Cardiac Arrest
Questions from small group to help prepare for Course 3 final exam
- 1.
You are called to see a patient in the ER with a rapid heart rate. The patient is somewhat confused but denies chest pain or shortness of breath. The treatment for this rhythm includes all of the following EXCEPT:
- A.
Assess ABCs
- B.
Procainamide
- C.
Magnesium
- D.
High-energy defibrillation
- E.
Apply CPR
Correct Answer
B. ProcainamideExplanation
ECG criteria for Torsades de Pointes: heart rate is fast and the rhythm is irregular. The QRS complex is wide and the direction of polarity is changing. Torsades de Pointes is a variant form of VT in which the polarity periodically changes from positive to negative. P waves are not apparent. The relationship between the P waves and QRS complexes is not defined since the P waves are not identifiable. TREATMENT: Always assess the ABCs first. It is important to distinguish Torsade de Pointes from VT since the treatment is different. Torsade de Pointes is associated with a long QT interval. Agents such as quinine and procainamide can prolong the QT interval and worsen the arrhythmia. Torsades is an unstable rhythm and decays rapidly to VT. Torsades is associated with electrolyte abnormalities, drug overdose or other toxins. Magnesium may be beneficial for Torsade de Pointes associated with long QT syndrome. If the patient has become unstable, use defibrillation rather than synchronized cardioversion for polymorphic VT since it will be difficult to sync to the irregular waveform (start with 200J). Low energy level shocks can cause VT. Apply CPR and the remainder of the pulseless arrest algorithm.Rate this question:
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- 2.
Which of the following is NOT an ECG criterion for Ventricular Fibrillation?
- A.
HR very rapid and the rhythm is not regular
- B.
QRS complex is absent
- C.
P waves are absent
- D.
Wide QRS complexes
- E.
Voltage fluctuations ("coarse" and "fine")
- F.
Can look like asystole
- G.
No relationship between P waves and QRS complexes
Correct Answer
D. Wide QRS complexesExplanation
1. the heart rate is very rapid and the rhythm is not regular.
2. the QRS complex is absent.
3. P waves are absent.
4. There are no P waves or QRS complexes so there is no relationship between them.
5. In V fib, areas of the ventricles are depolarizing and repolarizing in a completely disorganized fashion. All pumping function of the ventricles is lost.
6. The ECG may show voltage fluctuations. The amplitude of these waves is descrived by the terms "coarse" and "fine".
7. If it is unclear if the rhythm is v fib or asystole, treat as if it is V fib since it is the much more successfully treated arrhythmia.Rate this question:
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- 3.
Which of the following about CPR is INCORRECT?
- A.
Resume CPR immediately after electrical defibrillation. Continue for 5 cycles of CPR, then assess and continue the treatment algorithm. Three stacked shocks are no longer recommended
- B.
Do not allow the chest to fully recoil between compressions.
- C.
CPR should be performed until the defibrillator is available. Effective CPR is most important when the first defibrillation attempt is made more than four minutes after the arrest
- D.
For adults that are not intubated, compress 30 times then deliver 2 positive pressure breaths. Repeat this cycle at 100 compressions per minute.
Correct Answer
B. Do not allow the chest to fully recoil between compressions.Explanation
ALLOW the chest to fully recoil between compressions.Rate this question:
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- 4.
Which of the following about electrical defibrillation is INCORRECT?
- A.
Early electrical defibrillation is the definitive treatment for V fib
- B.
Defibrillate as soon as possible. For an unwitnessed arrest outside the hospital, there is some evidence that electrical defibrillation may be more effective after 5 cycles of CPR.
- C.
The initial energy setting should be 120-200 Joules for biphasic defibrillators and 200-360 Joules for monophasic defibrillators. Set to 200 Joules if the defibrillator is not clearly labeled as monophasic or biphasic.
- D.
Resume CPR immediately after electrical defibrillation. Continue for 5 cycles of CPR, then assess and continue the treatment algorithm. Three stacked shocks are no longer recommended.
- E.
