ACLS COMPLETE 2022 327 QUESTIONS WITH COMPLETE SOLUTIONS, Exams of Nursing

Download ACLS COMPLETE 2022 327 QUESTIONS WITH COMPLETE SOLUTIONS and more Exams Nursing in PDF only on Docsity! ACLS COMPLETE 2022| 327 QUESTIONS| WITH COMPLETE SOLUTIONS BEST PLAYLIST I'VE FOUND FOR ALL HEART.ORG ACLS CODES! correct answer: https://www.youtube.com/watch? v=qQTpqjvvduI&list=PLy60DSDPg9urf_l5ss1FLakrRQDKOkTZj This is a good starting point for Jose (big Megacode at end): https://www.youtube.com/watch? v=8OB7OreUjy0 . Use the feedback after failing to get closer and closer to passing! In which situation does bradycardia require treatment? correct answer: Hypotension Which intervention is most appropriate for the treatment of a patient in asystole? correct answer: Epinephrine You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previousy advised "no shock indicated." A rhythm check now finds asystole. After resuming high-quality compressions, which action do you take next? correct answer: Establish IV or IO access A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. The patient's blood pressure is 128/58 mm Hg, the PETCO2 is 38mm Hg, and the pulse oximetry reading is 98%. There is vascular access in the left arm, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirm a supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal maneuvers. what is your next action? correct answer: Administer adenosine 6mg IV push A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a toal does of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 88/56 mm Hg. Which therapy is now indicated? correct answer: Epinephrine 2 to 10 mcg/min A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug should be administered first? correct answer: Epinephrine 1 mg IV/IO A 62-year-old man suddenly experienced difficulty speaking and left-sided weakness. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain si ordered. Which best describes the guidelines for antiplatelet and fibrinolytic therapy? correct answer: Hold aspirin for at least 24 hours if rtPA is administered A patient is in refractory ventricular fibrillation and has received multiple appropriate defribillation shocks, epinephrine 1 mg IV twice, and an initial dose of amiodarone 300mg IV. The patient is intubated. Which best describe the recommended second does of amiodarone for this patient? correct answer: 150 mg IV push A patient with sinus bradycardia and a heart rate of 42/min has diaphoresis and a blood pressure of 80/60mm Hg. What is the initial does of atropine? correct answer: 0.5mg A 35-year-old woman has palpitations, light-headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminating the rhythm. An IV has been established. Which drug should be administered? correct answer: Adenosine 6mg A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. If no pathway for medication administration is in place, which method is preferred? correct answer: IV or IO What is the indication for the use of magnesium in cardiac arrest? correct answer: Pulseless ventricular tachycardia-associated torsades de pointes A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70 mm Hg. He has a history of angina. What action is recommended next? correct answer: Seeking expert consultation A patient is in cardiac arrest. High-quality chest compressions are being given. The patient is intubated, and an IV has been started. The rhythm is asystole. What is the first drug/dose to administer? correct answer: Epinephrine 1mg IV/IO A patient is in refractory ventricular fibrillation. High-quality CPR is in progress. One does of epinephrine was given after the second shock. An antiarrhythmic drug was given immediately after the third shock. You are the team leader. Which medication do you order next. correct answer: Epinephrine 1 mg A patient with possible STEMI has ongoing chest discomfort. What is a contraindication to nitrate administration? correct answer: Use of a phosphodiestrase inhibitor within the previous 24 hours A 57-year-old woman has palpitation, chest discomfort, and tachycardia. The monitor shows a regular wide-QRS at a rate of 180/min. She becomes diaphoretic, and her blood pressure is 80/60 mm HG/ Which action do you take next? correct answer: Perform electrical cordioversion A patient with STEMI has ongoing chest discomfort. Heparin 4000 units IV bolus and a heparin infusion of 1000 units per hour are being administered. The patient did not take aspirin because he has a history of gastritis, with was treated 5 years ago. What is your next action? correct answer: Give aspirin 160-325 mg to chew You are caring for a 66-year-old man with a history