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James Alfaro says
Great site, user friendly. Everything is clear. Good exercising for CC students like me.
Thank you for creating it!!!!!!
ghulam mahdi says
post cardiac arrest induce therapeutic hypothermia prognostically how much benificial for the patient?
Jeff with admin. says
Here a quote from the AHA Provider manual about the subject:
“Therapeutic hypothermia is the only intervention demonstrated to improve neurological recovery after cardiac arrest.”
I would say that it is very beneficial if it is carried out properly by a team of trained medical staff. The entire post arrest phase is extremely important to the patients survival and recovery to discharge.
Regards, Jeff
Ndapewa says
this site is really good ad helping out alot.
Loida Buaquina says
In this situation, why do we use Cardioversion? why not Defib?
Jeff with admin. says
At the beginning of the scenario, the patient’s rhythm deteriorates from stable SVT into unstable SVT at this point, synchronized cardioversion would be indicated because synchronized cardioversion is used for tachycardia with a pulse. This hopefully prevents the shock from precipitating the tachycardia into a more letal rhythm.
Defibrillation is indicated for Pulseless VT and VF and should be used in such cases unless you are not able to achieve capture when attempting to synchronized for synchronized cardioversion. In this case, defibrillation would be indicated.
Regards, Jeff
Vesna Humo says
Hi Jeff,
lung CTA. For what is it?
Jeff with admin. says
CTA stands for “clear to auscultation.” This means that all lung fields are clear when you listen with as stethoscope.
NASSER HATTAB says
Great job,ihave a question. If Vt/ vf pulseless ,pt is in hospital monitored. What s the first shocking or beginning CPR .
Jeff with admin. says
If the patient is attached to a defibrillator monitor you would shock immediately. If the defibrillator must be brought to the room, you would shout for help and start CPR. Then shock as soon as the defibrillator is attached to the patient.
C M says
shouldn’t this be unsynchronized at 360J
Jeremy Barker says
CM, You would not want to Defibrilate this pt. at 360 J. when he is in SVT. First you will want to consider if this pt. is stable or unstable, by this pts. vital signs he is stable. Next you would want to see if symptomatic, if he is stable and non symptomatic then the best approach in my opinion would be the least invasive. I have found it to always be a good idea to try vagal maneuvers first, although we all no they are generally unsuccessful, but I have seen it work quite a few times, so it is worth a try. Next prior to electricity in a stable pt. would be some adenosine 6 mg. IV rapid push as close to the the core as you can, the half life on adenosine is only about 7 seconds so be sure you don’t push it in a vein at his ankles, although this could work it is best to attempt your procedures where they have the best chance for success, following this the next 2 doses are 12, if you find these to be unsuccessful your next step would be to SYNCHRONIZED cardiovert. Sorry this is a long explanation but I have learned more when people are willing to spend a few extra minutes to teach than just answers. Stay Safe! JGB NREMT-P
Bulo says
Thanks to all of you. Made it easier to understand
Jeffrey Touchberry says
The site is great. Thanks, question- is pulseless VT different that VT with a pulse? I was thinking PEA with pulseless VT ie “any rhythm that has NO pulse is considered PEA”? Maybe I am thinking the old way “Treat the patient not the rhythm”?????? When new pulseless VT rhythm identified, I was thinking you start at the beginning of the PEA algorithm???
Jeff with admin. says
“Any VT without a pulse should be treated with the left branch (VT/VF) pulseless arrest algorithm. It is true that pulseless VT is technically PEA, but it is an exception to the rule when it comes to how the rhythm is treated.
If you have no pulse with any other rhythm (bradycardia, SR, etc.) you would treat with the right branch (PEA/Asystole) of the pulseless arrest algorithm.
Hope this helps.
Kind regards,
Jeff
dr M Khurram S says
Save the life is healthy activity.
Betty Hemphill says
Thank you
Abdul Lateef says
In this rhythm of Stable SVT, if the patient gives history of bronchial asthma (where Adenosine should be avoided) what is the next alternative for managment of this rhythm?
