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The first thing you do is:4A. make sure the airway is openB. shake and shout} at the victimC. look for a Medic-Alert braceletD. feel for a pulseB6The first step to perform when youencounter a pote}ntial cardiac arrestvictim is to establish that theperson is truly unresponsive. Todo this, you shake and shout at thevi}ctim.2Before you start CPR you shouldalways:8A. ask bystanders what happened to the victimB. get permission to begin} CPR from the victim's familyC. be sure victim is breathless and pulselessD. check for medical information in the }victim's walletC9The steps in initiating CPR are1) shake, shout--establishingunresponsiveness, 2) open theairway, 3) ch}eck for breathing, andif not present, 4) give two breaths,5) check for a pulse, and if notpresent, 6) start CPR. You woul}dn'twant to initiate CPR on someone whois merely sleeping.2To establish unresponsivenessin an infant, the rescuer should}:5A. pick up the infant by the ankles and gently shakeB. blow hard into the infant's earC. gently tap or shake the inf}antD. clap the hands loudlyC4Arousing an infant should be nodifferent from the adult who issuspected of being unconscio}us--thatis, shake and shout.2After determining that the victimis unconscious, your next step is:5A. give 4 "stacked" br}eathsB. feel for a carotid pulseC. listen and look for signs of air movementD. open the airwayD4After you haved trie}d to arouse thevictim, you position the head toopen up the airway. You then checkfor signs of breathing.2One can determ}ine if an unconsciousvictim is breathing by:6A. checking the blood pressureB. checking for cyanosisC. checking the pulse}D. looking, listening, and feeling for the signs of air and chest movementD3Hold the ear over the mouth and nose,w}atch the chest. Air movement canbe felt, heard, or seen.2You find no signs of breathing inan unresponsive victim. You:}4A. feel for a pulseB. give 2 breathsC. give 4 breathsD. perform the Heimlich maneuverB8The standards for CPR now call} fortwo rather slow but full breaths,rather than the four "stacked"breaths recommended previously.This is because the rap}id forcefulbreaths blew air into the stomach,making CPR more difficult andallowing regurgitation.3What's the most common} cause ofairway obstruction in an unconsciousperson?4A. mucousB. foodC. denturesD. tongueD6As the muscles relax in }theunconscious person, the tongue fallsback to occlude the airway. Properpositioning of the head and neckis therefore th}e most importantstep in clearing the airway!3The "universal distress signal"to signal others that you're chokingis:4A.} take rapid heavy breathsB. make retching soundsC. put your hand on your throatD. wave your arms rapidlyC6Holding the h}and at the throat isthe universally recognized signalof choking. The rescuer asks thevictim, "Can you speak?" If hecan'}t speak, then the airway isobstructed.3For a conscious victim with acomplete airway obstruction, therescuer should:8A.} perform a finger sweep to remove the obstruction and attempt to ventilateB. deliver 3 manual thrusts and perform a} finger sweepC. deliver 4 back blows and perform a pharyngeal finger sweepD. none of the aboveD5One should not stick }one's fingersdown the throat of a consciousperson. The Heimlich maneuver isused to try to expell the objectwhich is obst}ructing the airway.3An INFANT has a complete airwayobstruction, not relieved by backblows. The rescuer should:6A. admi}nister four abdominal thrustsB. administer four additional back blowsC. administer four chest thrustsD. turn the infant} upside down and shake itC6Chest thrusts are used to generatethe air flow needed to dislodge aforeign body from an i}nfant's airway.Abdominal thrusts are not used,because the infant's abdominal organsare more vulnerable.4Sometimes it is }difficult to performartificial respirations. Which ofthe following is NOT a common causeof failure to ventilate the lungs}?5A. tight clothingB. buildup of air in the stomachC. inadequate tilting of the headD. lack of an airtight seal between} mouth of rescuer and victimA8Tight clothing would not be expectedto prevent respirations. A stomachbloated by air fr}om artificialrespirations, an airway occludedby improper head position, and lackof a good seal are common causes offailur}e to move adequate air intothe lungs.3What conditions should youestablish before you start doingchest compressions?7A.} the victim's pupils are dilatedB. signs that brain damage may be occurringC. evidence that breathing and pulse are a}bsentD. the victim has weak pulse and shallow respirationsC5If the pulse is truly gone, nobreaths will be taken. If }you cannotfeel a pulse, but the victim seemsto be breathing, then victim is NOTin need of CPR.3When finding someone who }is notbreathing, you should check thepulse:6A. after one minute of rescue breathingB. after the first two ventilation}sC. immediately after opening the airwayD. before ventilations are givenB5After establishing breathlessnessand givin}g the victim two breaths, apause of 5 to 10 seconds is taken.During this time, the rescuer feelsthe carotid pulse.3When }the rescuer feels the pulseof the adult victim, the other handof the rescuer should:4A. maintain the head tiltB. sweep o}ut the victim's mouthC. feel the chest for movementD. find landmark for compressionsA4When feeling for a pulse, one hand}remains on the forehead to maintainthe head tilt, while the hand whichwas under the neck feels for a pulse.2The recommen}ded way to check foran infant's pulse is:8A. feel for the carotid pulse in the neckB. feel for the brachial pulse in } the upper armC. feel for the radial pulse in the wristD. feel for the femoral pulse in the groinB4The pulse in a}n infant is best feltin the grove under the inside edgeof the biceps muscle. This is thebrachial pulse.2Before actually} starting CPR, theproper performance sequence is:11A. establish breathlessness establish unresponsiveness establish }pulselessnessB. establish unresponsiveness two full breaths establish breathlessness establish pulselessnessC. est}ablish unresponsiveness establish breathlessness two full breaths establish pulselessnessC6First, you check to se}e that thevictim is truly unconsciousness.Then, you open the airway and checkfor breathing. If the patient isbreathless,} you give two breaths,then feel for a pulse.3The proper rate of chest compressionfor two-rescuer CPR on either anadult o}r a child is:4A. 60 times a minuteB. 60 to 80 times a minuteC. 80 times a minuteD. 80 to 100 times a minuteD7With eit}her one- or two-rescuerCPR, the chest is compressed 80to 100 times per minute. Thisis a recent change in the BLSrecommen}dations. This holds forboth adult and child victims (butnot infants).2The rate of chest compressions fora neonate under}going CPR is:4A. 60B. 80C. 100D. 120D7A newborn's normal heart rate ismuch faster than a child or adult.The rate of} chest compression shouldreflect this. An baby's chest iscompressed 120 times a minute byholding the chest and pressing d}ownon the sternum with the thumbs.4To complicate things further, themethod and rate of chest compressionare different in} an infant than inthe newborn. The recommendation is:5A. 80-100 per minute, heel of handB. 80-100 per minute, tips of } fingersC. 100 per minute, tips of fingersD. 