Subsequent shock energy should be equal to or lesser than previous shock energy
Correct Answer
E. Subsequent shock energy should be equal to or lesser than previous shock energyExplanation
Subsequent shock energy should be equal to or GREATER than previous shock energyRate this question:
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- 5.
Which of the following is NOT an appropriate positioning of defibrillation pads?
- A.
The optimum sternal electrode position is just to the left of the upper sternal border below the clavicle.
- B.
The optimum sternal electrode position is just to the right of the upper sternal border below the clavicle.
- C.
The optimum apex position is to the left of the left nipple with the center of the electrode in the midaxillary line.
- D.
Anteriorly and posteriorly over the left hemithorax
Correct Answer
A. The optimum sternal electrode position is just to the left of the upper sternal border below the clavicle. -
- 6.
The pharmacologic action of epinephrine in cardiac arrests is:
- A.
Beneficial mainly due to alpha stimulation, which increases systemic vascular resistance and improves coronary and cerebral blood flow.
- B.
Beneficial mainly due to alpha stimulation, which increases myocardial electrical activity and strength of contraction
- C.
Beneficial mainly due to beta stimulation, which increases systemic vascular resistance and improves coronary and cerebral blood flow
Correct Answer
A. Beneficial mainly due to alpha stimulation, which increases systemic vascular resistance and improves coronary and cerebral blood flow.Explanation
Beneficial mainly due to alpha stimulation - increases systemic vascular resistance and improves coronary and cerebral blood flow. Value of beta stimulation is controversial - increases myocardial electrical activity and strength of contraction, but also increases myocardial oxygen requirements and automaticity.Rate this question:
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- 7.
Which of the following is NOT a use for epinephrine
- A.
Cardiac arrest from v fib
- B.
Cardiac arrest from VT
- C.
Reverse the effect of beta-blockers
- D.
Cardiac arrest from asystole
- E.
Extreme hypotension
- F.
Cardiac arrest from pulseless electrical activity
- G.
Bradycardia
- H.
Heart block
Correct Answer
C. Reverse the effect of beta-blockersExplanation
epinephrine is contra-indicated in patients on beta-blockers.Rate this question:
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- 8.
Adult dose of epinephrine for cardiac arrest:
- A.
1 mg IV push every 3-5 min
- B.
2-5 mg IV push every 3-5 min
- C.
1 mg, 3 mg, 5 mg IV push 3 min apart
- D.
2-2.5 mg per ETT via endotracheal tube
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
Recommended dose: 1 mg IV push every 3-5 min.
Intermediate dose: 2-5 mg IV push every 3-5 min.
Escalating dose: 1 mg, 3 mg, 5 mg IV push 3 min apart.
High dose: 0.1 mg/kg IV push every 3-5 min.
Epinephrine can be delivered via the endotracheal tube. Increase dose to 2-2.5 mg per ETT.Rate this question:
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- 9.
Adult dose of epinephrine for bradycardia and severe hypotension:
- A.
1 mg IV push every 3-5 min.
- B.
1 mg, 3 mg, 5 mg IV push 3 min apart
- C.
2-10 mcg/min continuous infusion
- D.
All of the above
Correct Answer
C. 2-10 mcg/min continuous infusion -
- 10.
Potential complications of epinephrine include all of the following EXCEPT
- A.
Hypertension
- B.
Tachycardia
- C.
Arrhythmias
- D.
Myocardial ischemia
- E.
Stroke
Correct Answer
E. Stroke -
- 11.
How do you define Pulseless Electrical Activity?
- A.
Absence of a detectable pulse with electrical activity other than VT or V fib
- B.
Asystole
- C.
VT or V fib
Correct Answer
A. Absence of a detectable pulse with electrical activity other than VT or V fib -
- 12.
Which of the following is NOT one of the potential etiologies for PEA?
- A.
Hypovolemia
- B.
Hypoxia
- C.
Hydrogen ion-acidosis
- D.
Hyper/hypokalemia
- E.
Hypothermia
- F.
Myocardial Infarction
- G.
