AMERICAN RED CROSS (ACLS) FINAL EXAM QUESTIONS AND CORRECT ANSWERS, Exams of Nursing

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AMERICAN RED CROSS (ACLS) FINAL EXAM QUESTIONS AND CORRECT ANSWERS Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of myocardial ischemia, what will your first actions include (if not completed by EMS before arrival)? o Obtain a 12-lead electrocardiogram (ECG) o Administer a blood thinner o Administer aspirin and establish IV access o Activate the ST-segment elevation myocardial infarction (STEMI) team o If SPO2 is less than 90%, start oxygen o Assess airway, breathing, and circulation (ABCs) o Administer epinephrine 1 mg IV o Consider nitroglycerin, morphine and a P2Y inhibitor -----------CORRECT ANSWER: o Obtain a 12-lead electrocardiogram (ECG) o Administer aspirin and establish IV access o Activate the ST-segment elevation myocardial infarction (STEMI) team o If SPO2 is less than 90%, start oxygen o Assess airway, breathing, and circulation (ABCs) o Consider nitroglycerin, morphine and a P2Y inhibitor His initial vital signs are HR 120/min, BP 135/88 mm Hg, RR 23/min, SpO2 87%, and temperature 37.3C. When considering oxygen saturation, what is your course of action? o Intubate the patient immediately o Administer albuterol nebulizer o Do not start oxygen o Start oxygen at 4L/min via nasal cannula -----------CORRECT ANSWER: o Start oxygen at 4L/min via nasal cannula What additional question help you determine next steps? o Do you take any medication? o Do you have any allergies? o When was the last time you went to the doctor? o When did the symptoms start? o Have you had any recent falls? -----------CORRECT ANSWER: o Do you take any medication? o Do you have any allergies? o When did the symptoms start? Your patient continues to say that he has chest discomfort. What treatment can you repeat as long as it is not contradicted by vital signs? o Morphine sublingual every 1 to 3 minutes o Morphine IV every 1 to 3 minutes o Nitroglycerine sublingual or translingual every 3 to 5 minutes o Nitroglycerine every 1 to 3 minutes -----------CORRECT ANSWER: o Nitroglycerine sublingual or translingual every 3 to 5 minutes What is your interpretation of the patient's ECG tracing? o Anterior ST-segment elevation of myocardial infarction (STEMI) o Ventricular tachycardia o Posterior ST-segment elevation myocardial infarction (STEMI) o Normal sinus rhythm with premature ventricular contractions -----------CORRECT ANSWER: o Anterior ST-segment elevation of myocardial infarction (STEMI) With the diagnosis of STEMI, what is the most probable treatment? o Release to home o Admission to an intensive car unit o Admission for observation o Admission for PCI or fibrinolysis -----------CORRECT ANSWER: o Admission for PCI or fibrinolysis What is your goal for PCI when treating this patient? o Door-to-balloon inflation time of 30 minutes o First medical contact-to-balloon inflation time of 90 minutes o Door-to-needle time of 90 minutes o First medical contact-to-needle time of 30 minutes -----------CORRECT ANSWER: o First medical contact-to-balloon inflation time of 90 minutes The patient's vital signs show HR 92/min, RR 14/min, BP 130/86 mm Hg, SpO2 97%, and atrial fibrillation on the monitor. What additional assessment and stabilization activities should be completed with the first 10 minutes after the patient's arrival? o Establish IV access o Order an emergent CT scan or MRI of the brain and review patient history o Monitor for worsening symptoms o Activate the stroke team o Complete neurologic screening o Check glucose o Administer O2 -----------CORRECT ANSWER: o Establish IV access o Order an emergent CT scan or MRI of the brain and review patient history o Activate the stroke team o Complete neurologic screening o Check glucose What needs to be completed for this patient within 20 minutes after hospital arrival? o Neurologic assessment o Admission to a monitored bed o Interpretation of the emergent CT scan or MRI of the brain o Administration of fibrinolytic therapy -----------CORRECT ANSWER: o Neurologic assessment After 2 more minutes of CPR, you conduct a rhythm check and a pulse check, confirming absence of a pulse. Based on the organized rhythm below, describe the patient's condition? o Normal sinus rhythm o Pulseless electrical activity o Sinus bradycardia o Junctional rhythm -----------CORRECT ANSWER: o Pulseless electrical activity Once PEA is identified and there are no signs of ROSC, you continue CPR. What is your next step for appropriate care for this patient? o Administer epinephrine 1mg IV o Administer amiodarone 150mg IV o Administer amiodarone 300mg IV o Administer epinephrine 1.5mg IV -----------CORRECT ANSWER: o Administer epinephrine 1mg IV After 2 minutes of CPR, you conduct another rhythm check and determine that the patient has the following rhythm and is showing signs of ROSC. How do you continue treating this patient? o Administer another dose of 1mg of epinephrine o Move to the Adult Post-Cardiac Arrest Care Algorithm o Resume CPR and repeat the