120 per minute, tips of fingersC13The recommendations are: newborn: 120 c}omp. per minute, hands around chest, press with thumbsinfant: 100 comp. per minute, press with m}iddle and ring fingerschild: 80-100 comp. per minute, heel of one handadult: 80-100 comp. per minute,} heel of one hand on the compressing hand4To perform chest compressions on anadult, one hand is placed o}n the topof the other with the heel of thelower hand pressing:5A. over the lower one-half of the sternumB. on the upp}er third of the sternumC. on the middle of the sternumD. on the xiphoid processA5The hand is placed over the lowerhalf }of the sternum. The edge ofthe hand closest to the victim'sface should be about two finger's-widths below the bump on the} sternum.2When compressing the chest of achild:5A. use the heel of one handB. use the index and middle fingers of on}e handC. use the heels of both handsD. use the thumbs of both handsA3For a child (not an infant) therescuer uses the he}el of one handto compress the chest.2In one-rescuer CPR, breaths aregiven:7A. one breath after five chest compressio}nsB. at about five per minuteC. one breath every fifteen chest compressionsD. two breaths every fifteen chest compre}ssionsD6In one-rescuer CPR, the chest iscompressed 15 times, then tworespirations are given. This cycleis repeated rap}idly enough thatabout 80 to 100 chest compressionsare given in one minute.4If you find yourself alone with acardiac arre}st victim, with nolikelihood that someone else willcome by, you should:8A. telephone for help before starting CPRB. d}o nothing and wait for help to arriveC. open the victim's airway then telephone for helpD. perform CPR for one minute}, then telephone for helpD4The rescuer should begin CPR becauseof the small chance that the patientwill get a pulse a}nd spontaneousrespirations due to the CPR.3What's the best indication thatyour external chest compressionsare producing }adequate blood flow?7A. change in patient's colorB. constriction of pupilsC. a second person feels a pulse in the caro}tid artery with each compressionD. there's no way to determine this without special instrumentsC5Although a good ca}se could be madefor a change in color meaning goodblood flow, palpating a good pulsewith each compression is the bestindi}cation of adequate blood flow.4During CPR, how often shouldyou feel the carotid pulse to checkfor return of a spontaneous}heartbeat?6A. after the first minute of CPR and every few minutes thereafterB. after the first five minutes of CPR }and then every five minutesC. every ten minutesD. every fifteen minutesA2The pulse is checked after oneminute, then eve}ry few minutes.1CPR should not be interrupted:8A. for more than 3 seconds to check responsivenessB. for more than 20 }seconds for any reasonC. for more than 7 seconds with NO exceptionsD. for more than 7 seconds EXCEPT in certain ci}rcumstancesD5CPR should not be interrupted exceptin such circumstances as callingan ambulance. Pauses to check forthe }return of a pulse should belimited to 7 seconds.3During two-rescuer CPR, the personresponsible to check for the returnof} spontaneous pulse is:4A. the rescuer at the headB. the rescuer at the chestC. either individual during a ten- second }pause every 5 minutesA10The pulse check is done by therescuer at the head of the patient.This is done by feeling the car}otidartery for five seconds every fewminutes. The pulse check can alsobe conveniently done while tradingplaces: the resc}uer who is givingchest compressions moves to thehead, and while opening the airway,feels for a pulse.3When one rescuer p}erforms CPR, theratio of chest compressions to lunginflations for an adult victim is:4A. 12 compressions to 2 ventilation}sB. 5 compressions to 1 ventilationC. 7 compressions to 1 ventilationD. 15 compressions to 2 ventilationsD5One-rescuer }CPR is performed ascycles of 15 compressions followedby 2 ventilations. The chestcompression rate is 80 to 100 perminute}.7When CPR is performed by medicalpersonel, the two-rescuer methodis used. Prior to intubing thepatient, artificial ven}tilationsare given about once every fivechest compressions. The rescuerdoing compressions:6A. pauses briefly to allow l}ung inflationB. keeps compressions clock-regularC. times his compression to occur while the air is going inD. mainta}ins the head tiltA9A brief pause in chest compressionsallows lung inflation by mouth-to-mouth or bag-mask. This allows }amore complete lung filling with lessair blown into the stomach. Oncethe patient is intubated, theventilations can be gi}ven withoutsynchronizing to the intervalbetween chest compressions.s:4A. make sure the airway is openB. shake and shoutF4Many organs affect the differentparts of the blood as it circulates.Which organ has the least to do withthe blood?5A. }bone marrowB. kidneysC. spleenD. pancreasE. liverD8White blood cells, red blood cells,and platelets are produced in t}hebone marrow. The kidney stimulatesblood production and regulates theamount of fluid in the blood. Theliver and spleen} act to "clean up"the blood by removing old cells andimpurities.6Blood is composed of a fluid calledplasma, and cells, m}ost of which arered blood cells. The red blood cellscarry oxygen. How much of the bloodis cells (compared to the totalv}olume)?4A. normally 20%B. normally 40%C. normally 60%D. normally 80%B7The portion of blood which is cellsis called t }he . It'susually 40 to 48. In other words, ifyou separate red cells from plasma,you'd find that 40 to 48 perce }ntof the blood was made up of red blood cells.4As used, oxygen-poor blood comesback from the body via the superior }and inferior vena cava, it entersa heart chamber called the:4A. right atriumB. right ventricleC. left atriumD. left ven }tricleA5The right atrium is a receivingchamber which gets "used" blood fromthe body. From there it goes overthe tricus }pid valve into the rightventricle.2Where does blood go as it is pumpedout of the right ventricle?4A. through the aorta }to the lungsB. across into the left ventricleC. into the pulmonary arteryD. out to the bodyC10This is a tricky question}. The bloodfrom the right ventricle DOES go tothe lungs, but it is pumped throughthe PULMONARY artery. The right sideof} the heart gets oxygen-poor bloodfrom the body, stores it in the right atrium, stuffs it into theright ventricle, which pu}mps it viathe pulmonary artery into the lungs,where it will pick up oxygen.7The pulmonary veins take oxygen-richblood fr}om the lungs to the leftatrium. The left atrium contracts,pushing blood across the mitralValve into the left ventricle. }Theleft ventricle pumps blood out intothe:3A. pulmonary arteryB. carotid arteryC. aortaC4The left ventricle, the str}ongestchamber of the heart, pumps blood outto the body through a large, archingartery called the aorta.2The heart can be} regarded as allof the following EXCEPT:5A. a muscleB. a self-charging and discharging batteryC. a pumpD. an endocri}ne organD8The heart is composed of specialmuscle fibers which pump blood whenthey contract. Certain fibers inthe heart} start an electric shock,which runs over the heart to make itcontract. After contracting, theheart fibers "recharge" elec}tricallyfor the next contraction.5In the carotid arteries in the neck,there are nerves which determine ifthe blood press}ure is too high or toolow. The right amount of pressureon the blood is necessary because:10A. there has to be enough pre}ssure to fill up the heart.B. if the pressure is too low, blood vessels may burst and bleed in the brain, causing a} stroke.C. the pressure should be just enough to push the blood through the capillaries.D. a high blood pressure does}n't get enough oxygen to the cells.C8Nerves affect the heart and the bloodvessels to keep the blood pressurein the ri}ght range. If the pressureis too low, the blood moves poorlythrough the capillaries, "starving"the cells of oxygen. If t}he pressureis too high, arteries may be damaged,causing a stroke.2The kidney affects the circulationin all the following} ways EXCEPT:8A. releases chemicals to raise blood pressureB. removes old or damaged blood cellsC. removes dissolved w }astes and impuritiesD. stimulates new blood productionE. regulates the water content of the bloodB11The kidney mon!