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Which of the following statements about the use of magnesium in cardiac arrest is most accurate?
Magnesium is indicated for VF/pulseless VT associated with torsades de pointes.
A patient with ST-segment elevation MI has ongoing chest discomfort. Fibrinolytic therapy has
been ordered. Heparin 4000 units IV bolus was administered, and a heparin infusion of 1000 units per hour is
being administered. Aspirin was not taken by the patient because he had a history of gastritis treated 5 years
ago. Your next action is to:
Give aspirin 160 to 325 mg chewed immediately.
A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a
total of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure
is 110/60 mm Hg. Which of the following is now indicated?
Start epinephrine 2 to 10 mcg/min.
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A 62-year-old man suddenly experienced difficulty speaking and left-side weakness. He was
brought to the emergency department. He meets initial criteria for fibrinolytic therapy, and a CT scan of the
brain is ordered. What are the guidelines for antiplatelet and fibrinolytic therapy
Do not give aspirin for at least 24 hours if rtPA is administered
A patient with possible ST-segment elevation MI has ongoing chest discomfort. Which of the
following would be a contraindication to the administration of nitrates?
Use of a phosphodiesterase inhibitor within 12 hours
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Of the
following, which drug and dose should be administered first by the IV/IO route?
Epinephrine 1 mg
: A 35-year-old woman has palpitations, light-headedness, and a stable tachycardia. The monitor
shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in
terminating the rhythm. An IV has been established. What drug should be administered IV?
Adenosine 6 mg
A patient with sinus bradycardia and heart rate of 42/min has diaphoresis and a blood pressure of
80/60 mm Hg. What is the initial dose of atropine?
0.5 mg
A patient is in refractory ventricular fibrillation and has received multiple appropriate
defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of 300 mg amiodarone IV. The patient is
intubated. A second dose of amiodarone is now called for. The recommended second dose of amiodarone is
150 mg IV push
A patient with a possible acute coronary syndrome has ongoing chest discomfort unresponsive to
3 sublingual nitroglycerin tablets. There are no contraindications, and 4 mg of morphine sulfate was
administered. Shortly afterward, blood pressure falls to 88/60 mm Hg, and the patient has increased chest
discomfort. You should
Give normal saline 250 mL to 500 mL fluid bolus
A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is
asymptomatic, with a blood pressure of 110/70 mm Hg. He has a history of angina. Which of the following actions is recommended?
Seeking expert consultation
You arrive on the scene with the code team. High-quality CPR is in progress. An AED has
previously advised “no shock indicated.” A rhythm check now finds asystole. After resuming high-quality
compressions, your next action is to
Gain IV or IO access
A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been
given. Which is the next drug/dose to anticipate to administer
Amiodarone 300 mg
Your patient has been intubated. IV/IO access is not available. Which combination of drugs can
be administered by the endotracheal route
Lidocaine, epinephrine, vasopressin
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. What
is the recommended route for drug administration during CPR?
iv.oi
A patient is in refractory ventricular fibrillation. High-quality CPR is in progress, and shocks have
been given. One dose of epinephrine was given after the second shock. An antiarrhythmic drug was given
immediately after the third shock. What drug should the team leader request to be prepared for administration
next?
Second dose of epinephrine 1 mg
A 57-year-old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a
regular wide-complex ORS at a rate of 180/min. She becomes diaphoretic, and her blood pressure is 80/60 mm Hg. The next action is to:
Perform immediate electrical cardioversion
Bradycardia requires treatment when
Chest pain or shortness of breath is present
Which of the following statements is most accurate regarding the administration of vasopressin
during cardiac arrest?
The correct dose of vasopressin is 40 units administered by IV or IO
A patient is in cardiac arrest. High-quality chest compressions are being given. The patient is
intubated and an IV has been started. The rhythm is asystole. Which is the first drug/dose to administer?
Epinephrine 1 mg or vasopressin 40 units IV or IO
A 45-year-old woman with a history of palpitations develops light-headedness and palpitations.
She has received adenosine 6 mg IV for the rhythm shown above (Reentry supraventricular tachycardia) without conversion of the rhythm. She is now
extremely apprehensive. Blood pressure is 108/70 mm Hg. What is the next appropriate intervention?
Repeat adenosine 12 mg IV
A patient in the emergency department develops recurrent chest discomfort (8/10) suspicious for
ischemia. His monitored rhythm becomes irregular as seen above. Oxygen is being administered by nasal
cannula at 4 L/min, and an IV line is in place. Blood pressure is 160/96 mm Hg. There are no allergies or
contraindications to any medication. You would first order:
Sublingual nitroglycerin 0.4 mg
Following initiation of CPR and 1 shock for VF, this rhythm is present on the next rhythm check.
A second shock is given and chest compressions are resumed immediately. An IV is in place and no drugs have
been given. Bag-mask ventilations are producing visible chest rise. What is your next order?
