# Static Cardiology Study Tips



## TheMowingMonk

Hey Guys, Just looking for any study tips for the static cardiology section of the paramedic national reg skills test, its seems like a weird test so if any one has any tips or ideas to study it would be helpful,

also if anyone knows where a good stopping point for the treatments of the rhythms are since they don't really give you many tips are how far to take a treatment of a rhythm that doesn't change, thanks for any help


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## firecoins

go over your ACLS. If you knwo this, you will pass.  I just passed this station at my recert. Its straightfoward. 

Study rhythms at skillstat.com.


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## Dominion

I've been told that the stations tend to go something like:

"You are on the scene of a pulseless apneic patient with this rhythm" They show you a picture of vfib and then you recite the algorithm.

Begin CPR if unwitnessed, if witnessed defibrilate if appropriate at 200J monophasic (or whatever you phase du jour is) with 2nd shock at 300J and 3rd and remaining shocks at 360J.  Continue to perform CPR for cycles of two minutes assessing for rhythm change and ROSC after each cycle, defibrilate immediately following rhythm check if appropriate.  During 2 minute cycles obtain a secure airway with ETT or Secondary Airway, obtain IV access.  1mg Epi 1:10000 IVP q3-5, consider Vasopressin 40U IVP in place of first or second Epi dose.  Conisder use of antiarrhythmic Lidocaine 1mg/kg to 1.5mg/kg or Amiodarone 300mg with repeat dose of 150mg.  Assess rhythm for Torsades, if present consider Magnesium 1-2g.  End.

this is how we did our practice statics and if I jumbled something up or missed something, my bad I'm tired


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## Shishkabob

You go in to the room and they ask if you have any questions.  They hand you a piece of paper with a 6 second strip and relevant patirht info in it.  You then treat the rhythm how you would in the field. 

Ie if its bradycardic but not symptomatic, you wont pace or use atropine, even if the rate is 40.


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## firecoins

Dominion said:


> I've been told that the stations tend to go something like:
> 
> "You are on the scene of a pulseless apneic patient with this rhythm" They show you a picture of vfib and then you recite the algorithm.
> 
> Assess rhythm for Torsades, if present consider Magnesium 1-2g.  End.
> 
> P



you assess v-fib for torsades? I know what you mean but I don't recommend telling them about rhythms they havent shown you yet.  

Just stick to what they show you.  If they show you V-fib do the V-fib ACLS protocols. Than reevaluate for any change.  If the next picture is Torsades, than tell them about Mag.


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## firecoins

Linuss said:


> You go in to the room and they ask if you have any questions.  They hand you a piece of paper with a 6 second strip and relevant patirht info in it.  You then treat the rhythm how you would in the field.
> 
> Ie if its bradycardic but not symptomatic, you wont pace or use atropine, even if the rate is 40.



exactly.  They could show you normal sinus.  How would you treat that?  You wouldn't.

I do suggest that if they show you any rhythm, ask if there is a corresponding pulse so that you know if you got PEA.


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## zmedic

Dominion said:


> I've been told that the stations tend to go something like:
> Conisder use of antiarrhythmic Lidocaine 1mg/kg to 1.5mg/kg or Amiodarone 300mg with repeat dose of 150mg.  Assess rhythm for Torsades, if present consider Magnesium 1-2g.  End.



I never took the NREMT test for medic, so maybe they want this. But i'd be really careful using the word "consider" on a test. When I'm testing people I'm pissed when they tell me they would consider doing something. It's supposed to be as if you are there, on scene. There is no considering vasopressin when you are running the code, either you give it or you don't. Considering is a cop out answer because you are saying that you know you can do it in the protocols but you aren't hanging yourself out there with an actual answer. 

Again, if they want you to recite the algorithm then it's fine, but otherwise you should say "I'd give 40 units of vasopressin" or not, not that you'd consider it.


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## Dominion

zmedic said:


> I never took the NREMT test for medic, so maybe they want this. But i'd be really careful using the word "consider" on a test. When I'm testing people I'm pissed when they tell me they would consider doing something. It's supposed to be as if you are there, on scene. There is no considering vasopressin when you are running the code, either you give it or you don't. Considering is a cop out answer because you are saying that you know you can do it in the protocols but you aren't hanging yourself out there with an actual answer.
> 
> Again, if they want you to recite the algorithm then it's fine, but otherwise you should say "I'd give 40 units of vasopressin" or not, not that you'd consider it.



