Advanced Cardiac Life Support (ACLS) Guidelines, Exams of Advanced Education

Download Advanced Cardiac Life Support (ACLS) Guidelines and more Exams Advanced Education in PDF only on Docsity! ACLS WRITTEN EXAM FINAL QUESTIONS AND ANSWERS 2023-2024 You find an unresponsive pt. who is not breathing. After activating the emergency response system, you determine there is no pulse. What is your next action? - ANS Start chest compressions of at least 100 per min. You are evaluating a 58-year-old man with chest pain. The blood pressure is 92/50 mm Hg, the heart rate is 92/min, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry reading is 97%. What assessment step is most important now? - ANS Obtaining a 12 lead ECG. What is the preferred method of access for epi administration during cardiac arrest in most pts? - ANS Peripheral IV An AED does not promptly analyze a rythm. What is your next step? - ANS 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? - ANS 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? - ANS Resume compressions What is a common but sometimes fatal mistake in cardiac arrest management? - ANS Prolonged interruptions in chest compressions. Which action is a componant of high-quality chest comressions? - ANS Allowing complete chest recoil Which action increases the chance of successful conversion of ventricular fibrillation? - ANS Providing quality compressions immediately before a defibrillation attempt. Which situation BEST describes pulseless electrical activity? - ANS Sinus rythm without a pulse What is the BEST strategy for performing high-quality CPR on a patient with an advanced airway in place? - ANS 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? - ANS Chest compressions may not be effective. The use of quantitative capnography in intubated patients - ANS 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? - ANS Consider terminating resuscitive efforts after consulting medical control. Which is a safe and effective practice within the defibrillation sequence? - ANS 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? - ANS Begin chest compressions. What is an advantage of using hands-free defibrillation pads instead of defibrillation paddles? - ANS Hands-free pads allow for a more rapid defibrillation. What action is recommended to help minimize interruptions in chest compressions during CPR? - ANS Continue CPR while charging the defibrillator. Which action is included in the BLS survey? - ANS Early defibrillation Which drug and dose are recommended for the management of a patient in refractory ventricular fibrillation? - ANS Amioderone 300mg What is the appropriate interval for an interruption in chest compressions? - ANS 10 seconds or less Which of the following is a sign of effective CPR? - ANS PETCO2 ≥10 mm Hg What is the primary purpose of a medical emergency team (MET) or rapid response team (RRT)? - ANS Identifying and treating early clinical deterioration. Which action improves the quality of chest compressions delivered during a resuscitation attempt? - ANS 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? - ANS 1 breath every 5-6 seconds What is the potential danger of using ties that pass circumferentially around the patient's neck when securing an advanced airway? - ANS Obstruction of venous return from the brain What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube? - ANS Continuous waveform capnography hat is the recommended IV fluid (normal saline or Ringer's lactate) bolus dose for a patient who achieves ROSC but is hypotensive during the post-cardiac arrest period? - ANS 1 to 2 Liters What is the minimum systolic blood pressure one should attempt to achieve with fluid, inotropic, or vasopressor administration in a hypotensive post-cardiac arrest patient who achieves ROSC? - ANS 90mm Hg What is the first treatment priority for a patient who achieves ROSC? - ANS Optimizing ventilation and oxygenation. What should be done to minimize interruptions in chest compressions during CPR? - ANS Continue CPR while the defibrillator is charging. Which condition is an indication to stop or withhold resuscitative efforts? - ANS Safety threat to providers After verifying the absence of a pulse, you initiate CPR with adequate bag-mask ventilation. The patient's lead II ECG appears below. What is your next action? - ANS IV or IO access After verifying unresponsiveness and abnormal breathing, you activate the emergency response team. What is your next action? - ANS Check for a pulse. What is the recommendation on the use of cricoid pressure to prevent aspiration during cardiac arrest? - ANS Not recommended for routine use What survival advantages does CPR provide to a patient in ventricular fibrillation? - ANS Produces a small amount of blood flow to the heart What is the recommended compression rate for performing CPR? - ANS At least 100 per minute EMS personnel arrive to find a patient in cardiac arrest. Bystanders are performing CPR. After attaching a cardiac monitor, the responder observes the following rhythm strip. What is the most important early intervention? - ANS defibrillation A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. The next intervention is to - ANS administer a second shock. What is the recommended next step after a defibrillation attempt? - ANS Begin CPR, starting with chest compressions. Which of the following is the recommended first choice for establishing intravenous access during the attempted resuscitation of a patient in cardiac arrest? - ANS Antecubital vein Which finding is a sign of ineffective CPR? - ANS PETCO2 <10 mm Hg How often should the team leader switch chest compressors during a resuscitation attempt? - ANS . Every 2 minutes IV/IO drug administration during CPR should be - ANS given rapidly during compressions What is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation? - ANS 300 mg 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? - ANS Closed-loop communication How long should it take to perform a pulse check during the BLS Survey? - ANS 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? - ANS Check the patient's pulse. An AED advises a shock for a pulseless patient lying in snow. What is the next action? - ANS 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? - ANS Epinephrine What is the minimum depth of chest compressions for an adult in cardiac arrest? - ANS 2 inches A patient with pulseless ventricular tachycardia is defibrillated. What is the next action? - ANS 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? - ANS 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? - ANS Intraosseous (IO) What is the appropriate rate of chest compressions for an adult in cardiac arrest? - ANS 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? - ANS 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? - ANS 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? - ANS 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? - ANS Seeking expert consultation A postoperative patient in the ICU reports new chest pain. What actions have the highest priority? - ANS 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? - ANS 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? - ANS 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. - ANS stable supraventricular tachycardia What is the most appropriate intervention for a rapidly deteriorating patient who has this lead II ECG? - ANS Synchronized cardioversion Bradycardia require treatment when? - ANS chest pain or shortness of breath is present how do you treat non-symptomatic bradycardia - ANS monitor and observe what constitutes symptomatic bradycardia - ANS hypotension altered mental status signs of shock chest pain acute heart failure A patient with sinus bradycardia and a heart rate of 42 has diaphoresis and blood pressure of 80/60. What is the initial dose of atropine? - ANS 0.5 mg how do you treat symptomatic bradycardia - ANS give 0.5mg atropine every 3-5 mins to max of 3mg if that doesn't work try one of the following: transcutaneous pacing 2-10mcg/kg / minute dopamine infusion 2-10mcg per minute epinephrine infusion what is considered a tachycardia requiring treatment - ANS over 150 per minute when do you consider cardioversion - ANS if persistent tachycardia is causing: hypotension altered mental status signs of shock chest pain acute heart failure if persistent tachycardia does not present with symptoms what do you need to consider - ANS wide QRS? greater than 0.12 seconds Your patient has been intubated. IV/IVO access is not available. Which combination of drugs can be administered by endotracheal route? - ANS Lidocaine, epinephrine, vasopressin reentry supraventricular tachycardia - ANS polymorphic ventricular tachycardia - aka torsades - ANS atrial fibrilation - ANS sinus tachycardia - ANS coarse ventricular fibrillation - ANS atrial flutter - ANS reentry supraventricular tachycardia - ANS sinus bradycardia - ANS monomorphic ventricular tachycardia - ANS fine ventricular fibrillation - ANS second degree AV block type 1 wenckenbach - ANS second degree AV block mobitz type 2 - ANS third degree AV block - ANS asystole - ANS normal sinus rhythm - ANS pulseless electrical activity - ANS agonal rhythm/asystole - ANS The five links in the adult Chain of Survival - ANS 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 - ANS 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 - ANS 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 - ANS ROSC return of spontaneous circulation