of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. The CT scan is negative for hemorrhage. The patient is receiving oxygen via nasal cannula at 2L/min, and an IV has been established. His blood pressure is 180/100mm Hg. Which drug do you anticipate giving to this patient? correct answer: Aspirin An AED does not promptly analyze a rythm. What is your next step? correct answer: Begin chest compressions. You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm below, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. What management step is your next priority? correct answer: Administer 1mg of epinephrine During a pause in CPR, you see this lead II ECG rhythm on the monitor. The patient has no pulse. What is the next action? correct answer: Resume compressions What is a common but sometimes fatal mistake in cardiac arrest management? correct answer: Prolonged interruptions in chest compressions. Which action is a componant of high-quality chest comressions? correct answer: Allowing complete chest recoil Which action increases the chance of successful conversion of ventricular fibrillation? correct answer: Providing quality compressions immediately before a defibrillation attempt. Which situation BEST describes pulseless electrical activity? correct answer: Sinus rythm without a pulse What is the BEST strategy for performing high-quality CPR on a patient with an advanced airway in place? correct answer: Provide continuous chest compressions without pauses and 10 ventilations per minute. Three minutes after witnessing a cardiac arrest, one member of your team inserts an endotracheal tube while another performs continuous chest compressions. During subsequent ventilation, you notice the presence of a waveform on the capnography screen and a PETCO2 level of 8 mm Hg. What is the significance of this finding? correct answer: Chest compressions may not be effective. The use of quantitative capnography in intubated patients correct answer: allows for monitoring of CPR quality. For the past 25 minutes, an EMS crew has attempted resuscitation of a patient who originally presented in ventricular fibrillation. After the first shock, the ECG screen displayed asystole, which has persisted despite 2 doses of epinephrine, a fluid bolus, and high-quality CPR. What is your next treatment? correct answer: Consider terminating resuscitive efforts after consulting medical control. Which is a safe and effective practice within the defibrillation sequence? correct answer: Be sure oxygen is not blowing over the patient's chest during the shock. During your assessment, your patient suddenly loses consciousness. After calling for help and determining that the patient is not breathing, you are unsure whether the patient has a pulse. What is your next action? correct answer: Begin chest compressions. What is an advantage of using hands-free defibrillation pads instead of defibrillation paddles? correct answer: Hands-free pads allow for a more rapid defibrillation. What action is recommended to help minimize interruptions in chest compressions during CPR? correct answer: Continue CPR while charging the defibrillator. Which action is included in the BLS survey? correct answer: Early defibrillation Which drug and dose are recommended for the management of a patient in refractory ventricular fibrillation? correct answer: Amioderone 300mg What is the appropriate interval for an interruption in chest compressions? correct answer: 10 seconds or less Which of the following is a sign of effective CPR? correct answer: PETCO2 ≥10 mm Hg What is the primary purpose of a medical emergency team (MET) or rapid response team (RRT)? correct answer: Identifying and treating early clinical deterioration. Which action improves the quality of chest compressions delivered during a resuscitation attempt? correct answer: Switch providers about every 2 minutes or every 5 compression cycles. What is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse rate of 80/min? correct answer: 1 breath every 5-6 seconds A patient presents to the emergency department with new onset of dizziness and fatigue. On examination, the patient's heart rate is 35/min, the blood pressure is 70/50 mm Hg, the respiratory rate is 22 breaths/min, and the oxygen saturation is 95%. What is the appropriate first medication? correct answer: Atropine 0.5mg A patient with dizziness and shortness of breath with a sinus bradycardia of 40/min. The initial atropine dose was ineffective, and your monitor/defibrillator is not equipped with a transcutaneous pacemaker. What is the appropriate dose of dopamine for this patient? correct answer: 2 to 10 