The rational I've always heard by saying "Consider" in a testing environment is that you are demonstrating that you know all options available to you.  Not that you are copping out on making a decision.  For example say you get the same scenario above and you don't even mention vasopressin, the proctor could possibly fail you because you didn't demonstrate a full knowledge of your ACLS protocols.  However I've been schooled by a proctor already during ride time for saying "Well I'd consider..." he had the same thing to say.  "Either do it or don't do it, don't consider."  Like my own personal Yoda!

As for the Torsades, you are correct.  Like i said I was sleepy and just doing the entire Vfib/VTach algorithm   If it's V-Fib on your static you won't mention torsades.  If it's V-Tach....mmmmm...maybe, it just depends.


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## Shishkabob

Naw, don't consider crap when it comes to static / dynamic cardio.  Do the full ACLS algorithm, word for word.  "First I'd start with 1.5mg/kg lidocaine, max it to 3mg/kg, then I would move on to 300mg IVP of Amiodarone"


When you do the Oral stations or trauma assessment, that's where you can consider to your hearts content.  I considered RSI in my trauma station, which bit me on the butt because they then asked the dosage which I had a total brain fart on for a moment.


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## mgr22

I've tested lots of students on that station. The last time I did it was 2006. Assuming it hasn't changed since then:

1. You get a maximum of three points for each of four EKG/scenarios: one point is for interpreting the rhythm correctly, the other two depend on how you verbalize your handling of the scenario.

2. If you don't get the rhythm right, you don't get any points for the scenario, either.

3. The maximum total points is 12. The number for passing is not known until the day of the exam.

4. Almost always, there's at least one scenario that tests your judgment about not over-treating a relatively asymptomatic patient; e.g. AFib in the 80s, no other s/s.

5. You need to know the ACLS algorithms. If your local protocols differ, don't go there.

6. Some of the most common mistakes I've seen: treating s/s as rate-related when the HR is controlled; cardioverting symptomatic, slow AFib; not noticing 2nd and 3rd-degree HBs; treating bradycardia in the 50s accompanied by CP with atropine.

Hope this helps.


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## redcrossemt

I test students at this station a lot. To me, saying "consider" is fine, but definitely not required. I would support just saying one way to do it - amiodarone or lidocaine are fine either way for instance. Giving me multiple answers is setting yourself up for wasted time and getting confused. The below "student" speak is quoted from Dominion above.

*Student:* 1mg Epi 1:10000 IVP q3-5, consider Vasopressin 40U IVP in place of first or second Epi dose.

*Examiner:* In the patient scenario presented with a rhythm as shown on the card, would you give epinephrine or vasopressin and how much?

*Student:*Conisder use of antiarrhythmic Lidocaine 1mg/kg to 1.5mg/kg or Amiodarone 300mg with repeat dose of 150mg.  

*Examiner:* In the patient scenario presented with a rhythm as shown on the card, would you give lidocaine or amiodarone? Would you give 1 mg/kg or 1.5 mg/kg?

*Student:*Assess rhythm for Torsades, if present consider Magnesium 1-2g.

*Examiner:* Tell me again what the rhythm on the card is. Would you give magnesium and, if so, how much?


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## mgr22

Redcrossemt reminded me of one more piece of advice: don't go into more detail than you have to. It's like being audited -- answer the questions asked. You get no extra credit for "brilliance above and beyond the average medic," and you risk being asked follow-up questions that you're not prepared to answer.


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## Dominion

Thanks for the advice even though I didn't realize I needed it.  The way we practiced was to recite the entire algorithm to learn it.  I will start practicing as above for boards, IE only choose one path, as long as it's right and I'm performing the correct interventions (or not performing as the case may be) I should be ok....


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## TheMowingMonk

Thanks for all the input, I ended up talking through it with some buddies, studying my ECG book and the ACLS algorithms. Seem to work well cause I retook the skill yesterday and passed! so done with all that, now onto the written.


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