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You are treating a patient with ventricular fibrillation. As the
defibrillator is charging, you should:
A: check the defibrillator to ensure the synchronizer is
activated.
B: ensure that CPR is continuing until the defibrillator is
charged.
C: visually confirm that nobody is touching the patient.
D: ask your partner to ventilate the patient at 20 breaths/min.
- ANSWER-*B: ensure that CPR is continuing until the
defibrillator is charged.* Reason:
A major emphasis is placed on minimizing interruptions in CPR.
Evidence has shown that even a brief pause in chest
compressions can result in a significant decrease in coronary
and cerebral perfusion. Therefore, CPR should be continuing—
even as the defibrillator is charging. When the defibrillator is
charged, ensure (visually and verbally) that nobody is touching
the patient, and then deliver the shock. When defibrillating a
patient with V-Fib, you must ensure that the synchronizer is off;
the synchronizer will not be able to identify an R wave in V-Fib
,due to the chaotic nature of the dysrhythmia. Cardiac arrest
patients (adults, children, and infants) should be ventilated at a
rate of 8 to 10 breaths/min after an advanced airway device has
been placed (eg, ET tube, multilumen airway, supraglottic
airway). Excessive ventilation rates should be avoided; they
cause increased intrathoracic pressure, which may impair
venous return and cardiac output.
A 145-pound man requires a dopamine infusion at 15 µg/kg/min
for severe hypotension. You have a premixed bag containing
800 mg of dopamine in 500 mL of normal saline. If you are using
a microdrip administration set (60 gtts/mL), how many drops
per minute should you deliver to achieve the required dose? A:
48
B: 42
C: 30
D: 36 - ANSWER-*D: 36*
Ventricular ejection fraction is defined as the:
A: percentage of blood in the ventricle pumped out during a
contraction.
B: volume of blood pumped into the left ventricle from the left
atrium.
C: amount of blood pumped out from either ventricle per
contraction. D: amount of blood pumped from either ventricle
each minute. - ANSWER-*A: percentage of blood in the
ventricle pumped out during a contraction.* Reason:
Ejection fraction (EF) is the percentage of blood that is pumped
from the ventricle per contraction. The total volume of blood
,pumped out of the ventricle per contraction is called the stroke
volume (SV). If the ventricle contains 100 mL of blood before a
contraction, but only ejects 55 mL when it contracts (SV), the
ejection fraction is 55% (100 mL × 0.55 = 55 mL). Ejection
fraction should be at least 65% in the adult. Cardiac output (CO)
is the volume of blood ejected from the left ventricle each
minute, and is calculated by multiplying the stroke volume by
the heart rate; in the adult, this is typically 5 to 6 L/min
You arrive approximately 8 minutes after a 51-year-old male
collapsed at a family event. After determining that he is
unresponsive and apneic, you should:
A: begin CPR, starting with chest compressions.
B: immediately assess the patient's cardiac rhythm.
C: assess for a carotid pulse for 5 to 10 seconds.
D: give 2 rescue breaths and check for a pulse. - ANSWER-
*C: assess for a carotid pulse for 5 to 10 seconds.* Reason:
After determining that an adult patient is unresponsive and
apneic, you should assess for a carotid pulse for at least 5
seconds but no more than 10 seconds. If the patient has a
pulse, open the airway and provide rescue breathing. If the
patient does not have a pulse, begin CPR (starting with chest
compressions), then open the airway and give 2 rescue breaths.
Assess the patient's cardiac rhythm as soon as a
monitor/defibrillator is available.
ECG indicators of Wolff-Parkinson-White (WPW) syndrome
include:
A: tall P waves, QT interval prolongation, and tachycardia.
, B: narrow QRS complexes and peaked T waves.
C: delta waves, flattened T waves, and bradycardia.
D: short PR intervals, delta waves, and QRS widening. -
ANSWER-*D: short PR intervals, delta waves, and QRS
widening* Reason:
Wolff-Parkinson-White (WPW) syndrome is a condition in which
accessory pathways—called the bundle of Kent—bypass the
atrioventricular (AV) node, causing the ventricles to depolarize
earlier than normal (preexcitation). Because the normal delay at
the AV node does not occur, the PR intervals in patients with
WPW are usually less than 0.12 seconds (120 ms). When
conduction occurs down the AV node and simultaneously
along the bundle of Kent in an anterograde fashion, the two
waves of depolarization meet (fusion). This manifests on the
ECG as a delta wave—slurring or notching at the beginning of
the QRS complex—which may cause QRS widening. The bundle
of Kent is a potential site for a reentry circuit because it allows
continued transmission of an electrical impulse from the atria
to the ventricles. Therefore, patients with WPW are prone to
reentry tachycardias—most notably, AV reentry
supraventricular tachycardia (SVT).
A patient's medication regimen includes fluoxetine, Toprol,
Proscar, lansoprazole, and Klonopin. Which of these
medications is used to treat cardiovascular disorders?
A: fluoxetine
B: Toprol
C: lansoprazole