mcg/kg per minute A patient has sudden onset of dizziness. The patient's heart rate is 180/min, blood pressure is 110/70 mm Hg, respiratory rate is 18 breaths/min, and pulse oximetry reading is 98% on room air. The lead II ECG is shown below: correct answer: Vagal manuever. A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. The patient's blood pressure is 128/58 mm Hg, the PETCO2 is 38 mm Hg, and the pulse oximetry reading is 98%. There is vascular access at the left internal jugular vein, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirms a supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal maneuvers. What is the next recommended intervention? correct answer: Adenosine 6mg IV push You are receiving a radio report from an EMS team en route with a patient who may be having an acute stroke. The hospital CT scanner is not working at this time. What should you do in this situation? correct answer: Divert the patient to a hospital 15 minutes away with CT capabilities. Choose an appropriate indication to stop or withhold resuscitative efforts. correct answer: Evidence of rigor mortis. A 49-year-old woman arrives in the emergency department with persistent epigastric pain. She had been taking oral antacids for the past 6 hours because she thought she had heartburn. The initial blood pressure is 118/72 mm Hg, the heart rate is 92/min and regular, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry reading is 96%. Which is the most appropriate intervention to perform next? correct answer: Obtain a 12 lead ECG. A patient in respiratory failure becomes apneic but continues to have a strong pulse. The heart rate is dropping rapidly and now shows a sinus bradycardia at a rate of 30/min. What intervention has the highest priority? correct answer: Simple airway manuevers and assisted ventilations. What is the appropriate procedure for endotracheal tube suctioning after the appropriate catheter is selected? correct answer: Suction during withdrawal but for no longer than 10 seconds. While treating a patient with dizziness, a blood pressure of 68/30 mm Hg, and cool, clammy skin, you see this lead II ECG rhythm:What is the first intervention ? correct answer: Atropine 0.5mg A 68-year-old woman experienced a sudden onset of right arm weakness. EMS personnel measure a blood pressure of 140/90 mm Hg, a heart rate of 78/min, a nonlabored respiratory rate of 14 breaths/min, and a pulse oximetry reading of 97%. The lead II ECG displays sinus rhythm. What is the most appropriate action for the EMS team to perform next? correct answer: Cincinnati Prehospital Stroke Scale assessment EMS is transporting a patient with a positive prehospital stroke assessment. Upon arrival in the emergency department, the initial blood pressure is 138/78 mm Hg, the pulse rate is 80/min, the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95% on room air. The lead II ECG displays sinus rhythm. The blood glucose level is within normal limits. What intervention should you perform next? correct answer: Head CT scan What is the proper ventilation rate for a patient in cardiac arrest who has an advanced airway in place? correct answer: 8-10 breaths per minute A team leader orders 1 mg of epinephrine, and a team member verbally acknowledges when the medication is administered. What element of effective resuscitation team dynamics does this represent? correct answer: Closed-loop communication How long should it take to perform a pulse check during the BLS Survey? correct answer: 5 to 10 seconds Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive and notice that he is taking agonal breaths. What is the next step in your assessment and management of this patient? correct answer: Check the patient's pulse. An AED advises a shock for a pulseless patient lying in snow. What is the next action? correct answer: Administer the shock immediately and continue as directed by the AED. Which treatment or medication is appropriate for the treatment of a patient in asystole? correct answer: Epinephrine What is the minimum depth of chest compressions for an adult in cardiac arrest? correct answer: 2 inches A patient with pulseless ventricular tachycardia is defibrillated. What is the next action? correct answer: Start chest compressions at a rate of at least 100/min. You have completed your first 2-minute period of CPR. You see an organized, nonshockable rhythm on the ECG monitor. What is the next action? correct answer: Have a team member attempt to palpate a carotid pulse. Emergency medical responders are unable to obtain a peripheral IV for a patient in cardiac arrest. What is the next most preferred route