Tablets (drugs)
- H.
Tamponade-cardiac
- I.
Tension pneumothorax
- J.
Thrombosis - coronary
- K.
Thrombosis - pulmonary
Correct Answer
F. Myocardial InfarctionExplanation
5 H's and 5 T'sRate this question:
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- 13.
Which of the following is NOT part of the general treatment of PEA?
- A.
ABCs
- B.
Vigorous chest compressions
- C.
Fluid boluses
- D.
Epinephrine to improve coronary perfusion
- E.
Amiodarone if bradycardic
- F.
Determine underlying etiology
Correct Answer
E. Amiodarone if bradycardicExplanation
1. Airway - secure a patent airway
2. Breathing - ensure ventilation with oxygen but avoid hyperventilation.
3. Circulation - administer vigorous chest compressions.
4. Circulation - obtain IV access and administer fluid boluses if potentially
hypovolemic.
5. Circulation - administer epinephrine as a vasopressor to improve
coronary perfusion. Administer atropine if bradycardic.
6. The students need to be reminded of the importance of resuscitating the
patient and trying to determine the underlying etiology for the PEA at the
simultaneously.Rate this question:
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- 14.
All of the following are signs of cardiovascular instability EXCEPT
- A.
Confusion
- B.
Lethargy
- C.
Chest pain
- D.
Sepsis
- E.
Severe hypotension
- F.
Pulmonary edema
- G.
Shortness of breath
Correct Answer
D. Sepsis -
- 15.
What criteria on ECG are suggestive of a diagnosis of VT? (5)
- A.
Wide QRS
- B.
Narrow QRS
- C.
AV dissociation
- D.
Regular rhythm
- E.
Fusion or capture beat
- F.
NW axis
- G.
Positive QRS concordance in anterior leads
Correct Answer(s)
A. Wide QRS
C. AV dissociation
E. Fusion or capture beat
F. NW axis
G. Positive QRS concordance in anterior leads -
- 16.
Which of the following is TRUE about the treatment for unstable VT?
- A.
Begin CPR before preparing for cardioversion
- B.
Treat pulseless VT the same as V fib
- C.
Unsynchronized cardioversion
- D.
Start cardioversion at 360 joules
Correct Answer
B. Treat pulseless VT the same as V fibExplanation
1. Treatment of sustained ventricular tachycardia depends on the
hemodynamic status.
2. Treat pulseless ventricular tachycardia the same as ventricular
fibrillation.
3. For unstable ventricular tachycardia, prepare for immediate
synchronized cardioversion. Start at 100 Joules and increase to 200,
300, 360 Joules.Rate this question:
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- 17.
Which of the following is NOT an ECG criterion for type 1 second-degree AV block (Wenkebach)?
- A.
Heart rate slow to normal
- B.
Rhythm not regular - some QRS complexes missing
- C.
Wide QRS
- D.
P waves are upright
- E.
There are more P waves than QRS complexes.
- F.
The PR interval progressively lengthens
- G.
The shortest PR interval follows the dropped beat.
- H.
The PR interval progressively lengthens until a QRS complex is dropped.
- I.
Inferior wall infarctions
Correct Answer
C. Wide QRSExplanation
1. The heart rate is slow to normal. The rhythm is not regular since some
QRS complexes are missing.
2. The QRS complex is narrow.
3. The P waves are upright.
4. There are more P waves than QRS complexes. The PR interval
progressively lengthens until a QRS complex is dropped. The shortest
PR interval follows the dropped beat.
5. Second degree type I AV block is also known as Mobitz Type I or
Wenkebach. The conduction block occurs in the AV node. The PR
interval progressively lengthens until the impulse is not conducted to the
ventricles.
6. Second degree type I AV block is most commonly associated with right
coronary artery occlusion with inferior wall infarctions. This block
generally has a good prognosis.Rate this question:
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- 18.
Which of the following is NOT an ECG criterion for type 2 second-degree AV block:
- A.
Heart rate slow to normal, irregular rhythm
- B.
QRS complexes missing
- C.