Jeff with admin. says
Here is the reference for the information provided below: Circulation. 2010; 122: Part 8: Adult Advanced Cardiovascular Life Support S747
For Stable, narrow-complex tachycardias if rhythm the remains uncontrolled or unconverted by adenosine or adenosine cannot be given. And previously, vagal maneuvers did not convert, you can use Diltiazem or Verapamil.
Diltiazem: Initial dose 15 to 20
mg (0.25 mg/kg) IV over 2
minutes; additional 20 to 25 mg
(0.35 mg/kg) IV in 15 minutes if
needed; 5 to 15 mg/h IV
maintenance infusion (titrated to
AF heart rate if given for rate
control)
Verapamil: Initial dose 2.5 to 5
mg IV given over 2 minutes; may
repeat as 5 to 10 mg every 15 to
30 minutes to total dose of 20 to
30 mg
Scotty says
I don’t understand why in V-fib their are 2 shocks given before epi is given even if the pt already has an IV. Why not give epi after first shock?
Jeff with admin. says
The main reason is that AHA wants to deemphasize the use of medications because there is no clinical evidence that shows that they are effective for increasing survival rates.
AHA wants to emphasize high quality chest compressions and early defibrillation because there is clinical evidence that shows increased positive outcomes with the use of high quality chest compressions and early defibrillation.
Most of the codes, I have participated in, we give epinephrine as soon as we have IV access. If we already have IV access, we give it right away.
For continuity at the site in following the AHA ACLS guidelines, I try to go strictly by the book which says give the first dose of epinephrine after the 2nd shock.
If you are performing high quality chest compressions and are attempting defibrillation as early as possible, I see no good reason why a physician would delay the use of the epinephrine.
Regards,
Jeff
Chad Andrews says
Thanks, I got it right.
Dina says
Many Thanks
Sonia says
Hi. I felt stumped immediately because this patient is stable.
I felt we needed IV access immediately and a body temperature. He is likely dehydrated and I did not feel that giving medication as the second step was appropriate.
Sonia says
I am continuing the case and I am still very bothered by not having a temperature or IV acess with blous of NS.
Jeff with admin. says
These megacode scenarios are designed to prepare you to go through the ACLS algorithms. They strictly adhere to the AHA guidelines. In the first question, you establish IV access. IV bolus is not indicated at this time. The patient is in narrow complex SVT with a heart rate of 180. In the assessment portion toward the top, the scenario states that the patient’s skin is warm. The patient is not hypothermic. –regards, Jeff
Jeff with admin. says
Heart rates greater than 150 are not likely do to underlying causes. Sinus tachycardia usually does not exceed 120-130/min. (pg. 125 AHA provider manual) The rhythm strip is narrow complex SVT and the rate is 180.–Jeff
Shawn Mason says
The scenario shows a well hydrated person with a perfusing rhythm with a rate of 180 with a BP.
The correct answer is shown as give 5 cycles of CPR????? The question does not suit the scenario!
Jeff with admin. says
Shawn the information above the horizontal line prior to the question is from the beginning of the scenario. After you start the scenario, you only follow what you see below the horizontal line on the page. —Jeff
rob says
FOr question number 1, one could argue that the patient should be cardioverted instead of vagal, due to the patient is pale and having palpitations even though his VS are stable except for the fact his heart rate is 180
Jeff with admin. says
Hi Robert, If the patient is stable which he is, per the algorithm, you would attempt vagal maneuvers. All of the scenarios follow the algorithm as closely as possible. Thanks, Jeff
erdoc says
Pallor and palpitations are not signs of instability. As per ACLS definition: hypotension, AMS, signs of shock, ongoing ischemic chest pain, exacerbation CHF.
Jeff with admin. says
In question 3, the patient develops severe chest pain and his vital signs are: HR 220, BP (not obtainable), and weak pulse. The patient also has LOC changes. This is when the patient becomes unstable and is treated as unstable.
Any information above the horizontal line on the megacode scenarios are the information for the beginning of the scenario. For questions after this, the information that follows the question number is what should be read.
Kind regards, Jeff