for drug administration? correct answer: Intraosseous (IO) What is the appropriate rate of chest compressions for an adult in cardiac arrest? correct answer: At least 100/min You are receiving a radio report from an EMS team en route with a patient who may be having an acute stroke. The hospital CT scanner is not working at this time. What should you do in this situation? correct answer: Divert the patient to a hospital 15 minutes away with CT capabilities. A 53-year-old man has shortness of breath, chest discomfort, and weakness. The patient's blood pressure is 102/59 mm Hg, the heart rate is 230/min, the respiratory rate is 16 breaths/min, and the pulse oximetry reading is 96%. The lead II ECG is displayed below. A patent peripheral IV is in place. What is the next action? correct answer: Vagal maneuvers A 49-year-old man has retrosternal chest pain radiating into the left arm. The patient is diaphoretic, with associated shortness of breath. The blood pressure is 130/88 mm Hg, the heart rate is 110/min, the respiratory rate is 22 breaths/min, and the pulse oximetry value is 95%. The patient's 12-lead ECG shows ST-segment elevation in the anterior leads. First responders administered 160 mg of aspirin, and there is a patent peripheral IV. The pain is described as an 8 on a scale of 1 to 10 and is unrelieved after 3 doses of nitroglycerin. What is the next action? correct answer: Administer 2 to 4 mg of morphine by slow IV bolus. A 56-year-old man reports that he has palpitations but not chest pain or difficulty breathing. The blood pressure is 132/68 mm Hg, the pulse is 130/min and regular, the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95%. The lead II ECG displays a wide-complex tachycardia. What is the next action after establishing an IV and obtaining a 12-lead ECG? correct answer: Seeking expert consultation A postoperative patient in the ICU reports new chest pain. What actions have the highest priority? correct answer: Obtain a 12-lead ECG and administer aspirin if not contraindicated. An 80-year-old woman presents to the emergency department with dizziness. She now states she is asymptomatic after walking around. Her blood pressure is 102/72 mm Hg. She is alert and oriented. Her lead II ECG is below. After you start an IV, what is the next action? correct answer: Conduct a problem-focused history and physical examination. What is the recommended oral dose of aspirin for patients suspected of having one of the acute coronary syndromes? correct answer: 160 to 325 mg A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient's lead II ECG is displayed below. correct answer: stable supraventricular tachycardia What is the most appropriate intervention for a rapidly deteriorating patient who has this lead II ECG? correct answer: Synchronized cardioversion What is the purpose of a medical emergency team (MET) or rapid response team (RRT)? correct answer: Improving patient outcomes by identifying and treating early clinical deterioration What is the recommended assisted ventilation rate for patients in respiratory arrest with a perfusing rhythm? correct answer: 10 to 12 breaths per minute Family members found a 45-year-old woman unresponsive in bed. The patient is unconscious and in respiratory arrest. What is the recommended initial airway management technique? correct answer: Performing a head tilt-chin lift maneuver A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the following lead II ECG rhythm: What is the appropriate next intervention? correct answer: Synchronized cardioversion A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm: What is the appropriate next intervention? correct answer: Defibrillation What is the recommended energy dose for biphasic synchronized cardioversion of atrial fibrillation? correct answer: 120to200J Which of the following is an acceptable method of selecting an appropriately sized oropharyngeal airway (OPA)? correct answer: Measure from the corner of the mouth to the angle of the mandible. Which is a contraindication to nitroglycerin administration in the management of acute coronary syndromes? correct answer: Right ventricular infarction and dysfunction What is the recommended initial intervention for managing hypotension in the immediate period after return of spontaneous circulation (ROSC)? correct answer: Administration of IV or IO fluid bolus Which is an appropriate and important intervention to perform for a patient who achieves ROSC during an out-of-hospital resuscitation? correct answer: Transport the patient to a facility capable of performing PCI. What is the immediate danger of excessive ventilation during