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Advanced Cardiac Life Support - 2024
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Question #342
A patient has been resuscitated from cardiac arrest and is being prepared for transport. She is incubated and is receiving 100% oxygen. During the resuscitation she received 2 doses of epinephrine 1 mg, atropine 1 mg, and lidocaine 100 mg IV. You now observe the above rhythm on the cardiac monitor. The rhythm abnormality is becoming more frequent and increasing in number.
You should order:
Give amiodarone 300 mg IV, start infusion
Give lidocaine 1 to 1.5 mg IV
Repeat epinephrine 1 mg IV
Give lidocaine 0.5 to 0.75 mg/kg IV, start lidocaine infusion
Give amiodarone 150 mg IV, start infusion
A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks at you for instruction. Your immediate next order is:
Give atropine 1 mg IV
Resume high-quality chest compressions
Give amiodarone 300 mg IV
Perform endotracheal intubation
Give epinephrine 1 mg IV
A patient presents with the above rhythm complaining of an irregular heartbeat. She has no other complaints. Past medical history is significant for a myocardial infarction 7 years ago. Blood pressure is 110/70 mmHg. At this time you would
Continue monitoring and seek expert consultation
Administer nitroglycerin 0.4 mg sublingual or spray
Perform emergency synchronized cardioversion
Administer lidocaine 1 mo/kg IV
Perform elective synchronized cardioversion with presedation
You arrive on-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 is in progress, and effective ventilation is being provided with bag-mask. An IV has been initiated. You would now
Initiate transcutaneous pacing
Give epinephrine 1.0 mg IV
Order immediate endotracheal intubation
Give atropine 0.5 mg IV
Give atropine 1 mg IV
A 45-year-old woman with a history of palpitations develops lightheadedness and palpitations. She has received adenosine 6 mg IV for the rhythm shown above without conversion of the rhythm. She is now extremely apprehensive. Blood pressure is 108/70 mmHg. The next appropriate intervention is
Perform vagal maneuvers and repeat adenosine 6 mg IV
Perform immediate unsynchronized cardioversion
Repeat adenosine 12 mg IV
Repeat adenosine 3 mg IV
Sedate and perform synchronized cardioversion
You arrive on-scene and find a 56-year-old diabetic woman complaining of chest discomfort. She is pale and diaphoretic, complaining
of lightheadedness. Her blood pressure is 80/60 mmHg. The cardiac monitor documents the rhythm above. She is receiving oxygen at 4 L/min by nasal cannula, and an IV has been established. Transcutaneous pacing has been requested but is not yet available.
Your next order is -
Give morphine sulfate 4 mg IV
Start dopamine at 2 to 10 ug/kg per minute
Give atropine 0.5 mg IV
Give atropine 1 mg IV
Give nitroglycerin 0.4 mg SL
You are evaluating a patient with 15-minute duration of chest pain during transportation to the emergency department. He is receiving oxygen, and 2 sublingual nitroglycerin tablets have relieved his chest discomfort. He has no complaints but appears anxious. Blood pressure is 130/70 mmHg. You observe the above rhythm on the monitor and your next action is
Give atropine 0.5 mg IV
Initiate transcutaneous pacing (TCP)
Continue monitoring patient, prepare for TCP
Administer nitroglycerin 0.4 mg SL
Start epinephrine 2 to 10 ug/min and titrate
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 mmHg. She is apprehensive but has no complaints other than palpitations. At this time you would
Give magnesium sulfate 1 to 2 g over 20 minutes
Seek expert consultation
Give amiodarone 300 mg IV, start infusion
Give lidocaine 1 to 1.5 mg IV, start lidocaine infusion
A patient in the ED 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 intravenous line is patent. Blood pressure is 160/96 mmHg. There are no allergies or contraindications to any medication. You would first order
Lidocaine 1 mg/kg IV and infusion 2 mg/min
Morphine sulfate 2 to 4 mg IV
Nitroglycerin 0.4 mg SL
Amiodarone 150 mg IV
Intravenous nitroglycerin initiated at 10 ug/min and titrated
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 top normal to slightly prolonged. He has received 2 doses of epinephrine 1 mg and 1 dose of amiodarone 300 mg IV so far. For his next medication you would now order
Repeat amiodarone 150 mg IV
Lidocaine 1 to 1.5 mg IV and start infusion 2 mg/minute
Repeat amiodarone 300 mg IV
Give magnesium sulfate 1 to 2 g IV diluted in 10 ml_ D5W given over 5 to 20 minutes
Give sodium bicarbonate 50 mEq IV
This patient suddenly collapsed and is poorly responsive. The patient has a weak carotid pulse. A cardiac monitor, oxygen, and an intravenous line have been initiated. The code cart with all drugs and pF transcutaneous pacer is immediately available. Next you would
Initiate dopamine at 10 to 20 ug/kg per minute and titrate heart rate
Give atropine 1 mg IV up to a total dose of 3 mg
Initiate epinephrine at 2 to 10 ug per minute and titrate heart rate
Initiate dopamine at 2 to 10 ug/kg per minute and titrate heart rate
Begin transcutaneous pacing
Following initiation of CPR and one shock for VF, this rhythm is present on the next rhythm check. A second shock is given and chest compressions are immediately resumed. 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 amiodarone 300 mg IV
Administer 3 sequential (stacked) shocks at 360 Joules (monophasic defibrillator)
Perform endotracheal intubation; administer 100% oxygen
Administer 3 sequential (stacked) shocks at 200 Joules (biphasic defibrillator)
Prepare to give epinephrine 1 mg IV
A patient with an acute Ml on a 12-lead ECG transmitted by the paramedics has the above findings on a rhythm strip when a monitor is placed in the ED. The patient had resolution of moderate (5/10) chest pain with three doses of sublingual nitroglycerin. Blood pressure is 104/70 mmHg. Which intervention below is most important, reducing in-hospital and 30-day mortality?
Atropine 1 mg IV, total dose 3 mg as needed
Intravenous nitroglycerin for 24 hours
Reperfusion therapy
Atropine 0.5 mg IV, total dose 2 mg as needed
Temporary pacing