}itors the concentrationof the blood, removing water or holding back water when required.When blood flow to the kidney slow"}s,it releases hormones which raise theblood pressure. It also releaseshormones which stimulate blood cellproduction. Wa#}stes pass through thekidney into the urine. It does not,however, remove old blood cells--theliver and spleen do that.8R$}ed blood cells carry oxygen. Whiteblood cells also circulate in theblood, although there are much fewerof them. They rea%}ct to things theyfind which are "foreign" to the body,such as bacteria. There are severaltypes of white blood cell. Whic&}h ofthese is NOT a white blood cell?5A. thrombocyteB. lymphocyteC. eosinophilD. monocyteE. polymorphonuclear leukocyte'}A6"Thrombocyte" is another name forplatelets, the body's clotting cells.These cells activate when tissue isdamaged, sti(}cking to the surface.They release chemicals which make theblood around them clot.6Arteries are large, muscular bloodvess)}els which take blood away fromthe heart under pressure. Veins areweak, thin-walled vessels whichreturn blood to the heart*}. In between arteries and veins are:6A. arteriovenous fistulae, capillary, venuleB. arteriole, hemangioma, veno+}us sinusC. arteriole, capillary, venuleD. sinusoid, capillary, hemangiomaC7Arteries branch off into arterioles.The ,}smallest vessel, the one thatthe cells get their oxygen andnutrients from, is called the capillary. As capillaries collec-}tinto small vessels, these are calledvenules.1The systolic blood pressure is:6A. normally below 90 mm HgB. the average.} pressure in the blood vesselsC. the arterial pressure while the heart is contractingD. normally above 140 mm HgC7/}When the heart is contracting, thisis called SYSTOLE. The systolicblood pressure, therefore, is thepressure measured duri0}ng the heart'scontraction. It averages around120 mm Hg, and is considered too highif it's above 140 mm Hg.2A diastolic 1}blood pressure which isbelow 90 mm Hg indicates:5A. a normal reading, unless below 60 mm Hg B. shockC. no cardiac pat2}hologyD. hypotensionA9The diastolic blood pressure is thepressure measured between the heart'scontractions. This press3}ure keepsblood moving forward through thecapillaries even while the heart isresting. A reading above 90 meanshypertensio4}n (high blood pressure),while a reading below 60 usually means hypotension or shock.4When the blood pressure is too l5}owto adequately bring nutrients to thecells, we call it "shock". The mostcommon cause of shock is:4A. severe heart dama6}ge (heart attack)B. allergic reactionsC. emotional reactionsD. blood lossD7The most common cause of low bloodpressure 7}is loss of blood volumethrough bleeding from an injury,or from internal bleeding. It'streated initially by giving fluids8}and/or blood to replace the lostvolume.2The first reaction of the body tosignificant blood volume loss is:7A. sweating 9}and slowing of the pulseB. constricting blood vessels and speeding the pulseC. dilating blood vessels and speeding :}the pulseD. sweating, lightheadedness, and dilated skin blood vesselsB9The body attempts to "defend" theright range o;}f blood pressure. Whenblood or fluids are lost from theblood stream, the body tries tocompensate. The blood vessels are<}constricted, making a smaller spacefor the smaller blood volume, and theheart tries to pump harder and faster.5A. x1A normal pH is:4A. 7.4 with a range of 7.35 to 7.45B. 7.4 with a range of 7.0 to 8.0C. 7.0 (neutral), range 7.0 to 7.4>}D. 7.0 with a range of 6.5 to 7.5A4The normal pH of the human bodyis slightly alkaline at 7.4 pH.A lower pH means excess?} acid; ahigher pH means excess alkali.1A pH of 7.1 means:3A. acidosisB. alkalosisC. either of the aboveA5Even thoug@}h a pH of 7.1 is above"neutral" (the pH of water), it isstill lower than the normal humanbody. A pH lower than 7.4 meansA}excess acid--acidosis.2When carbon dioxide is dissolved inthe blood stream, it:3A. raises the pHB. causes alkalosisC. B}lowers the pHC4Carbon dioxide is a mild acid.When it dissolves in blood, itmakes the blood slightly more acid.More acidC} means a lower pH.2When sodium bicarbonate is injectedinto a patient's vein, it:2A. raises the pHB. lowers the pHA3BD}icarbonate is a weak base (alkali).This makes the blood less acid,raising the pH.4When bicarbonate interacts withacid, iE}t yields carbon dioxide andwater. In the body, this carbondioxide is:4A. eliminated through the kidneyB. picked up by hF}emoglobinC. breathed out through the lungsD. neutralized by tissue fluidsC6When bicarbonate is given to apatient, it neG}utralizes acid,creating extra carbon dioxide inthe process. If ventilations areadequate, this carbon dioxide is"blown ofH}f" through the lungs.2A normal carbon dioxide pressurein the blood stream would be:4A. 20 mm HgB. 30 mm HgC. 40 mm HgI}D. 50 mm HgC4The measured carbon dioxide onarterial blood gas measurementshould be about 40 millimetersof mercury.5A J}low pH (acidosis) with acarbon dioxide measurement of60 would be due to "respiratoryacidosis". To correct this,you wouldK}:3A. speed up the ventilationsB. slow down the ventilationsC. give bicarbonate IVA6This patient's acidosis is dueto cL}arbon dioxide buildup--theresult of inadequate ventilations.To raise the pH to normal, youincrease the ventilation rate,bM}lowing off more carbon dioxide.3A patient with chest pain has apH of 7.55 and carbon dioxide of28. He has:4A. respiratN}ory acidosisB. respiratory alkalosisC. metabolic acidosisD. metabolic alkalosisB5This patient is hyperventilating--raiO}sing his pH by blowing off the(slightly acidic) carbon dioxide.Relief of pain will probably curethis problem.6In the midP}st of resuscitation,blood gases on a patient withV-fib show: pH = 7.62 PaCO2= 42This patient's problem is:4A. bicarbQ}onate overdoseB. he needs bicarbonateC. respiratory alkalosisD. metabolic acidosisA8This patient has alkalosis (highpHR}) which is NOT due to rapidventilations. We know that it'snot respiratory alkalosis becausethe carbon dioxide is about noS}rmal.The most likely explanation for hisalkalosis is excessive use ofbicarbonate.2Before resuscitation is started,a patT}ient in cardiac arrest has:6A. metabolic acidosisB. metabolic alkalosisC. respiratory acidosisD. respiratory alkalosisEU}. A and C are trueF. B and D are trueE8When the circulation stops, acidsstart to build up. These acids arethe result oV}f anaerobic metabolism(metabolism without oxygen). Thisresults in metabolic acidosis. Atthe same time, respirations stopW}.Carbon dioxide builds up, resultingin respiratory acidosis as well.3The treatment for severe metabolicacidosis during cX}ardiac arrestis accomplished by:3A. hyperventilationB. bicarbonate IVC. both of the aboveC7Hyperventilation is usefulY} duringcardiac arrest because 1) it partlyreverses the acidosis by balancingit with respiratory alkalosis, and2) it blowsZ} off the carbon dioxidereleased by injected bicarbonateinteracting with acid.witho 8.0C. 7.0 (neutral), range 7.0 to 7.4T3You "witness" an arrest--that is,you see the person collapse andfeel NO pulse. Your first step is:4A. get the defibril!