SHARP EKG ALL FINALS QUESTIONS AND
ANSWERS SET A+
✔✔3rd degree block - ✔✔Independent and extra P waves, and QRS complex. P & V is
regular (irregular 2nd type 1).
✔✔PEA - ✔✔any rhythm )other than vfib or wide-complex tachycardia) that doesn't
produce a pulse. Usually reversable and part of the H's and T's.
✔✔vtach (wide-complex tachycardia) - ✔✔3 or more beats>100. Wide complex
tachycardia w/out pulse and polymorphic vtach (Torsades de Pointes) must be treated
as vfib.
✔✔Vfib - ✔✔NO cardiac output (BP). Most important is immediate uninterrupted CPR
and defib asap.
✔✔Amiodarone - ✔✔1. Main Actions: Effects sodium, potassium, and calcium channels
as well as having alpha and beta- adrenergic blocking properties. Indications:
ventricular rate control in rapid atrial rhythms in patients with severe LV dysfunction,
acts as an adjunct to cardioversion of wide complex tachycardia, and pharmacological
cardioversion of atrial fibrillation 2. Standing Order: Ventricular Fibrillation/ Pulseless V-
tach 3. Considerations: Will produce hypotension and/or bradycardia when given too
quickly. If side effects occur, fluids, pressors, chronotropic agents or temporary pacing
may be useful
✔✔ASA (aspirin) - ✔✔1. Main Actions: Early administration of ASA has been associated
with decreased mortality rates in several clinical trials. It produces a rapid antiplatelet
effect with near total inhibition of thromboxane A2 production. It reduces coronary
reocclusion and recurrent ischemic events after fibrinolytic therapy. 2. Standing Order:
Chest pain 3. Considerations: Aspirin suppositories are safe and may be safely given to
patients with severe GI disorders, vomiting, or nausea. Best to chew ASA
, ✔✔Atropine - ✔✔Anticholinergic. 1. Main Actions: Reverses cholinergic- mediated
decreases in heart rate, and will increase the rate of the sinus node, so it is useful in the
treatment of symptomatic bradycardia. 2. Standing Order: Bradycardia-Unstable 3.
Considerations: May cause tachycardia, angina. Use cautiously in presence of acute
MI, myocardial ischemia.
✔✔Diphenhydramine (Benadryl) - ✔✔1. Main Actions: Antihistamine effect 2. Standing
Order: Severe Anaphylaxis 3. Considerations: Half life prolonged with age, normally 4-
8hrs, decreases mental alertness and psychomotor performance, increases intraocular
pressure, caution with hyperthyroidism, bronchial asthma, CV disease, hypertension.
May cause sloughing of tissue at infusion site
✔✔Dopamine - ✔✔1. Main Actions: A catecholamine that stimulates alpha and beta
adrenergic receptors. The effects are dose related. Doses of 0.5-3mcg/kg/min produce
renal vasodilation Doses of 2-10mcg/kg/min increase cardiac contractility Doses of 10-
20mcg/kg/min produce vasoconstriction. **Note: On PCU level of care, the max drip
dose is 5 mcg/kg/min. Unless the patient requires ICU emergent transfer, then the dose
may use up to 20 mcg/kg/min 2. Standing Order: Hypotension-symptomatic
Bradycardia- when Atropine ineffective 3. Considerations: **Indicated for hypotension
after fluid resuscitation. Dose is titrated to achieve hemodynamic effect. Increases
MV02 without compensatory increases in coronary blood flow causing an imbalance
between 02 supply and demand and may lead to myocardial ischemia. Increases HR
and may induce/exacerbate tachyarrhythmias. Extravasation causes tissue necrosis
and sloughing at site of infusion.
✔✔Ephedrine (PACU only) - ✔✔1. Main Actions: A sympathomimetic agent that causes
vasoconstriction 2. Standing Order: Hypotension in the post-anesthetic patient (PACU
only) 3. Considerations: Can cause cardiovascular changes (excitation, tachycardia)
and urinary retention.
✔✔Epinephrine - ✔✔1. Main Actions: An alpha-adrenergic drug producing potent
vasoconstriction. It can increase coronary and cerebral perfusion pressure during CPR,
but can also increase myocardial work and reduce subendocardial perfusion. 2.
Standing Order: Asystole Unstable Bradycardia PEA V Fib/Pulseless V Tach Severe
Anaphylaxis 3. Considerations: May induce or exacerbate ventricular ectopy especially
when patient has electrolyte imbalance. Coronary ischemia may occur and is not related
to dose, ischemic renal failure can occur with high doses. The drug of choice for severe
anaphylaxis reactions because it blocks inflammatory mediator release from sensitized
cells.
✔✔Hydrocortisone - ✔✔1. Main Actions: Mineral corticoid effect, used for persistent
hypotension 2. Standing Order: Severe Anaphylaxis 3. Considerations: Dose/duration-
dependent. May increase risk of GI distress Barbiturates, Dilantin, rifampin may
decrease effect of steroid
ANSWERS SET A+
✔✔3rd degree block - ✔✔Independent and extra P waves, and QRS complex. P & V is
regular (irregular 2nd type 1).
