Scenario data: An 82-year-old female in your ER complains of weakness, lightheadedness, and mild pain in her chest. You are assessing her at this time.

Assessment:
Skin: Pale/Cool/Cyanotic
Cardio: Weak radial pulse, HR 32, BP 70/30
Resp: CTA in all lung fields, RR 22
CNS: Weak but responds to questions, oriented
Monitor: (see below)

What is the patient's rhythm?

The patient is in sinus bradycardia at this time and is symptomatic. What are some important initial interventions?

In the bradycardia algorithm there are two pathways (observe the patient and transcutaneous pacing) that can be chosen. What is the primary decision point that will determine which pathway to choose?

You have determined that the patient has symptomatic sinus bradycardia. For your first intervention you give 1.0 mg IV bolus of atropine.
The patient's condition does not change. Based on the assessment what will be your next intervention?

Which medication is as an alternative to pacing in symptomatic unstable bradycardia?

As you prepare for transcutaneous pacing, the patient states that she does not feel well and becomes short of air. This is what you see on the monitor.

What is the rhythm?

You recognize that the patient’s condition is worsening and she is in a 3rd-degree block (complete block) so you begin pacing. Your attempts to pace the patient fail and she becomes unresponsive. She has no pulse and you see this rhythm change.

Identify the rhythm.

You identify the rhythm as ventricular fibrillation. What algorithm are you going to use for this rhythm?

With witnessed VF what is your first intervention?

You shock with 120 Joules. What is your next intervention?

CPR includes ventilations and chest compressions. What is the correct compression to ventilation ratio when using a BVM with multiple rescuers?

After 5 cycles of CPR your next intervention is __________________

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

After the 2nd shock (200 Joules), you start 5 cycles of CPR. What medication should you give at this time?

(True or False): Medications should be given during CPR cycles?

You give 1mg epinephrine IV and know to repeat every 3-5 minutes. You follow the epinephrine with completion of 5 cycles of CPR, a rhythm check and a shock delivery (300 J) since there was no rhythm change. You begin another cycle of CPR and want to give an antiarrhythmic. Amiodarone is not available. What is your other choice?

What is the correct dosage for the initial dose of lidocaine?

You give the first dose of lidocaine followed by 5 cycles of CPR. After the CPR your rhythm check shows the rhythm below. The patient has a pulse. VS are HR 80; BP 110/70; RR 4. The patient remains unresponsive:

What is this rhythm?

Congratulations! The patient has a return of spontaneous circulation (ROSC). The patient remains unresponsive. In this scenario which of the following would be important in the post-resuscitation phase?

Since targeted temperature management needs to be implemented you should choose a single target temperature between _____°C and _____°C selected, achieved, and then maintained constantly for at least 24 hours.

True or False: Prophylactic administration of lidocaine to patients during the post-cardiac arrest phase is not recommended.