the post-cardiac arrest period for patients who achieve ROSC? correct answer: Decreased cerebral blood flow What is the recommended target temperature range for achieving therapeutic hypothermia after cardiac arrest? correct answer: 32°C to 34°C What is the recommended duration of therapeutic hypothermia after reaching the target temperature? correct answer: 12 to 24 hours What is the danger of routinely administering high concentrations of oxygen during the post- cardiac arrest period for patients who achieve ROSC? correct answer: Potential oxygen toxicity What is the recommended dose of epinephrine for the treatment of hypotension in a post- cardiac arrest patient who achieves ROSC? correct answer: 0.1 to 0.5 mcg/kg per minute IV infusion You have completed 2 min of CPR. The ECG monitor displays the lead below (PEA) and the patient has no pulse. You partner resumes chest compressions and an IV is in place. What management step is your next priority? correct answer: Administer 1mg of epinephrine A patient is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of 300 mg amiodarone IV. The patient is intubated. A second dose of amiodarone is now called for. The recommend second dose of amiodarone is ? correct answer: 150 mg IV push A patient is in refractory ventricular fibrillation. High CPR is in progress and shocks have been given. One dose of epinephrine was given after the second shock. An anti arrhythmic drug was given immediately after the the third shock. What drug should the team leader request to be prepared for administration next? correct answer: second dose of epinephrine 1 mg asystole correct answer: normal sinus rhythm correct answer: pulseless electrical activity correct answer: agonal rhythm/asystole correct answer: The five links in the adult Chain of Survival correct answer: 1- Immediate activation of EMS 2- Early CPR 3- Rapid defibrillation (not in peds) 4- Effective advanced life support 5- Integrated post-cardiac arrest care Type of breaths (not normal) that may be present in the first minutes after sudden cardiac arrest correct answer: Agonal gasps To place the pads on the victims bare chest, Place one pad on the upper-right chest (below the collarbone) and place the other pad correct answer: to the side of the left nipple, with the top edge of the pad a few inches below the armpit If the heart muscle resets and initiates an organized rhythm this is called correct answer: ROSC return of spontaneous circulation a patient is in cardiac arrest. ventricular fibrillation has been refractory to an initial shock. if no pathway for medication is in place, preferred method? correct answer: IV or IO A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 100/60 mm HG. What is now indicated? correct answer: EPI 2-10 mcg/min A patient with ST-segment elevation MI has ongoing chest discomfort. Fibrinolytic therapy has been ordered. Heparin 4000 units IV bolus was administered, and a heparin infusion of 1000 units per hour is being administered. ASA was not taken by the patient because he had a history of gastritis treated 5 years ago. What is the next action? correct answer: ASA 160-325 mg chew A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70 mm Hg. He has a history of angina. What should you do? correct answer: seek expert consultation A 35 year old woman has palpitations, light headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminating the rhythm. An IV has been established. What drug should be administered? correct answer: adenosine 6 mg A 57 year old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180 bpm. She becomes diaphoretic and her blood pressure is 80/60 mm Hg. What is the next action? correct answer: cardioversion when does bradycardia require treatment? correct answer: hypotension You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated". A rhythm check now finds asystole. After resuming high-quality compressions, your next action is to what? correct answer: establish IV or IO access you are caring for a 66 year old man with a history of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. the ct scan is negative for hemorrhage. The patient is receiving oxygen via nasal cannula at 2 L/min, and an IV has been established. His blood pressure is 180/100 mm Hg. Which drug do you anticipate giving? correct answer: aspirin A 62 year old man suddenly experienced difficulty speaking and left-sided weakness. He was brought into the emergency department. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. What are the guidelines for antiplatelet and fibrinolytic therapy? correct answer: hold aspirin for at least 24 hours if rtPA is administered a 45 year old woman has a history of palpitations develops lightheadedness and palpitations. She has received adenosine 6 mg IV for SVT without conversion. BP 128/70. next step? correct answer: adenosine 12 mg STEMI intervention is most important in reducing patients in hospital and 30 day mortality? correct answer: reperfusion therapy a patient has been resuscitated from cardiac arrest. During post-ROSC treatment, the patient becomes unresponsive, with the rhythm VT. What tx is indicated correct answer: unsynchronized high energy shock which action should you take immediately after providing an AED shock correct answer: resume chest compressions which action causes air to enter victim's stomach (gastric inflation) during bag-mask ventilation correct answer: ventilation too quickly, A patient becomes unresponsive. You are uncertain if a faint pulse is present with the rhythm below. What is your next action? correct answer: CPR you are the code team leader and arrive to find a patient with CPR in progress. On next rhythm check NSR. Pt reported chest discomfort and then collapsed. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise and IO access has been established. Intervention? correct answer: EPI 1 mg refractory ventricular fibrillation. 3rd shock just administered. what is next action correct answer: resume high-quality chest compression 2nd degree mobitz correct answer: 2nd degree wenckebach correct answer: coarse V fib correct answer: PEA correct answer: fine V Fib correct answer: A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks to you for instructions. Your immediate next order is? correct answer: resume high quality chest compressions A patient with sinus bradycardia and a heart rate of 42 bpm has diaphoresis and a BP of 80/60 mm Hg. What is the initial dose of atropine? correct answer: 0.5 mg When can you use magnesium in cardiac arrest? correct answer: VF/pulseless VT associated with torsades de pointes A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70 mm Hg. He has a history of angina. What should you do? correct answer: Seek expert consultation A patient with possible ST-segment elevation MI has ongoing chest discomfort. What is a containdication to the administration of nitrates? correct answer: Phosphodiesterase inhibitor within 12 hours Bradycardia requires treatment when? correct answer: Chest pain or shortness of breath You patient has been intubated. IV/IO access is not available. Which combination of drugs can be administered by the endotracheal route? correct answer: Lidocaine, epinephrine, vasopressin A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug and dose should be administered first by the IV/IO route? correct answer: Epinephrine 1 mg A patient is in refractory ventricular fibrillation. High quality CPR is in progress, and shocks have been given. One dose of epinephrine was given after the second shock. An antiarrhythmic drug was given immediately after the third shock. What drug should the team leader request to be prepared for administration next? correct answer: Second dose of epinephrine 1 mg If patient is in cardiac arrest and the rhythm is asystole and CPR is beign given. What is the first drug you should give? (a) Atropine 0.5 mg IV/IO (b) Atropine 1 mg IV/IO (c) Dopamine 2 to 20 mcg/kg per min IV/IO (d) Epinephrine 1 mg IV/IO correct answer: (d) Epinephrine 1 mg IV/IO A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138 bpm. He is asymptomatic, with a blood pressure of 110/70. He has a history of angina. What action is recommended next? (a) Giving adenosine 6 mg IV bolus (b) Giving lidocaine 1 to 1.5 mg IV bolus (c) Performing synchroniczed cardioversion (d) Seeking expert consultation correct answer: (d) Seeking expert consultation A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug should be administered first? (a) Atropine 1 mg IV/IO (b) Epinephrine 1 mg IV/IO (c) Lidocaine 1 mg/kg IV/IO (d) Sodium bicarbonate 50 mEq IV/IO correct answer: (b) Epinephrine 1 mg IV/IO You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated." A rhythm check now finds asystole. After resuming high-quality compressions, which action do you take next? (a) Call for a pulse check (b) Establish IV or IO access (c) Insert a laryngeal airway (d) Perform endotracheal intubation correct answer: (b) Establish IV or IO access A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next? (a) Adenosine 6 mg (b) Amiodarone 300 mg (c) Epinephrine 3 mg (d) Lidocaine 0.5 mg/kg correct answer: (b) Amiodarone 300 mg A 35 yr old female has palpitation, light-headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal manuevers have not been effective in terminating the rhythm. An IV has been established. Which drug should be administered? (a) Adenosine 6 mg (b) Atropine 0.5 mg (c) Epinephrine 2 to 10 mcg/kg per minute (d) Lidocaine correct answer: (a) Adenosine 6 mg Pt is in refractory ventricular fibrilation. CPR is in progress. 