\}latorB. start an IVC. hit the patient on the chestD. intubateC8The "precordial thump" is used fora "witnessed arrest".!]} It may stopventricular fibrillation if usedwithin seconds of onset. That'sbecause the blow generates a smallelectrical!^} current which might"mechanically defibrillate" theheart.7A patient with no pulse who hasa rhythm which is "too fast"--s!_}uchas ventricular fibrillation orventricular tachycardia--should bedefibrillated. The steps you shouldtake before trying!`} defibrillationinclude:5A. bicarbonate 1 mEq per kgB. atropine 0.5 mgC. epinephrine 1 mg IV pushD. lidocaine 1 mg per k!a}gE. none of the aboveE7No drug should take precedence overdefibrillation in the pulselesspatient with a "too fast" rhyt!b}hm(V-fib or V-tach). You start CPRand oxygenate the patient welluntil the defibrillator arrives,then you shock the patie!c}nt.3The starting defibrillation dosagefor a typical adult with a rhythmof V-fib is:4A. 50 joulesB. 100 joulesC. 200 j!d}oulesD. 360 joulesC7The first shock delivered to apatient in ventricular fibrillationshould be at 200 joules. If this!e}shock is not successful, a secondshock can be given at the samesetting, or the fibrillator can beturned up to 300 joules.!f}7A patient with pulseless V-tach(which is treated identically toV-fib) has had one shock at 200joules and a second shock !g}at 250.The rhythm is still V-tach withouta pulse. According to protocol,the next step would be:4A. set to 300 and defib!q}3B'DOS SYSB*+DUP SYSBUAUTORUN SYSB WINIT BASB(wQUIZ BASBeLESSON1 B:LESSON0 B=LESSON8 B0[LESSON7 B4LESSON9 B(LESSON2 B-LESSON6 B"LESSON5 B-?LESSON4 B0lLESSON3 rillateB. set to 360 and defibrillateC. start an IVD. intubateB5Before taking the time to start theIV, it seems logica!r}l to try shockingat the maximum setting. This givesthe best chance of minimizing the"time in arrest".3The usual startin!s}g setting fordefibrillating a child shouldbe around:4A. 1 joule/kgB. 2 joule/kgC. 4 joule/kgD. 6 joule/kgB8Defibril!t}lation of a child isstarted at about 2 joules perkilogram of body weight. If notsuccessful, the setting is turnedup to a!u}round 4 joules/kg. Becausedefibrillator settings are often inmultiples of 25, you'll have to setto the closest possible c!v}harge.10Ventricular fibrillation whichcontinues despite the sequenceof three initial "shocks" needsdrug therapy to aid i!w}n conversion.At this point, an IV is started forthat purpose, while oxygenating thepatient well by mask. The FIRSTdrug y!x}ou would give to a patientfound in V-fib (unwitnessed) wouldbe:5A. bicarbonateB. epinephrineC. lidocaineD. bretyliumE!y}. atropineB5Epinephrine is used to coursen thefibrillation, making it easier toconvert. It's easy to remember--"epi" i!z}s the first drug given anytime you can't feel a pulse.5After starting the IV and givingepinephrine to a patient with V-fi!{}bwhich didn't respond to the initialattempts at defibrillation, yournext shock would be given at:4A. 200 joulesB. 300 j!|}oulesC. 360 joulesD. 400 joulesC6Subsequent shocks are all deliveredat 360 joules, which is the maximumrecommended. U!}}nder the new protocolonly one 360 joule shock is given.If it's not effective, you progresson to anti-arrhythmic therapy.7!~}Refractory ventricular fibrillationrequires treatment with anti-arrhythmic drugs. By suppressingabnormal electrical acti!}vity, itbecomes possible to shock therhythm back to normal. Which drugdo you use first?4A. lidocaineB. bretyliumC. pr!}ocainamideD. verapamilA4Lidocaine is the drug of choice forV-tach, V-fib, and for PVC's (pre-mature ventricular contrac!}tions).The starting dose is 1 mg per kg.11Lidocaine is an excellent drug tosuppress cardiac "irritability."Irritability !}means the heart keepsreverting to abnormal rhythms suchas V-fib or V-tach, or is threateningto go into an abnormal rhythm !}by"throwing PVC's" (premature ventric-ular contractions). A 56 kilogramgirl with a crushed chest and PVC'swould need an !}initial lidocaine bolusof about:4A. 60 milligramsB. 30 milligramsC. 90 milligramsD. 15 milligramsA6Children do not u!}sually need lidocaine because their cardiacarrest usually results from hypoxia(drowning, choking). In this case,the hear!}t has been bruised. Thebolus should be 1 mg/kg.3If lidocaine is not successful atallowing defibrillation, the nextdrug !}you would consider is:4A. bicarbonateB. procainamideC. propranololD. bretyliumD4Bretylium is used if lidocaine andde!}fibrillation (360 joules) doesnot convert the rhythm. Thestarting dose is 5 mg per kg.5You have a patient with V-fib who!}has not responded to both lidocaineand bretylium. At this point youshould strongly consider thepossibility of:4A. acid!}osisB. pericardial tamponadeC. electromechanical dissociationD. hypermagnesemiaA7After giving bretylium and tryingonce!} more to defibrillate at 360joules, you would consider givingbicarbonate IF BLOOD GASES OR THECLINICAL HISTORY INDICATE TH!}E NEED.Bicarbonate is no longer givenroutinely.2If bretylium at 5 mg per kg is nothelpful, you should:3A. give 1 mEq/k!}g bicarbB. give procainamide 20 mg/minC. give bretylium 10 mg per kgC3If a second dose of bretylium isnecessary, give i!}t at twice thefirst dose--at 10 mg per kg.6V-tach which is "unstable"--thatis, with dyspnea, chest pain,ischemia, hypote!}nsion, orunconsciousness--should be shocked.The starting defibrillator settingwould be:4A. 50 joulesB. 100 joulesC. 20!}0 joulesD. 360 joulesA13Ventricular tachycardia is oftenconverted by low-energy shocks.The defibrillator is set tosync!}hronize the shock with theheart beat, which is called"synchronized cardioversion".In certain settings, V-tach shouldbe tr!}eated with NON-synchronizedshocks to avoid time delay. It'srecommended that if hypotension orunconsciousness is present, !}thepatient be simply defibrillatedwithout synchronization.se andfeel NO pulse. Your first step is:4A. get the defibril =4Chest trauma is a leading cause of death in young adults. Which of thefollowing is the threat tolife?5A. Pulmon%}ary contusionB. Air embolismC. Flail chestD. Tension pneumothoraxE. Cardiac tamponadeA6Of greatest urgency are those c%}hestinjuries which threaten respirationand circulation. These include airembolism, massive hemothorax, tensionpneumothor%}ax, open hemothorax, flailchest, and cardiac tamponade.1A flail chest is:7A. Air in the chest pressing on the lung, i%}nterfering with breathingB. A hole in the chest wall allowing air to go in and outC. Ribs broken in a way that allows a%} section of the chest to move independantlyC8Several neighboring ribs can moveindependantly from the rest of therib%} cage if they are broken in twoplaces. This is called a flailchest. This flail segment can movein the opposite direction%} from therest of the ribs, making the victim'sattempts to breathe worthless.2Cardiac tamponade is suggested by thecombin%}ation of:8A. Frothy pink sputum, cough, and dyspnea after hitting the steering wheel in an auto accidentB. Chest pai%}n, PVC's, and elevated cardiac enzymes after blunt chest traumaC. Shock and distended neck veins after a penetrati%}ng chest woundC7Cardiac tamponade occurs when bloodfrom a penetrating wound fills thepericardial sac, preventing filling%}of the heart. Shock results as thereis not enough blood in the heart topump. The blood backs up into theveins, distendi%}ng them.2The first step in treating an openpneumothorax would be:7A. Intubation and positive pressure ventilationB. %}Occlusion of the wound with vaseline gauzeC. "Crash" thoracotomy in the E.R.D. Thread a chest tube through the wound %}and purse-string