Prepare to give epinephrine 1 mg IV
You arrive on the scene to find a 56-year-old diabetic woman with dizziness. She is pale and
diaphoretic. Her blood pressure is 80/60 mm Hg. The cardiac monitor documents the rhythm below. (s. bradycardia) She is
receiving oxygen at 4 L/min by nasal cannula and an IV has been established. Your next order is:
Atropine 0.5 mg IV
A patient becomes unresponsive. You are uncertain if a faint pulse is present with the rhythm
below. What is your next action?
Begin CPR, starting with high-quality chest compressions.
The primary decision point in the bradycardia algorithm is the determination of:
adequate perfusion
This patient has been resuscitated from cardiac arrest. During the resuscitation, amiodarone 300
mg was administered. The patient developed severe chest discomfort with diaphoresis. He is now unresponsive.
What is the next indicated action?
Give an immediate unsynchronized high-energy shock (defibrillation dose) vt
You are monitoring the patient and note the rhythm below on the cardiac monitor. She has
dizziness and her blood pressure is 80/40 mm Hg. She has an IV in place. What is your next action?
Give atropine 0.5 mg IV
You arrive on the scene to find CPR in progress. Nursing staff report that the patient was
recovering from a pulmonary embolism and suddenly collapsed. There is no pulse or spontaneous respirations.
High-quality CPR and effective bag-mask ventilation are being provided. An IV has been initiated. What would
you do now?
Give epinephrine 1 mg IV
A 35-year-old woman presents to the emergency department with a chief compliant of
palpitations. She has no chest discomfort, shortness of breath, or light-headedness. Which of the following is
indicated first?
Perform vagal maneuvers.
You are monitoring a patient. He suddenly has the persistent rhythm shown below. You ask about
symptoms and he reports that he has mild palpitations, but otherwise he is clinically stable with unchanged vital
signs. What is your next action?
Administer adenosine 6 mg; seek expert consultation. looks like vtak – but pt is talking!
The patient suddenly becomes unconscious and has a weak carotid pulse. Cardiac monitoring,
supplementary oxygen, and an IV have been initiated. The code cart with all the drugs and transcutaneous pacer
are immediately available. Next you would:
Give atropine 0.5 mg IV
A patient’s 12-lead ECG was transmitted by the paramedics and showed an acute MI. The above
findings are seen on rhythm strip when a monitor is placed in emergency department. The patient had resolution
of moderate (5.10) chest pain with 3 doses of sublingual nitroglycerin. Blood pressure is 104/70 mm Hg. Which
intervention below is most important, reducing in-hospital and 30-day mortality?
Reperfusion therapy.
This patient was admitted to the general medical ward with a history of alcoholism. A code is in
progress and he has recurrent episodes of this rhythm. You review his chart. Notes about the 12-lead ECG say that his baseline QT interval is high normal to slightly prolonged. He has received 2 doses of epinephrine 1 mg
and 1 dose of amiodarone 300 mg IV so far. What would you order for his next medication? vtac poly
Give magnesium sulfate 1 to 2 g IV diluted in 10 mL D5W given over 5 to 20 minutes
: You are the code team leader and arrive to find a patient with above rhythm and CPR in progress.
Team members report that the patient was well but reported chest pain and then collapsed. She has no pulse or
respirations. Bag-mask ventilations are producing visible chest rise, high-quality CPR is in progress, and an IV
has been established. What would be your next order?
Administer epinephrine 1 mg.
A patient presents with the rhythm below and reports an irregular heartbeat. She has no other
symptoms. Her medical history is significant for a myocardial infarction 7 years ago. Blood pressure is 110/70
mm Hg. What would you do at this time?
Continue monitoring and seek expert consultation.
A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your
team looks to you for instructions. Your immediate next order is: asystole
Resume high-quality chest compressions.
You are evaluating a patient with chest discomfort lasting 15 minutes during transportation to the
emergency department. He is receiving oxygen and 2 sublingual nitroglycerin tablets have relieved his chest
discomfort. He reports no other symptoms but appears anxious. Blood pressure is 130/70 mm Hg. You observe
the rhythm below on the monitor. What is your next action?
Continue monitoring the patient and seek expert consultation
Following resuscitation with CPR and a single shock, you observe this rhythm while preparing
the patient for transport. Your patient is stable and blood pressure is 120/80 mm Hg. She is apprehensive but
has no symptoms other than palpitations. At this time you would:
Seek expert consultation
vfib- You are monitoring a patient with chest discomfort who suddenly becomes unresponsive. You
observe the following rhythm on the cardiac monitor. A defibrillator is present. What is your first action?
Give a single shock 200j
: A patient has been resuscitated from cardiac arrest and is being prepared for transport. She is
intubated and is receiving 100% oxygen. Blood pressure is 80/60 mm Hg. During the resuscitation, she received
2 doses of epinephrine 1 mg and 1 does of amiodarone 300 mg IV. You now observe this rhythm on the cardiac
monitor. The rhythm abnormality is becoming more frequent and increasing in number. You should order:
1 to 2 L of normal saline. (3rd block the worst)

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