Arrhythmias Flashcard 6
Rationale
C. Rationale: A pulse check should only be performed if rescuers observe an organized rhythm present on the monitor. Pulse checks delay or interrupt chest compressions and should be avoided until an organized rhythm is present on the monitor.
Question
In the VF/pulseless VT algorithm, pulse checks are performed:
A. After every 2 ventilations
B. After every 2-minute increment of CPR
C. Only if an organized rhythm is observed on the monitor
D. After every defibrillation attempt
Answer
C. Only if an organized rhythm is observed on the monitor
Rationale
D. Rationale: These are all signs of tension pneumothorax. In addition, the trachea may deviate to the unaffected side. Treatment for tension pneumothorax is needle decompression/chest tube insertion.
Question
Jugular venous distention, absence of a pulse felt with CPR, unequal breath sounds, and difficulty ventilating the patient may indicate:
A. Drug or toxin overdose
B. Massive MI
C. Cardiac tamponade
D. Tension pneumothorax
Answer
D. Tension pneumothorax
Rationale
D. Rationale: When asystole is identified on the monitor, clinicians must quickly rule out other causes of an isoelectric ECG, such as those listed. Providers should also check two different leads.
Question
Possible causes of an isoelectric ECG (flat line) include:
A. Gain or amplitude too low
B. No power supply to the monitor
C. Loose/unattached leads
D. All of these
Answer
D. All of these
Rationale
A. Rationale: Conscious patients require analgesia. Electrical stimulation may cause muscular jerking that can mimic the carotid pulse.
Question
Precautions for transcutaneous pacing include:
a. TCP is contraindicated in severe hypothermia.
b. Analgesia is not required.
c. Assess the carotid pulse to confirm mechanical capture.
d. All of the above
Answer
a. TCP is contraindicated in severe hypothermia.
Rationale
D. Rationale: Valid reasons to stop or withhold resuscitative efforts include rigor mortis, documented DNR (do not resuscitate) status, or a threat to the safety of healthcare providers. Trauma that is not compatible with life, such as decapitation, is also a valid reason not to begin CPR. Asystole carries a very poor prognosis and often represents the end of life—prolonged efforts are unnecessary. Rigor mortis indicates that the patient has been deceased for an extended period of time. Hypothermic patients should undergo rewarming before being declared dead.
Question
Reasons to withhold resuscitative efforts or stop CPR include:
A. Rescuer fatigue
B. Hypothermia
C. An organized rhythm on the monitor but no palpable pulse
D. Rigor mortis
Answer
D. Rigor mortis
Rationale
B. Rationale: Interruptions should be minimized in CPR. CPR should not be stopped to administer drugs.
Question
Resuscitators may stop CPR to administer drugs.
a. True
b. False
Answer
b. False
Rationale
C. Rationale: Gaining IV/IO access takes priority over insertion of an advanced airway in the asystole algorithm. Insertion of an advanced airway is recommended only when ventilation with a bag-mask is ineffective.
Question
Routine insertion of an advanced airway in asystole:
A. Is contraindicated in a patient in asystole
B. Should take priority over gaining IV/IO access
C. Should only be performed if ventilations with a bag-mask are ineffective
D. Is necessary so that epinephrine can be given
Answer
C. Should only be performed if ventilations with a bag-mask are ineffective
Rationale
B. Rationale: Sedation should be given to most conscious patients unless they are in cardiovascular collapse or rapidly deteriorating. Sedative approach includes parenteral narcotics for analgesia and parenteral benzodiazepines for anxiety and muscle contractions.
Question
Sedation should:
a. Be given to all conscious patients before pacing
b. Include benzodiazepines
c. Include Propofol
d. Not be given in the presence of acute ischemia
Answer
b. Include benzodiazepines
Rationale
C. Rationale: The rhythms that are amenable to defibrillation are ventricular fibrillation (VF) and pulseless VT. Asystole and PEA do not respond to defibrillation.
Question
Shockable rhythms include:
A. VF, PEA
B. Pulseless VT, PEA
C. VF, pulseless VT
D. VF, asystole
Answer
C. VF, pulseless VT
Rationale
A. Rationale: Whether an AED or a manual defibrillator is used, shocks delivered to the patient of VF or pulseless VT are unsynchronized. When a patient is in VF or pulseless VT, high-quality CPR should be provided until the pads have been placed and the defibrillator (whether an AED or a manual defibrillator) is ready to shock. Minimize any interruptions in CPR.
Question
Shocks delivered to the patient in VF or pulseless VT should be:
A. Unsynchronized
B. Synchronized
C. Either synchronized or unsynchronized – it doesn’t matter as long as the patient receives a shock
D. Delayed until the patient has been provided with 3–5 minutes of high-quality CPR
Answer
A. Unsynchronized