in placeB10An open pneumothorax, also called asucking chest wound, should beoccluded with vaseline gauz%}e. Thisis placed so it can act as a valve,allowing air under pressure to escapefrom the chest underneath it, butpreventi%}ng air from being sucked intothe chest during inspiration. Achest tube is placed at a moreoptimal site.6About 85% of si%}gnificant chest traumacan be treated conservatively--thatis, with chest tube placement andobservation. A good, quick refe%}rencefor emergency placement of a chesttube is:8A. Posterior axillary line across from the scapulaB. Second intercost%}al space in the mid-clavicular lineC. Anterior axillary line directly around the chest from the xyphoidD. Mid-axillar%}y line directly around the chest from the nippleD4By entering laterally, well abovethe diaphragm, and aiming superiorl%}y,most of the possible complicationsof tube thoracostomy can be avoided.3Common complications of chest tubeplacement inc%}lude all of thefollowing EXCEPT:6A. Vagally-induced cardiac arrhythmiaB. Laceration of the lungC. Laceration of one of t%}he great vesselsD. Entry into a bronchusE. Entry into the liver or spleenA7The common complications of chesttube ins%}ertion are related to1) improper position for placement,and 2) use of the trocar forinsertion. Tunneling and bluntentry %}with a hemostat followed byfinger dilation is recommended.2For removal of blood from the pleuralspace, a chest tube shoul%}d be:4A. Irrigated with salineB. Placed at the diaphragm borderC. 34 French or larger in sizeD. All of the aboveC3Sma%}ller chest tubes may fail toevacuate blood due to occlusion withclots.3A situation in which chest tubeplacement should b%}e deferred to theO.R. is:5A. Air embolismB. Massive hemothoraxC. Rupture of the tracheo-bronchial treeD. Flail chest%}B6A massive hemothorax indicatesbleeding from a major vessel. Theblood in the chest may be occludingfurther bleeding. %} Upon decompressionby chest tube placement, massivebleeding may again result.2Indications for thoracotomy includeall of %}the following EXCEPT:6A. Flail chestB. Rupture of the diaphragmC. More than 1 to 1.5 liters out of the chest tube at p%}lacementD. Continued passage of more than 300 cc's per hour for two hoursA4Evidence of severe bleeding orcontinuing m%}ajor bleeding, as wellas evidence of structures whichrequire repair, requires thoracotomy.2Bubbling in the chamber of the%} waterseal nearest the suction means:6A. The chest tube is allowing air to pass around it into the chestB. The connect%}ion of the water seal to the chest tube is leakingC. The water seal is defectiveD. The suction is about rightD3The su%}ction is usually set to about25 mm Hg. The first chamber, nearestthe wall suction, will bubble.2Bubbling in the middle c%}hamber of thewater seal means:9A. The suction is too highB. The chest tube is occluded by a clotC. The water seal uni%}t should be replaced D. Air is entering, either from a pneumothorax (which is normal), or from a leak in the tube c%}onnection (which should be fixed).D3Air entering via the tube whichconnects with the chest tube causesbubbling in the%} middle chamber.2Which of the following is NOT anindication for chest tube placement?5A. Penetrating chest woundB. Smal%}l hemothoraxC. 30% spontaneous pneumothoraxD. 25% pneumothorax with rib fractureE. Flail chestE11A chest tube can be th%}erapeutic ordiagnostic. It can remove air orfluid while healing progresses, orcan provide a means of monitoringintrathor%}acic bleeding to determinewhether operative intervention isnecessary. A flail chest withoutpneumothorax does not require %}chesttube placement--rather, stabilizethe chest wall to keep the brokensegment from moving.3Which of the following would%} be agood candidate for needle aspirationof the pleural space?5A. 5% pneumothorax with rib fractureB. 40% spontaneous pn%}eumothoraxC. low caliber gunshot with small hemothoraxD. Flail chestA3A small simple pneumothorax cansafely undergo %}a trial of needleaspiration.3Chest tube placement, with carefulobservation of output, would be thebest for:8A. Gunshot%} with M-16 to right upper chestB. Stab wound to chest with distended neck veinsC. Gunshot with .22 to left upper c%}hestD. Auto accident with opacified left hemithoraxC8One could safely observe a lowcaliber, low velocity gunshot woun%}d.Surgical resection of the involvedsegment is favored for high-velocity,high energy bullet wounds. Peri-cardial tampona%}de and massive hemo-thorax are not candidates for simplechest tube placement and observation. threat tolife?5A. Pulmon$`3Which of the following is the LEASTpreferable initial step for a patientwho is not breathing?4A. Mouth to mouthB. Mout)}h to facemaskC. Bag-valve to facemask D. Immediate intubationD8No time should be lost in oxygenatingthe patient. Venti)}lation should bestarted using the most rapid meansavailable. Intubation should bepostponed until the patient has beenoxy)}genated by other means. Thisavoids continued hypoxia whileattempting to intubate.3Which is NOT a correct part ofventila)}ting the patient by mask andbag-valve?6A. Cricoid pressure to prevent regurgitation and aspirationB. Head tilt and jaw)} thrustC. Suction of any foreign material in mouth and pharynxD. Oropharyngeal airwayA10Proper positioning of the hea)}d andjaw, removal of foreign material fromthe pharynx, and insertion of theoropharyngeal airway assure goodair passage in)} ventilating theunresponsive patient. Cricoid pressure is sometimes used to preventaspiration during intubation, but it)}is not considered a part of bag-valveventilation.2A problem with the oropharyngealairway is:4A. Nasal bleedingB. Perfo)}ration of the esophagusC. Retching in responsive patientsD. Does not control the tongueC7The oropharyngeal airway should)} onlybe used on unconscious patients, asit may otherwise provoke vomiting.It creates an air passage past thetongue, but d)}oes not enter the nosenor the esophagus, making the otherchoices incorrect.2All of the following are correctabout nasoph)}aryngeal airways EXCEPT:8A. It may cause nasal bleeding if forcedB. It creates a groove in the back of the tongueC.)} After insertion, the balloon is inflated to about 5 ccD. It is better tolerated than other methods by the conscious p)}atientC5The nasopharyngeal airway is insertedthrough the nose to the back of thetongue. It is best inserted gently,coa)}ted with anesthetic jelly. Thereis no balloon!1The esophageal obturator airway:7A. Should be removed before trying i)}ntubation.B. May be used on conscious patientsC. Has an inflatable cuff to occlude the esophagus.D. Cannot enter the tr)}achea.E. All of the above.C12The esophageal obturator airway isplaced through the mouth into themid-esophagus. The bal)}loon is inflated to prevent regurgitation.Ausculation after insertion rules outan intratracheal position for theobturator)}. On the unconsciouspatient, the endotracheal tube shouldbe inserted with the obturator inplace! Rupture of the esophagu)}s isa possible complication, particularlyafter caustic ingestions.2Endotracheal intubation is bestaccomplished:6A. In )}the "sniffing" position.B. With the neck fully extended.C. Using the upper teeth as a lever to pull the tongue forward.)}D. Holding the laryngoscope in the right hand.A7The laryngoscope is designed to beheld in the left hand, so the flange)}does not interfere with vision.The head is put in the "sniffing"position, and straight traction (notleverage) is used to )}pull the tongueup.2For a child, the correct size ofendotracheal tube would be:5A. One number less than age in years.B.)