the simulator question 1

A 40 year old man arrives at the ER accompanied by his family. He is complaining of palpitations after working outside for several hours. The assessment is as follow:

SKIN: Pale, warm and dry
CVS: Strongperipheral pulses and a BP of 125/80
CNS: Fully intact
RESP: RR is 22, no resp. difficulties, lungs CTA
The monitor shows narrow complex SVT with HR of 180
_____________________________________________________________________________________

1. You place oxygen at 2 litre by nasal phronge on the patient and start an IV. The
monitor continues to show a narrow complex SVT.

What is your next intervention?
- attempts vagal maneuvers.

2. You have performed vagal maneuvers and there is no change in the patient heart
rate and rhythm. What is your next step?
- give adenosine 6mg rapid IV push. If no conversion, give 12mg rapid IV push.

3. You give 6mg Adenosine rapid IV push with no effect. 12mg adenosine rapid IV
push is then given. The patient develops severe chest pain and his vital sign
are: HR220, BP (not obtainable), and weak pulse. The patient also has LOC change.
Your next step should be.
- perform immediate synchronized cardioversion.

4. After synchronized cardioversion is unsuccessful, the pt. continues to
deteriorate. The patient is now unconscious with pusleless ventricular
tachycardia. Below is what you see on the monitor:

What is your first intervention.
- give one unsynchronized schock (120-200 J)

5. The patient does not respond to the defibrillation. He remain unconscious in
ventricular tachycardia. What is your next intervention.
- Gives 5 cycles of CPR.

6. After completing 5 cycles of CPR, your rhythm check indicates a second shock.
You shock a second time, and the patient rhythm does not change. You resume CPR.
While completing the cycle of CPR what else shold be done?
- Give Epinephrine 1mg IV push(repeat every 3-5 minutes),
- Vasopressin 40 U IV push to replace the 1st or 2nd of epinephrine.

7. You have given the epinephrine or vasopressin and completed the 5 cycles of CPR.
A rhythm check reveals no change. You attempts at third defibrillation.
What will be your defibrillation setting?
- 120-200 Joules.

8. The third schock does not change the rhythm and you restart CPR (5 cycles). You
have schock, have given vasopressors (epinephrine and/or vasopressin), you have
have continued with effective CPR. What medication should be considered at this
points?
- Amiodarone

9. What is the correct dosing for amiodarone in the Pulseless Arrest Algorithm?
- 300mg IV once. Then consider an additional 150mg IV once.

10. Lidocaine can be used instead of amiodarone as an anti-arrhythm for pulseless
arrest. What is the proper dosing of lidocaine?
- 1 to 1.5 mg/kg 1st dose, then 0.5 to 0.75 mg/kg IV.

11. You give amiodarone 300mg 1st dose and the patient convert to a Normal Sinus
Rhythm. You are instructed to start an amiodarone drip for the postresuscitation
maintenance theraphy. What is the maximum cumulative dose for amiodarone in a
24 gour period?
- 2.2 grams.

12. The patient has been stabilized and intubated, but does not respond to verbal
commands. He is transported to the hospital's ICU. Since the patient is not
responsive what would be the most importants intervention in the post- cardiac
arrest phase.
- induced theraputic hypothermia.