steps of the PEA pathway o Pause CPR and consider an advanced airway -----------CORRECT ANSWER: o Move to the Adult Post-Cardiac Arrest Care Algorithm She has a palpable pulse, HR of 65/min, SpO2 of 94%, ETCO2 of 38 mm Hg, and BP 82/55 mm Hg. What are your highest priorities? Select all that apply. o Maintaining a target PaCO2 between 45 and 55 mm Hg o Maintaining SpO2 92% to 98% o Hyperventilation o Ventilating the patient with 10 breaths per minute o Maintaining a target PaCO2 between 35 and 45 mm Hg -----------CORRECT ANSWER: o Maintaining SpO2 92% to 98% o Ventilating the patient with 10 breaths per minute o Maintaining a target PaCO2 between 35 and 45 mm Hg In addition to managing the airway and respiratory parameters, which step is also prioritized during the initial stabilization phase? o Initiating targeted temperature management o Administering alteplase o Performing percutaneous coronary intervention o Treating hypotension -----------CORRECT ANSWER: o Treating hypotension Match the treatment for hypotension to the proper initial dosage for an adult based on the AHA guidelines. o Dopamine IV 5 to 20 mcg/kg per minute o Normal saline or lactated Ringer's to 2L o Norepinephrine IV 0.1 to 0.5 mcg/kg per minute o Epinephrine 2 to 10 mcg per minute -----------CORRECT ANSWER: o Dopamine IV 5 to 20 mcg/kg per minute o Normal saline or lactated Ringer's to 2L o Norepinephrine IV 0.1 to 0.5 mcg/kg per minute o Epinephrine 2 to 10 mcg per minute The patient's ventilation and blood pressure have responded to treatment. What other lab or diagnosis tests would be appropriate to consider at this time for reversible causes? o Arterial blood oxygen o 12-lead ECG o Troponin test o Arterial blood carbon dioxide o Temperature o Capnography -----------CORRECT ANSWER: o 12-lead ECG o Troponin test o Temperature You obtain a 12-lead ECG. What is the most appropriate action to take next? o Observe the patient o Transfer the patient to an intensive care unit o Discharge the patient and have her follow-up with her primary care provider o Transfer the patient to a cardiac-cath lab for percutaneous coronary intervention ----------- CORRECT ANSWER: o Transfer the patient to a cardiac-cath lab for percutaneous coronary intervention The patient is unable to follow verbal commands. What intervention should the team consider? o Obtaining another ECG o Targeted temperature management o Administering vasopressors o Transferring the patient to an intensive care unit -----------CORRECT ANSWER: o Targeted temperature management What is the primary purpose of the CPR coach on a resuscitation team? -----------CORRECT ANSWER: increasing CPR quality What is the most common type of stroke? -----------CORRECT ANSWER: ischemic stroke What is a contraindication to the administration of aspirin for the management of a pt with acute coronary syndromes? -----------CORRECT ANSWER: recent gastrointestinal bleeding What blood component is acted upon by aspirin administration during the management of a pt with ACS? -----------CORRECT ANSWER: platelets What is the most appropriate destination for pts with suspected acute ischemic stroke? ----------- CORRECT ANSWER: certified stroke center A 49-year-old man arrives at the emergency department with chest discomfort. He states that he was working in the garden this morning when his chest started hurting. The last episode lasted about 25 minutes, and he was sweaty. The chest discomfort is not relieved with rest. Within the first 10 minutes, on the basis of the pt showing symptoms suggestive of MI, what will your first actions include (if not completed by EMS before arrival)? -----------CORRECT ANSWER: If SpO2 is less than 90%, start oxygen Obtain a 12-lead EKG Administer aspirin and establish IV access Assess ABCs Consider nitroglycerin, morphine, and a P2Y inhibitor Activate the STEMI team His initial VS are HR 120/min, BP 135/88 mmHg, RR 23/min, SpO2 87%, and temperature 37.3 degrees C. When considering oxygen saturation, what is your course of action? Start oxygen at 4L/min via nasal cannula Do not start oxygen Intubate pt immediately Administer albuterol nebulizer -----------CORRECT ANSWER: Start oxygen at 4L/min via nasal cannula What additional questions help you determine next steps? -----------CORRECT ANSWER: When did the symptoms start? Do you have any allergies? Do you take any medication? Your pt continues to say that he has chest discomfort. What treatment can you repeat as long as it is not contraindicated by vital signs? Nitroglycerin IV every 1 to 3 mins Morphine sublingual every 1 to 3 mins Nitroglycerin sublingual or translingual every 3 to 5 mins Morphine IV every 1 to 3 mins -----------CORRECT ANSWER: Nitroglycerin sublingual or translingual every 3 to 5 mins What is your interpretation of the pt's EKG tracing? -----------CORRECT ANSWER: Anterior STEMI Which clinical finding is a contraindication to the administration of nitroglycerin? ----------- CORRECT ANSWER: Confirmed RV infarction Which is a step of closed-loop communication? Encouraging all team members to speak clearly