} The size of the little finger.C. The number equal to the weight divided by ten.D. The size of nostril.B4A rapid guid)}e to endotracheal tubesize in children is to compare tothe diameter of the end of the littlefinger.2Advantages of endotr)}acheal intubationinclude all of the following EXCEPT:9A. Stabilizing the neck in trauma victims.B. Protection from asp)}iration.C. Allows positive pressure ventilation.D. Makes trachea available for suctioning.E. Less likely t)}o cause gastric distention.A9Endotracheal intubation has theadvantage of complete control of theairway--preventing as)}piration whileallowing suctioning. Because airis directed into the lungs, gastricdistention is less of a problem.Intubat)}ion must be approached withgreat caution in neck-injuredpatients.1A cuff is NOT necessary on:6A. esophageal obturator a)}irwaysB. children under 8 years of ageC. adults who have not eaten for at least 12 hoursD. any intubated patient, if th)}e proper diameter was chosen.B4A cuff prevents air leakage, andblocks stomach contents from thelung. Young children,)} however, forma tight seal without the cuff.1Room air is:4A. 16% oxygenB. 21% oxygenC. 28% oxygenD. 40% oxygenB1No)}rmal room air has 21% oxygen.4When intubation cannot be completed, with inadequate ventilation of thepatient by mask, an )}alternativewould be:7A. bronchoscopic intubationB. tracheostomyC. transtracheal catheterD. cricothyrotomyE. either B o)}r DF. either C or DG. all of the aboveF9RAPID, emergency oxygenation of anobstructed airway can be accomplishedby putt)}ing a 14-guage IV catheterthrough the cricothyroid membrane.This is followed by high pressure(jet) oxygen delivery. A cri)}co-thyrotomy is followed by insertionof a small endotracheal tube andbag-valve oxygenation.g?4A. Mouth to mouthB. Mout(_5A case of second-degree atrioven- tricular block has not responded toa total of 2 milligrams atropine.Which drug would b-}e most useful asthe next step?4A. try another 2 mg atropineB. start a dopamine dripC. start an isoproterenol dripD. dig-}oxin, 0.25 mg slow I.V.C7Full doses of atropine have not helped, so more atropine will have noeffect. Isuprel is the ne-}xt stepfor refractory AV block. Isoprot-erenol is given as a drip, startingabout 0.03 mg per kg per minute andincreasing-} until effects are seen.3Isoproterenol has several drawbacks.These include all of the followingEXCEPT:6A. decreases myo-}cardial contractilityB. increases irritabilityC. increases oxygen needs of the heartD. may increase the size of an-} infarctA8Isuprel (isoproterenol) stronglystimulates the heart, increasingthe force of contraction, heart rate,oxyge-}n need, and irritability. Itreduces atrioventricular block. Itmust be used with caution--as afinal attempt before a pace-}maker inrefractory bradycardia or block.1Isoproterenol does NOT:5A. constrict the blood vesselsB. increase cardiac oxyg-}en useC. increase the heart rateD. increase the likelihood of fibrillationA7Isoproterenol is a potent cardiacstimula-}tor, but at cost. It mayincrease infarct size. It doesNOT constrict blood vessels, andtherefore can only raise bloodpre-}ssure if hypotension is duesolely to bradycardia.7Calcium is no longer part of anyACLS protocol! It is consideredto be -}actually harmful when usedduring CPR. IV calcium does,however, have two very valid uses.One is to correct life-threatenin-}ghypocalcemia. Another is:4A. life-threatening hyperkalemiaB. severe hyperthermiaC. refractory 3rd degree AV blockD. l-}ife-threatening hypernatremiaA6Calcium can reverse some of thecardiac disturbances caused bysevere hyperkalemia. Delibe-}ratealkalosis with bicarbonate, andan insulin-glucose infusion cantemporarily lower serum potassium.6Propranolol (Indera.}l) is a beta-blocker. It slows the heart, decreases AV conduction slightly, anddecreases the force of contraction.It is .}useful in all the followingsituations EXCEPT:6A. severe hypertension and suspected dissecting aneurismB. rate control .}in atrial fib. C. malignant hypertensionD. reducing cardiac work in cardiac shockD9Inderal can be used I.V. whe.}re rapidcontrol of blood pressure or heartrate is needed. Although not usuallythe first-choice drug, it can be usedfor r.}ate control in uncomplicatedatrial fibrillation. Because of itscardiac depressant and hypotensiveeffects, it is contra-in.}dicated incardiac shock.4In using Inderal I.V. for suspectedexpanding aortic aneurism in ahypertensive, tachycardic indi.}vidual,use a dose of:6A. 10 mg, repeated in 5 minutes if not effectiveB. 40 mg STAT, then 10 mg every 5 minutes up .}to 80 mgC. 1 mg, repeated up to 5 mg totalD. 40 mg per hour infusion by pumpC5Inderal is quite potent (and somewhathaza.}rdous) by the I.V. route. Anampule contains 1 milligram. Giveone ampule, repeated up to a totaldose of 5 mg.5Digoxin m. }ay be given I.V. when neededacutely. The usual use is to controlthe ventricular response to rapidatrial fibrillation. Th. }e usualstarting dose I.V. would be:3A. 0.5 milligramsB. 1 milligramC. 2 milligramsA4Give 0.5 mg Digoxin (one ampule o. }fadult strength) I.V., then titrateup to get the heart rate controlled.It is best not to exceed 1 mg.2Possible hazards o. }f Digoxin useinclude all of the following EXCEPT:7A. digitalis toxicity due to narrow therapeutic rangeB. myocardial d. }epressionC. aggravation of the effects of electrolyte abnormalitiesD. turning partial AV block into complete AV block.}B8Digoxin should be used carefully tocontrol heart rate, or to increasecontractility in the damaged heart.Its side effe.}cts of possible arrythmia, AV block, and slowing ofthe sinus rate (as well as its verynarrow "safe" range) should be kept.}in mind.5Dopamine is usually the first choicedrug for any form of shock. Itstimulates the heart and constrictsblood ves.}sels. Before deciding thatit is necessary, one should:8A. first try the less hazardous isoproterenolB. give lidocaine.} for the cardiac irritability it will causeC. use digoxin first to ensure adequate cardiac contractilityD. make s.}ure blood volume is adequateD7While it's safer than isoproterenol,dopamine does increase cardiacoxygen needs and irri.}tability tosome extent. However, getting theblood volume up to optimum mayraise blood pressure enough toeliminate the ne.}ed for dopamine.4Protocols for mixing dopamine varyfrom hospital to hospital. Theusual starting dose for a dopaminedrip.} would be:4A. 2-5 microgm/kg/minB. 20-30 microgm/kg/minC. 2-5 milligm/kg/minD. 20-30 milligm/kg/minA7Dopamine is star.}ted about 2 to 5 micrograms per kilogram per minute,then increased to effect. Usuallythe desired elevation of bloodpress.}ure will be seen by 20 mcg/kg per minute. A dosage chart trans- lates mcg/kg/min into drops/minute.5In high doses, d.}opamine acts as ageneralized vasoconstrictor. Anadvantage of dopamine is that, atlower doses (about 2 mic/kg/min),it cau.}ses:4A. cerebral anosmiaB. paradoxical vagal stimulationC. mesenteric vasodilationD. increased extremity perfusionC5D.}opamine at low doses may constrictthe general vasculature, yetslightly dilate mesenteric vessels.The increased blood flow .}to thekidneys can be extremely valuable.lar block has not responded toa total of 2 milligrams atropine.Which drug would b,*11Lidocaine is an excellent drug tosuppress cardiac "irritability."Irritability means the heart keepsreverting to abnorma2}l rhythms suchas V-fib or V-tach, or is threateningto go into an abnormal rhythm by"throwing PVC's" (premature ventric-ul2}ar contractions). A 56 kilogramgirl with a crushed chest and PVC'swould need an initial lidocaine bolusof about:4A. 60 2 }milligramsB. 