Lidocaine 50 mg IV
b. Cardiovert at 50 joules
c. verapamil 5 mg IV
d. Sedate and perform Electrical Cardioversion

29. The  patient’s  ECG  monitor is compatible with:

a. ventricular tachycardia
b. ventricular fibrillation
c. supraventricular tachycardia
d. torsade de pointes

30. Which of the following rhythms do not respond to electrical cardioversion?

a. Ventricular tachycardia
b. Ventricular fibrillation
c. monomorphic ventricular tachycardia
d. atrial flutter

VIDEO LINKS

Watch the following videos to gain knowledge on the following:

Code Blue Simulation https://www.youtube.com/watch?v=UGMEWSleQo8

Mock Code training https://www.youtube.com/watch?v=ksVakjS6-54

How to Triage patients in Emergency department | Triage and patient care

management | https://www.youtube.com/watch?v=iW6Q2cGrUJE

Reference:
Advanced Cardiac Life Support Written Examination Expanded Council on CPR Philippine Heart
Association (2016).

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