✔✔PEA - ✔✔any rhythm )other than vfib or wide-complex tachycardia) that doesn't
produce a pulse. Usually reversable and part of the H's and T's.
✔✔vtach (wide-complex tachycardia) - ✔✔3 or more beats>100. Wide complex
tachycardia w/out pulse and polymorphic vtach (Torsades de Pointes) must be treated
as vfib.
✔✔Vfib - ✔✔NO cardiac output (BP). Most important is immediate uninterrupted CPR
and defib asap.
✔✔Amiodarone - ✔✔1. Main Actions: Effects sodium, potassium, and calcium channels
as well as having alpha and beta- adrenergic blocking properties. Indications:
ventricular rate control in rapid atrial rhythms in patients with severe LV dysfunction,
acts as an adjunct to cardioversion of wide complex tachycardia, and pharmacological
cardioversion of atrial fibrillation 2. Standing Order: Ventricular Fibrillation/ Pulseless V-
tach 3. Considerations: Will produce hypotension and/or bradycardia when given too
quickly. If side effects occur, fluids, pressors, chronotropic agents or temporary pacing
may be useful
✔✔ASA (aspirin) - ✔✔1. Main Actions: Early administration of ASA has been associated
with decreased mortality rates in several clinical trials. It produces a rapid antiplatelet
effect with near total inhibition of thromboxane A2 production. It reduces coronary
reocclusion and recurrent ischemic events after fibrinolytic therapy. 2. Standing Order:
Chest pain 3. Considerations: Aspirin suppositories are safe and may be safely given to
patients with severe GI disorders, vomiting, or nausea. Best to chew ASA
, ✔✔Atropine - ✔✔Anticholinergic. 1. Main Actions: Reverses cholinergic- mediated
decreases in heart rate, and will increase the rate of the sinus node, so it is useful in the
treatment of symptomatic bradycardia. 2. Standing Order: Bradycardia-Unstable 3.
Considerations: May cause tachycardia, angina. Use cautiously in presence of acute
MI, myocardial ischemia.
✔✔Diphenhydramine (Benadryl) - ✔✔1. Main Actions: Antihistamine effect 2. Standing
Order: Severe Anaphylaxis 3. Considerations: Half life prolonged with age, normally 4-
8hrs, decreases mental alertness and psychomotor performance, increases intraocular
pressure, caution with hyperthyroidism, bronchial asthma, CV disease, hypertension.
May cause sloughing of tissue at infusion site
✔✔Dopamine - ✔✔1. Main Actions: A catecholamine that stimulates alpha and beta
adrenergic receptors. The effects are dose related. Doses of 0.5-3mcg/kg/min produce
renal vasodilation Doses of 2-10mcg/kg/min increase cardiac contractility Doses of 10-
20mcg/kg/min produce vasoconstriction. **Note: On PCU level of care, the max drip
dose is 5 mcg/kg/min. Unless the patient requires ICU emergent transfer, then the dose
may use up to 20 mcg/kg/min 2. Standing Order: Hypotension-symptomatic
Bradycardia- when Atropine ineffective 3. Considerations: **Indicated for hypotension
after fluid resuscitation. Dose is titrated to achieve hemodynamic effect. Increases
MV02 without compensatory increases in coronary blood flow causing an imbalance
between 02 supply and demand and may lead to myocardial ischemia. Increases HR
and may induce/exacerbate tachyarrhythmias. Extravasation causes tissue necrosis
and sloughing at site of infusion.
✔✔Ephedrine (PACU only) - ✔✔1. Main Actions: A sympathomimetic agent that causes
vasoconstriction 2. Standing Order: Hypotension in the post-anesthetic patient (PACU
only) 3. Considerations: Can cause cardiovascular changes (excitation, tachycardia)
and urinary retention.
✔✔Epinephrine - ✔✔1. Main Actions: An alpha-adrenergic drug producing potent
vasoconstriction. It can increase coronary and cerebral perfusion pressure during CPR,
but can also increase myocardial work and reduce subendocardial perfusion. 2.
Standing Order: Asystole Unstable Bradycardia PEA V Fib/Pulseless V Tach Severe
Anaphylaxis 3. Considerations: May induce or exacerbate ventricular ectopy especially
when patient has electrolyte imbalance. Coronary ischemia may occur and is not related
to dose, ischemic renal failure can occur with high doses. The drug of choice for severe
anaphylaxis reactions because it blocks inflammatory mediator release from sensitized
cells.
✔✔Hydrocortisone - ✔✔1. Main Actions: Mineral corticoid effect, used for persistent
hypotension 2. Standing Order: Severe Anaphylaxis 3. Considerations: Dose/duration-
dependent. May increase risk of GI distress Barbiturates, Dilantin, rifampin may
decrease effect of steroid