30 milligramsC. 90 milligramsD. 15 milligramsA6Children do not usually need lidocaine because their cardi2!}acarrest usually results from hypoxia(drowning, choking). In this case,the heart has been bruised. Thebolus should be 12"} mg/kg.6You give 100 mg of lidocaine to anobese middle-aged man who is havingchest pain and PVC's (8 per min).Rhythm is 2#}sinus. The PVC'scontinue. Your next drug orderwould be:3A. lidocaine 50 mg IV bolusB. bretylium 500 mg IVC. procainam2$}ide 20 mg per minuteA7For ventricular ectopy (PVC's),lidocaine is started as a 1 mg/kgIV bolus. If PVC's continue, more2%}lidocaine is given in 0.5 mg/kgdoses until the PVC's are suppressedor 3 mg/kg is reached. At thatpoint, procainamide wou2&}ld be tried.5Let's say that we gave the 100 kgman in the last question a total of2.5 mg per kg--250 mg all together.His 2'}PVC's are now suppressed. Whatabout a lidocaine drip?4A. No, because of danger of toxicityB. Yes, cautiously at 1 mg/min2(}C. Yes, at 2 mg/minD. Yes, at 4 mg/minD11Concentrations of lidocaine fall offquickly. It is necessary to give thedrug2)} as a bolus to get the level up.A drip alone would not be rapidlyeffective. After the PVC's havebeen suppressed, the lido2*}caineinfusion rate is proportional tothe amount of lidocaine that wasrequired to stop the PVC's. Inother words, if you h2+}ad to givea lot, use a high drip rate.3If lidocaine is not successful atstopping PVC's, the next drug youwould use would2,} be:4A. procainamideB. bretyliumC. atropineD. verapamilA5Lidocaine is used up to 3 mg perkg. If the PVC's still hav2-}e notstopped, the next drug used wouldbe procainamide. It is given as20 mg per minute.4Procainamide is being given to a2.}patient for ventricular ectopy at20 mg per minute. It should bestopped if:4A. the QRS widens by 50%B. hypotension deve2/}lopsC. 1000 mg total is givenD. any of the aboveD4Procainamide administration shouldbe monitored for QRS widening orhy20}potension. No more than 1000 mgshould be given.5Bretylium is a useful anti-arrhythmiadrug, and is given if lidocaineis 21}not successful in allowingdefibrillation of V-fib. A typicaldose would be:5A. 5 mg per kg, then 10 mg/kg if not effec22}tiveB. 1 mg per kg, repeated in 20 min.C. 20 mg per minute for an adult, up to 1000 mg totalA6Bretylium is given at 523} mg per kg(350 mg for a typical adult). Thendefibrillation is attempted. Ifthe rhythm doesn't convert, a seconddose of 24}10 mg per kg (twice thefirst dose) is given.2Bretylium has one important sideeffect. It is:5A. depression of cardiac m25}uscleB. atrioventricular blockC. risk of seizuresD. kidney damageE. hypotensionE5Because bretylium was developedorigi26}nally as a ganglionic-blockinghigh blood pressure medication, itcauses orthostatic hypotension, andmay aggravate cardiogen27}ic shock.1Verapamil is useful for:3A. supra-ventricular tachycardiaB. decreasing atrioventricular blockC. ventricular t28}achycardiaA7Verapamil is now the first-line drugfor tachycardia which originatesabove the atrioventricular node. Itpar29}tially blocks the AV node, suppressing abnormal circuits (PAT)or decreasing the rate that theventricle is "fired" (Atrial 2:}fib).6A 19 year-old girl complains ofpalpitations, lightheadedness, andshortness of breath. The EKG lookslike PAT (paro2;}xysmal atrial tachy-cardia). What would be the rightdose of verapamil?4A. 5 mg per minute up to 25 mg totalB. 1 mg, rep2<}eated up to two timesC. 5 mg, then 10 mg after 15 min if no effect from the first doseC7One precaution is that Inderal2=} andVerapamil should not be used together(this compounds the side effects).Verapamil may predispose the patientto hypoten2>}sion, AV block, andbradycardia, and is best avoided whenthere's a question of a heart attackart keepsreverting to abnorma0_6It's helpful to remember that ifthere's no pulse, the first druggiven to the patient is ALWAYS thesame regardless of wha6@}t type ofrhythm is on the monitor. This"cardiac stimulant" drug is:4A. epinephrineB. isoproterenolC. digoxinD. atropi6A}ne A11Epinephrine is the first drug usedfor V-fib, because it can "coarsen"the fibrillation, making it easierto convert6B}. Pulseless V-tach istreated just like V-fib. Epi isthe first drug used for asystole--and pulseless bradycardia is treat6C}edjust like asystole. Furthermore,it's the first drug used for EMD(electromechanical dissociation).Just remember: no pul6D}se = epi first.2When no IV is available, epinephrinecan be given endotracheally:4A. as 1 cc of 1/1000 solutionB. at 1/26E} the IV doseC. as 10 cc of 1/10,000 solutionD. by aerosol mistC7Epinephrine can be given by E.T.tube in the form of the6F} standardIV ampule (10 cc of 1 to 10,000).This is one milligram of epi.The amount of fluid (10 cc's)is not a concern. It6G}'s rapidlyabsorbed.4Besides epinephrine, other drugs canbe given endotracheally when no IVis available. Which of the dr6H}ugsbelow CANNOT be given by E.T. tube?6A. NaloxoneB. BicarbonateC. LidocaineD. AtropineE. Choices A, B, and CF. Choic6I}es A and BB6Naloxone, lidocaine, and atropineare effective endotracheally. Givethem in the same doses you'd useby vein6J}. In this way, needed therapydoesn't need to wait when the patienthas "bad veins".4Bicarbonate is supplied in pre-filled6K}syringes containing 50 millequiv.bicarbonate in 50 cc's of water. Itis used to correct:4A. alkalosisB. cardiac irritab6L}ilityC. acidosisD. low blood pressureC8Bicarbonate is no longer consideredpart of the routine treatment ofcardiac arre6M}st. It should be usedonly where clearly clinicallyindicated, either by a historysuggesting severe acidosis or byfinding 6N}severe acidosis on blood gasanalysis.5You decide, based on the patienthistory, that a patient in V-fibneeds bicarbonate 6O}therapy. Yourelay the order for bicarbonate tothe paramedics. You order:3A. 1 millequivalent per kilogramB. 0.5 millie6P}quivalent per kilogramC. 0.1 milliequivalent per kilogramA5The initial dose should be about onemEq/kg. For the average 6Q}adult, use75 mEq. This would be one and a halfampules, or 75 cc of bicarbonatesolution.3With an adult in continuingcar6R}diac arrest (no pulse)you should give bicarbonate:8A. automatically at 0.5 mEq per kg every 10 minutesB. automatically6S} at 1 mEq per kg every 5 minutesC. automatically at 1 mEq per kg every 10 minutesD. only as dictated by blood gas 6T}analysisD7You can, at your discretion, give0.5 mEq of bicarbonate every 10minutes. However, this is no longerrecommend6U}ed. Blood gases shouldbe drawn frequently to assess theneed for bicarbonate replacementtherapy.4As long as the patient 6V}is in cardiacarrest, give epinephrine (adrenaline)automatically. Of the dosesbelow, which is correct?3A. 1 cc every fiv6W}e minutesB. 1 mg every ten minutesC. 