Question about PEA

  1. 0
    This question is from the ACLS provider manual. In case you don't have the manual I will write the question out. You have to have the ECC guidelines 2000 manual to get the answers to these questions and I don't have that manual. I'm going over case 4 PEA and I'm not sure what the right answer is for this question.

    Thanks

    You are called to the ED to assist in the attempted resuscitation of a patient in pulseless cardiac arrest from unknown causes. When the patient arrives in the ED, chest compressions are being performed, and the patient is receiving ventilations through a tracheal tube placed by EMS personnel in the field. The patient is transferred to a gurney; you confirm that chest compressions are producing palpable femoral pulses, but no pulses are palpable between administered compressions. The patient is attached to a cardiac monitor that confirms the presence of organized QRS complexes. What is the first thing you should assess in an attempt to identify a reversible cause of cardiac arrest in this patient?

    A. check tracheal tube placement with primary and secondary techniques and evaluate breath sounds to rule out tension pneumothorax

    B. check arterial blood gases

    C. check serum electrolytes to rule out imbalances

    D. obtain a serum sample to identify drug overdose


    if anyone has the ECC guidelines 2000 it says the answers will be on page 151.

    My first guess for the FIRST thing you would do would be A, but I'm not sure if that's the answer or not. I have no way of knowing unless one of you can tell me.

    Thanks!
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  3. 16 Comments so far...

  4. 0
    I would say A. airway is always the most important,RECONFIRM TUBE and check for pnuemo. Then go for the 5Hs and 5Ts(hypoxia is treated first)or
    Myocardial infarct
    Acidosis
    Tension pnuemothrorax
    Cardiac tamponade
    Hypothermia
    Hyper/hypokalemia
    Hypoxia
    Hypovolememia
    Embolism (pulmonary/air/amniotic fluid
    Drug overdose, toxins
    Last edit by hollyster on Jun 20, '05
  5. 0
    Definitely A (airway, airway, airway). The ACLS manual is huge on tube placement and they go out of their way in that question to tell you that EMS placed the tube-that is your cue to check placement. (not to say that EMS cannot place a tube properly b/c of course they can but it can always become dislodged with transfer.
  6. 0
    Even if you dont like A, choices B, C & D all have you waiting for lab results while your patient is pulseless....never a good first option.

    TE=DustinRN]This question is from the ACLS provider manual. In case you don't have the manual I will write the question out. You have to have the ECC guidelines 2000 manual to get the answers to these questions and I don't have that manual. I'm going over case 4 PEA and I'm not sure what the right answer is for this question.

    Thanks

    You are called to the ED to assist in the attempted resuscitation of a patient in pulseless cardiac arrest from unknown causes. When the patient arrives in the ED, chest compressions are being performed, and the patient is receiving ventilations through a tracheal tube placed by EMS personnel in the field. The patient is transferred to a gurney; you confirm that chest compressions are producing palpable femoral pulses, but no pulses are palpable between administered compressions. The patient is attached to a cardiac monitor that confirms the presence of organized QRS complexes. What is the first thing you should assess in an attempt to identify a reversible cause of cardiac arrest in this patient?

    A. check tracheal tube placement with primary and secondary techniques and evaluate breath sounds to rule out tension pneumothorax

    B. check arterial blood gases

    C. check serum electrolytes to rule out imbalances

    D. obtain a serum sample to identify drug overdose


    if anyone has the ECC guidelines 2000 it says the answers will be on page 151.

    My first guess for the FIRST thing you would do would be A, but I'm not sure if that's the answer or not. I have no way of knowing unless one of you can tell me.

    Thanks![/QUOTE]
  7. 0
    Quote from candyndel
    Even if you dont like A, choices B, C & D all have you waiting for lab results while your patient is pulseless....never a good first option.

    TE=DustinRN]This question is from the ACLS provider manual. In case you don't have the manual I will write the question out. You have to have the ECC guidelines 2000 manual to get the answers to these questions and I don't have that manual. I'm going over case 4 PEA and I'm not sure what the right answer is for this question.

    Thanks

    You are called to the ED to assist in the attempted resuscitation of a patient in pulseless cardiac arrest from unknown causes. When the patient arrives in the ED, chest compressions are being performed, and the patient is receiving ventilations through a tracheal tube placed by EMS personnel in the field. The patient is transferred to a gurney; you confirm that chest compressions are producing palpable femoral pulses, but no pulses are palpable between administered compressions. The patient is attached to a cardiac monitor that confirms the presence of organized QRS complexes. What is the first thing you should assess in an attempt to identify a reversible cause of cardiac arrest in this patient?

    A. check tracheal tube placement with primary and secondary techniques and evaluate breath sounds to rule out tension pneumothorax

    B. check arterial blood gases

    C. check serum electrolytes to rule out imbalances

    D. obtain a serum sample to identify drug overdose


    if anyone has the ECC guidelines 2000 it says the answers will be on page 151.

    My first guess for the FIRST thing you would do would be A, but I'm not sure if that's the answer or not. I have no way of knowing unless one of you can tell me.

    Thanks!
    [/QUOTE]

    You are right. I am an instructor for AHA. Airway is always priority. By the time you processed the labs the pt would be dead if the airway is not functional.
  8. 0
    I would say A, especially because you moved the patient to a gurney. You are always supposed to recheck ET tube placement (not necessarily by CXR, but definately by auscultation) when you move a patient from a stetcher to a gurney or bed.
  9. 0
    I agree with everyone A is the most likely choise. There was and article in JEMS(journal of emergency medical services-I don't remember which one) that showed an ET tube can move up to 2"(enough to dislodge or to puncture the mainstem bronchi) just with a slight movement of the pts head.And as with any life support- ABC- airway 1st!
  10. 0
    I've done 7 cases so far and I'm just trying to figure out how people can remember all these algorithms for each individual case. A lot of things are starting to run together. Do most of you remember the algorithms by heart or do you just have a general knowledge of the treatments for that case? I'm just worried that I will totally forget everything once I actually do have one of the cases while at work.
  11. 0
    The more you are exposed to codes, the more you will remember with regards to ACLS. When I started on the cardiac floor, an RN from our unit was assigned to the code team that would cover the whole hospital on nights. Before I had ACLS, my charge RN would send me with the code team nurse if it wasn't too busy so that I could watch and learn.

    When I moved to the ER, I was exposed to so many codes that ACLS became imprinted in my brain. The good thing is that you all help eachother out - even the docs sometimes have a brain fart and one of the nurses will chime in with what drug to give next or the dosage.

    Try not to worry about it too much - you will remember things the more you are involved with them.
  12. 0
    A is the correct answer. You follow the primary secondary survey.......or if you take the experienced provider course ACLS-EP, you do the 5 quadrads...

    With PEA, you attempt to correct the most easiest and most common causes first.....Hypoxia, and hypovolemia.


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