1 dose of epinephrine given after second shock. An antiarrhythmic drug was given immediately after third shock. Which med is next? (a) Epinephrine 1 mg (b) Epinephrine 3 mg (c) Sodium bicarb 50 mEq (d) Second dose of antiarrhythmic drug correct answer: (a) Epinephrine 1 mg What is the indication for use of magnesium in cardiac arrest? (a) Ventricular tachycardia associated with a normal QT interval (b) Shock-refractory monomorphic ventricular tachycardia (c) Pulseless ventricular tachycardia-associated torsades de pointes (d) Shock-refractory ventricular fibrillation correct answer: (c) Pulseless ventricular tachycardia- associated torsades de pointes A pt is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. If no pathway for medication administration is in place, which method is preferred? (a) Central line (b) Endotracheal tube (c) External jugular vein (d) IV or IO correct answer: (d) IV or IO Which intervention is most appropriate for the treatment of a patient in asystole? (a) Atropine (b) Defibrillation (c) Epinephrine (d) Transcutaneous pacing correct answer: (c) Epinephrine You are caring for a 66 yr old man with a hx of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. The CT scane is negative for hemorrhage. The pt is receiving oxygen via nasal cannula at 2 L/min, and an IV has been established. His BP is 180/100. Which drug do you anticipate giving to this pt? (a) Aspirin (b) Glucose (D50) (c) Nicardipine (d) rTPA correct answer: (a) Aspirin Pt is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of amiodarone 300 mg IV. Pt is intubated. Which best describes the recommended second dose of amiodarone for this pt? (a) 1 mg/kg IV push (b) 1 to 2 mg/min infusion (c) 150 mg IV push (d) 300 mg IV push correct answer: (c) 150 mg IV push A monitored pt in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 200. Pt's BP is 128/58, PETCO2 is 38, and pulse oximetry reading is 98%. There is vascular access in the left arm, and pt has not been given any vasoactive drugs. 12 lead EKG confirms a supraventricular tachycardia w/ no evidence of ischemia or infarction. Heart rate has not responded to vagal manuevers. What is your next action? (a) Administer adenosine 6 mg IV push (b) Administer amiodarone 300 mg IV push (c) Perform synchronized cardioversion at 50 J (d) Perform synchronized cardioversion at 200 J correct answer: (a) Administer adenosine 6 mg IV push In which situation does bradycardia require treatment? (a) 12-lead ECG showing a normal sinus rhythm (b) Hypotension (c) Diastolic blood pressure > 90 (d) Systolic blood pressure > 100 correct answer: (b) Hypotension A 67 yr old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180/min. She becomes diaphoretic, and her blood pressure is 80/60. Which action do you take next? (a) Establish IV access (b) Obtain a 12 lead EKG (c) Perform electrical cardioversion (d) Seek expert consultation correct answer: (c) Perform electrical cardioversion Pt w/ sinus bradycardia and a heart rate of 42 has diaphoresis and a blood pressure of 80/60. What is the initial dose of atropine? (a) 0.1 mg (b) 0.5 mg (c) 1 mg (d) 3 mg correct answer: (b) 0.5 mg A pt w/ STEMI has ongoing chest discomfort. Heparin 4000 units IV bolus and a heparin infusion of 1000 units per hr are being administered. The pt did not take aspirin because he has a hx of gastritis, which was treated 5 yrs ago. What is your next action? (a) Give aspirin 160 to 325 mg to chew (b) Give clopidogrel 300 mg orally (c) Give enteric-coated aspirin 75 mg orally (d) Give enteric-coated aspirin 325 mg rectally correct answer: (a) Give aspirin 160 to 325 mg to chew 62 yr old man suddenly expereinced difficulty speaking and left-sided weakness. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. Which best describes the guidelines for antiplatelet and fibrinolytic therapy? (a) Give aspirin 160 to 325 mg to be chewed immediately (b) Give aspirin 160 mg and clopidogrel 75 mg orally After initiation of CPR and 1 shock for ventricular fibrillation, pt is still in ventricular fibrillation at next rhythm check. A second shock is given, and chest compressions are resumed immediately. An IV is in place, and no drugs have been given. BBag-mask ventilations are producing visible chest rise. What is your next intervention? (a) Administer 3 sequential (stacked) shocks at 360 J (monophasic defibrillator) (b) Give amiodarone 300 mg IV/IO (c) Give epinephrine 1 mg IV/IO (d) Intubate and administer 100% oxygen correct answer: (c) Give epinephrine 1 mg IV/IO What is the maximum interval for pausing chest compressions? correct answer: 10 seconds A 35 yr old woman presents w/ a chief complaint of palpitations. She has no chest discomfort, shortness of breath, or light-headedness. Her BP is 120/78. On EKG, it shows she is in SVT. Which intervention is indicated first? (a) Adenosine 3 mg IV bolus (b) Adenosine 12 mg IV slow push (over 1 to 2 min) (c) Metoprolol 5 mg IV and repeat if necessary (d) Vagal manuevers correct answer: (d) Vagal manuevers Your patient is not responsive and is not breathing. You can palpate a carotid pulse. Which action do you take next? (a) Apply an AED (b) Obtain a 12 lead EKG (c) Start an IV (d) Start rescue breathing correct answer: (d) Start rescue breathing What is more important to start for a nonresponsive patient with no pulse, putting on an AED or starting rescue breathing? correct answer: Starting rescue breathing You arrive on scene to find CPR in progress. Nursing staff report the pt was recovering from a pulmonary embolism and suddenly collapsed. Two shocks have been delivered, and an IV has been initiated. What do you administer now? (a) Atropine 0.5 mg IV (b) Epinephrine 1 mg IV (c) Endotracheal intubation (d) Transcutaneous pacing correct answer: (b) Epinephrine 1 mg IV A patient becomes unresponsive. You are uncertain if a faint pulse is present. An IV is in place. Which action do you take next? (a) Begin transcutaneous pacing (b) Start high-quality CPR (c) Administer atropine 1 mg (d) Administer epinephrine 1 mg IV correct answer: (b) Start high-quality CPR If cases where ______ is the likely cause of cardiac arrest, VENTILATION becomes much more important correct answer: hypoxia ___________ correlates w/ ROSC correct answer: High quality CPR What are the consequences of interrupting CPR? correct answer: coronary perfusion falls __________ can help indicate coronary perfusion pressure correct answer: Capnography Adequate CPR compression are at least correct answer: 2 inches Why should chest compressions recoil? correct answer: To ensure adequate coronary perfusion pressure Chest compression fraction should be around correct answer: 60-80% Don't spend more than ____ seconds without compressions correct answer: 10 seconds What should the tidal volume be for adequate ventilations? correct answer: 500-600 mL or half of a bag squeeze What should be the first thing you do when you arrive on scene? correct answer: See if patient is conscious or unconscious What do you do next If the patient is unconscious when you first arrive on scene? correct answer: Initiate BLS If a patient is not responsive when you first arrive on scene, what should you do next? correct answer: Call code Get AED During BLS, should you check breathing and pulse (a) Separately (b) Simultaenously correct answer: (b) Simultaenously If pt is not breathing normally but has pulse, what should you do? correct answer: Bypass chest compressions and ventilate every 5-6 seconds After intubating someone, what should you do next? correct answer: Provide 1 ventilation every 6 seconds What should you assess for in the Disability function of ABCDE? correct answer: Neurologic function - Alert - Pain - Voice - Unresponsive What are the H's of PEA? correct answer: Hypovolemia Hypoxia H+ (acidosis) HyperK+ HypoK+ Hypothermia What are the T's of PEA? correct answer: Trauma Tension PTX Tamponade Toxins Thrombosis (Pulmonary or Coronary) Why should you not excessively ventilate? correct answer: Causes gastric insufflation Incr intrathoracic pressure Decr venous return and CO Decr survival When do you use oropharyngeal airways? correct answer: Unconscious pts No gag reflex pts When do you use a nasopharyngeal airway? correct answer: Conscious, semiconscious, or unconscious pts with or without gag flex Oropharyngeal airway correct answer: Nasopharyngeal airway correct answer: When should you proceed with an advanced airway? correct answer: Difficult to bag mask vent Airway compromise Need to isolate airway What should you use to monitor ET tube? correct answer: Waveform capnography If waveform capnography jumps up, it may indicate... correct answer: ROSC If a patient is in cardiac arrest what are the first two steps? correct answer: (1) CPR (2) Attach AED What rhythms are shockable? correct answer: VFib or pulseless VTach What rhythms are NOT shockable correct answer: Asystole or PEA How often should you give epinephrine? correct answer: Every 3-5 minutes