0.01 mg per kg every five minutesC6Epinephrine comes in pre-filledsyringes (ampule6X}s) which contain onemilligram in 10 cc's. For anadult, give 0.5 to 1 mg everyfive minutes. For children, thedose is 0.06Y}1 mg per kg.6A patient with a slow rhythm whichis causing signs or symptoms needstreatment to speed the heart rate.The d6Z}rug of choice for severebradycardia or atrioventricularblock is:6A. isoproterenolB. verapamilC. propranololD. calcium 6[}chlorideE. atropineF. dopamineE10A patient with a slow heart ratewhich is causing him no problemscan simply be observe6\}d. If theslow rate is causing signs orsymptoms, however, atropine is usedto speed the heart. Atropineblocks nerve and c6]}hemical effectswhich tend to slow (or stop) theheart and slow conduction throughthe AV node.6Atropine increases the rate6^} of theheart and increases the conductionthrough the AV (atrioventricular)node, and is also used for asystole(cardiac sta6_}ndstill). The properdose for asystole is:8A. for adults, 1 mg initially, repeated once if requiredB. for adults, 1 mg6`}/kg, then 0.5 mg/kg to a total of 3 mg/kgC. for adults, 5 mg bolus, then 10 mg if not effectiveD. for children, .01 c6a}c per kg, repeated up to three times A8Atropine can aid in overcomingasystole by blocking vagal toneon the heart. F6b}urther dosesbeyond 2 mg (for an adult) do nogood, because vagal nerve effectsare completely blocked at thatlevel. Atropi6c}ne is supplied as onemg in 10 cc's of fluid.4An eight-year old drowning victimhas a heart rate of 35. He lookslike he w6d}eighs about 25 kg. How muchatropine would you give?6A. 1 ampule, repeated up to three timesB. 0.25 mg, repeated up to6e} a total of 1 mgC. .05 mg, repeated up to .2 mg totalD. none of the aboveB7Atropine is given at a dose of 0.01mg per6f} kg. For a standard ampule,this measures as 0.1 cc per kg.Notice that the dose of epi andatropine are the same: a startin6g}gdose of each is 0.01 mg per kg forthe pediatric patient.5A boy who was struck by a car arrestsin the emergency room. H6h}e needsepinephrine every five minutes. Heappears to weigh about 35 kg.What's the approximate epi dose?5A. 17.5 ccB. 1.6i}75 ccC. 3.5 ccD. 35 ccE. 7 ccC9Epinephrine is given as 0.01 mg perkg of body weight every five minutes.0.01 mg of 1/16j}0,000 epinephrineis 0.1 cc. So a convenient wayto calculate the epi dose is tojust divide the weight in kg by10. (35 kg6k} / 10 --> 3.5 cc's)This works identically foratropine!irst druggiven to the patient is ALWAYS thesame regardless of wha4:3Of the following indications forintravenous cannulation, which isthe LEAST often needed?4A. administration of fluidsB.:m} administration of drugsC. passage of cardiac pacing wireD. venous blood samples for labC8An intravenous line is the mos:n}tpractical way to rapidly administerfluids and drugs. Venous bloodsamples are often obtained as theIV catheter is placed:o}. A pacing wirecan be passed even through aperipheral vein, but this is a lesscommon use for an IV catheter.5Placing an:p} IV line is not completelyfree of hazards. Which of thefollowing problems is COMPLETELYpreventable by proper insertionte:q}chnique?4A. pain of insertionB. hematoma formationC. catheter-induced sepsisD. catheter embolizationD11Proper techniq:r}ue can reduce the painof insertion, reduce the chance ofvein damage and hematoma formation,and decrease bacterial contamin:s}ation.But even with good technique, theseproblems can occur. Catheterembolization, which means the tip ofthe catheter is:t} cut off and floatsaway, should NOT occur. It isprevented by never pushing the needleahead once it has been withdrawn!3:u}Upper extremity veins are preferredfor IV's over leg veins. Why arethe leg veins generally avoided?6A. increased likelih:v}ood and severity of venous thrombosisB. inadequate flow ratesC. loss of IV due to motion and downward positionD. int:w}olerable discomfortA9Upper extremity veins are preferredin adults because venous thrombosisis likely to occur in the leg:x}s.Many IV solutions and drugs irritatethe veins. Venous thrombosis isnot only more likely in the legs, butmore dangerous:y} when it does occur.If, however, a leg IV is the onlyIV you can get, go for it.2Which IV catheter would have themost rap:z}id possible flow?4A. 14 guage, 5 cm lengthB. 16 guage, 20 cm lengthC. 18 guage, 3 cm lengthD. 20 guage, 3 cm lengthA9:{}IV catheters get smaller as theguage number gets larger. A 22-guageIV catheter is smaller than a 20-guage. Fluid can be :|}forced into avein more rapidly through a shortcatheter than a long one, but thediameter (guage) is the most criticaldimen:}}sion. The wider the bore, thefaster the possible flow rate.5The risk of air embolism must beconsidered when placing an I:~}Vcatheter into a central vein (such asthe subclavian or internal jugular).The most important precaution is:8A. making su:}re all bubbles are out of the IV tubingB. tip the patient's body so the head and chest are downwardC. remove the syri:}nge from the needle during expiration, then occludeD. advance the catheter while the patient breathes inC8Significa:}nt air embolism can occurif the patient inspires while theneedle is uncovered. The negativepressure sucks air into the ce:}ntralvein. If the patient is on aventilator, however, the needleshould be removed while the machineis blowing air INTO t:}he chest.4Which of the following is NOT anadvantage of internal jugular veincannulation over subclavian veincannulation?:}6A. less interference with CPRB. less risk of pneumothoraxC. allows more free movementD. easier pacemaker insertion E. :}hematomas are visible, and easily compressableC6Internal jugular cannulation isusually easier to perform duringCPR, :}with less risk of complications.It does, however, restrict the ambulatory patient because neckmovement must be limited.5:}Attempting to place an internaljugular IV line has resulted in arapidly expanding neck hematoma.The patient is getting CPR:}. Youcompress the hematoma and:9A. attempt a subclavian IVB. attempt an external jugular IV on the same sideC. attem:}pt either an external jugular or internal jugular on the opposite sideD. immediately proceed to cutdown and explora:}tion on the side of the hematomaA8After a hematoma has formed, it ishazardous to attempt any punctureon the opposite :}side, because anotherhematoma on the opposite side couldocclude the airway. One would go toa site away from the neck, suc:}h asa peripheral cutdown or subclavianpuncture.5The subclavian vein can be enteredby puncturing the skin at thejunction:} of the outer 1/3 and inner2/3 of the clavicle (the clavicularnotch area) and aiming towards:4A. the xyphoid processB. t:}he center of the sternumC. the suprasternal notchD. the angle of the jawC7Correctly directing the needle isvery importa:}nt during subclaviancannulation. By aiming for thenotch between the medial ends of theclavicles, the chance of puncturing:}the lung or the subclavian arteryis decreased.2The internal jugular vein can befound:6A. beneath the sternal head of t:}he sternomastoid muscleB. directly below and slightly in front of the angle of the jawC. just in front of the trapezi:}us muscle 10 cm below the jawA5The sternal head of the sternomastoidmuscle is used as a landmark forcannulating the i:}nternal jugular.It may be approached there fromin front or in back of the muscle.2A major advantage of the externaljugul:}ar vein is:8A. it provides easier pacer wire insertionB. it can be treated just like a peripheral vein IVC. the rig:}ht atrium can be reliably entered without any guidewireD. it is always easily found even in cardiac arrest patientsB:}8Proper technique makes externaljugular IV placement no differentthan peripheral vein placement. Itcan be treated the sa:}me once inplace. Advancing pacing wires orcentral catheters via the externaljugular requires special techniquesand equip:}ment, however.4The femoral vein is found just belowthe inguinal ligament in the groin.Going from lateral to medial, onef:}inds:3A. nerve, artery, veinB. artery, vein, nerveC. vein, artery, nerveA8Going from the outer part of theinguinal li:}gament towards the pubicarea, one finds first nerve, thenartery, then vein. For venouspuncture or cannulation, one finds:}the arterial pulse, then punctures and advances just medial to thispulse.ST often needed?4A. administration of fluidsB.8L.BASEAx@A@@@N