More P waves than QRS complexes
- D.
Fixed PR interval
- E.
Inferior wall infarctions
Correct Answer
E. Inferior wall infarctionsExplanation
1. The heart rate is slow to normal and the rhythm is not regular. QRS
complexes are missing.
2. There are more P waves than QRS complexes. The PR interval is fixed
and usually has normal duration.
3. Second degree type II AV block is also known as Mobitz Type II. The
conduction block is infranodal. The PR interval is fixed duration until the
impulse is not conducted to the ventricles.
4. Second degree type II AV block is most commonly associated with
anterior wall infarctions. This block has a propensity to progress to third
degree AV block.Rate this question:
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- 19.
Which of the following is NOT a criterion for third-degree AV block:
- A.
Heart rate slow to normal, irregular rhythm
- B.
Wide QRS
- C.
More P waves than QRS complexes
- D.
Atrial and ventricular regularity independent of each other
- E.
P waves "march through" QRS complexes
Correct Answer
A. Heart rate slow to normal, irregular rhythmExplanation
1. The heart rate is slow to normal and the rhythm is regular.
2. The QRS complex is often wide.
3. There are usually more P waves than QRS complexes. There is usually
atrial and ventricular regularity, but they are independent of each other. P
waves march through QRS complexes.
4. Third degree AV block is complete heart block. The atria beat at their
rate while the ventricular rate is determined by a junctional or ventricular
pacemaker. P waves "march through" or are unrelated to QRS
complexes.Rate this question:
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- 20.
Which of the following are signs and symptoms of bradycardia? (5)
- A.
Chest pain
- B.
Syncope
- C.
Severe dyspnea
- D.
Impending sense of doom
- E.
Arrhythmia
- F.
Decreased level of consciousness
- G.
Hypotension
- H.
Congestive heart failure
Correct Answer(s)
A. Chest pain
C. Severe dyspnea
F. Decreased level of consciousness
G. Hypotension
H. Congestive heart failure -
- 21.
How do you treat asymptomatic bradycardia?
- A.
Atropine 0.5-1.0 mg IV, repeat every 3-5 minutes
- B.
Transvenous pacemaker
- C.
Dopamine 2-10 mcg/kg/min
- D.
Epinephrine 2-10 mcg/min
- E.
Transcutaneous pacemaker
- F.
None of the above
Correct Answer
F. None of the aboveExplanation
Treat bradycardia if there are serious signs or symptoms due to the
bradycardia.
1. Assess patient; observe if no signs or symptoms.
2. Atropine 0.5-1.0 mg IV if signs or symptoms, repeat every 3-5 minutes if
continued signs or symptoms. Note that the denervated, transplanted
heart will not respond to atropine.
3. Consider pacemaker if available.
4. Infuse dopamine 2-10 mcg/kg per min or epinephrine 2-10 mcg/min if
continued signs or symptoms.
5. If no serious symptoms, but Mobitz II or Third degree heart block:
a. Prepare for transvenous pacer.
b. Use TCP (TransCutaneous Pacemaker) as a potential bridge device.Rate this question:
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- 22.
Which of the following about the pharmacologic action of atropine is FALSE?
- A.
Parasympathetic - reverses bradycardia due to excessively high vagal tone
- B.
Competitive blockade of acetylcholine at muscarinic receptors
- C.
Increases sinus node automaticity and AV conduction
- D.
Increases bronchial secretions
Correct Answer
D. Increases bronchial secretionsExplanation
Parasympatholytic - reverses bradycardia due to excessively high
vagal tone
• Competitive blockade of acetylcholine at muscarinic receptors.
• Increases sinus node automaticity and AV conduction.Rate this question:
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- 23.
Which of the following is NOT a potential complication of atropine?
- A.
Tachyarrhythmias
- B.
Exacerbation of MI
- C.
Paradoxical bradycardia
- D.
Dry mouth, urinary retention, blurred vision, flushed skin
- E.
Ataxia, delirium, coma
- F.
Hematoma
Correct Answer
F. Hematoma -
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