Scenario data: 35 year old male in ER who states that his heart rate just won’t slow down. He was playing in a soccer game and during the half-time his heart would not stop “racing.” Assessment:

Skin: Ashen/Slightly Diaphoretic/Cool to touch
Cardio: HR 180-200; BP 70/35
Resp: RR 32, Lungs CTA Bilaterally from apex to base
CNS: Alert; significant weakness, dizziness, and chest pain 6/10

Three supportive measures of most importance as you begin care on the pt. are:

2. After you attach the monitor, you see the following rhythm on the monitor.

Which rhythm below is correct?

You identify the rhythm as a narrow complex SVT.
Skin: Ashen/Slightly Diaphoretic/Cool to touch
Cardio: HR 190; BP 70/35
Resp: RR 32, Lungs CTA Bilaterally from apex to base; O2 sat 88%
CNS: Alert; significant weakness, dizziness, and chest pain 6/10

Would you classify the patient as stable or unstable?

Since the patient is unstable, your next intervention is to ___________________.

As you prepare for immediate synchronized cardioversion, you start the IV and attached the monitor/defibrillator to the patient. What is the most important of the considerations for synchronized cardioversion listed below?

You perform synchronized cardioversion. After cardioversion the rhythm remains the same and the patient remains sedated. What should you do?

You give another synchronized shock and then observe a rhythm change on the monitor. This is what you see:

What is the rhythm?

You identify the rhythm as VF (ventricular fibrillation) and a pulse check reveals that the patient is pulseless. You start the left branch of the cardiac arrest algorithm. What is your first intervention?

Before you perform the defibrillation what should you make sure and do?

You defibrillate the patient using unsynchronized cardioversion. What is the initial dosage used for electrical defibrillation of ventricular fibrillation?

After you defibrillate with 120 J, what is your next intervention?

You give 5 cycles of CPR, you should now perform what intervention?

There is no change, the patient remains in VF and has no pulse. What is your next intervention?

After you shock with an increased dose of 200 J, you immediately begin CPR for 5 cycles. What is your next intervention?

You give the epinephrine 1mg IV followed by the 20ml NS flush. What's next?

After the 5 cycles of CPR, you perform a rhythm check. This is what you see:

The rhythm is organized, and a pulse check reveals that the patient remains pulseless. What is the rhythm?

Since the patient is in PEA, what is your next intervention?

As you begin CPR, you give 1 mg of epinephrine IV push. During PEA how often will you give epinephrine while continuing CPR?

Congratulations, the patient has had a return of spontaneous circulation (ROSC) and supportive measures are being implemented. After ROSC, the patient had several short runs of ventricular tachycardia. In light of the continued arrhythmias, Amiodarone should now be started as an infusion. What is the correct dosing for the first 6 hours of an amiodarone infusion?