Abandoning ego Using distinctive speech and a controlled voice Confirming task completion before assigning another task -----------CORRECT ANSWER: Confirming task completion before assigning another task While performing the BLS assessment, you initiate high-quality CPR and assist ventilation with a bag-mask device. The AED does NOT recommend a shock. Which action in the primary assessment should you perform first? -----------CORRECT ANSWER: Determine is the pt's airway is patent What is the average respiratory rate for an adult at rest? -----------CORRECT ANSWER: 12 to 20/min Evidence suggests that there is a higher likelihood of good to excellent functional outcome when alteplase is given to adults with an acute ischemic stroke within what time frame? ----------- CORRECT ANSWER: 3 hours What is a contraindication to the use of an oropharyngeal airway? -----------CORRECT ANSWER: conscious patient In which of the following can nasopharyngeal airways be used? -----------CORRECT ANSWER: Conscious Unconscious Semiconscious What is the primary advantage of using a stroke severity tool? -----------CORRECT ANSWER: it helps identify large-vessel occlusion stroke The EMS team brings a 54-year-old pt to the emergency department who had been experiencing severe SOB and difficulty breathing. The pt loses consciousness on arrival. What initial actions should be taken? -----------CORRECT ANSWER: Check for responsiveness Assess ABCs Call for additional help The pt is unresponsive and not breathing but has a strong pulse. What should your initial actions include? -----------CORRECT ANSWER: Open the pt's airway via a head tilt-chin lift or jaw thrust Initiate ventilation with a bag-mask device attached to supplemental oxygen The pt's signs are HR 84/min, BP 124/73 mmHg, SpO2 is. 66%, and the skin is cyanotic around the mouth and extremities. What is the recommended rate for rescue breaths? -----------CORRECT ANSWER: 1 breath every 6 seconds While ventilating the pt, you hear loud gurgling sounds coming from the airway. What is your next action? -----------CORRECT ANSWER: suction the airway The pt is not responding well to ventilation and suctioning. You decide to intubate the pt. In addition to clinical assessment, what is the single most reliable method of confirming and monitoring correct placement of the ET tube? -----------CORRECT ANSWER: Quantitative waveform capnography The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the pt's nose to the __________. -----------CORRECT ANSWER: earlobe What is the first-line treatment for unstable bradycardia? -----------CORRECT ANSWER: Atropine What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube? -----------CORRECT ANSWER: Quantitative waveform capnography What is a complication of IV atropine when administered in doses of less than 0.5 mg? ----------- CORRECT ANSWER: further slowing of the heart rate A 75-year-old man presents to the emergency department. His wife states that he fainted 45 mins ago, while watching TV. She said he has had episodes of confusion and fatigue during the past week. The pt presents with HR 30/min (weak pulse), BP 66/43 mmHg, RR 20/min, and SpO2 89%. He is alert and responsive. What should your next steps be to assess and treat this pt? -----------CORRECT ANSWER: Maintain the airway and administer oxygen if needed Establish IV access Obtain a 12-lead EKG What is the pt's rhythm? -----------CORRECT ANSWER: third-degree AV block You determine that the pt has poor perfusion. What is your next step? -----------CORRECT ANSWER: Administer atropine 1 mg IV The pt does not respond to atropine. The VS are HR 34/min, BP 66/43 mmHg, RR 18/min, and SpO2 is 91%. He is responsive, but dizzy. What options do you have to treat the pt? -----------CORRECT ANSWER: Administer epinephrine 2 to 10 mcg per minute infusion Initiate transcutaneous pacing Administer dopamine 5 to 20 mcg/kg per minute infusion The pt does not respond to treatments. The vital signs are HR 40/min (weak pulse), BP 66/43 mmHg, RR 18/min, and SpO2 91%. He is responsive, but states that he feels tired. What should you consider? -----------CORRECT ANSWER: Prepare for transvenous pacing Seek expert consultation What is the recommended infusion rate for dopamine in the management of symptomatic bradycardia unresponsive to atropine? -----------CORRECT ANSWER: 5 to 20 mcg/kg per minute What is the recommended infusion rate for epinephrine in the management of symptomatic bradycardia unresponsive to atropine? -----------CORRECT ANSWER: 2 to 10 mcg per minute What is the recommended initial therapy for a pt with stable narrow-complex tachycardia, after establishing an IV and acquiring a 12-lead EKG? -----------CORRECT ANSWER: vagal maneuvers You are treating a pt with a HR of 186/min. Which symptom (if present) suggests an unstable tachycardia? -----------CORRECT ANSWER: Hypotension What is the recommended initial dose of adenosine for the management to SVT unresponsive to vagal maneuvers? -----------CORRECT ANSWER: 6 mg IV A 72-year-old male pt has been suffering from progressive dizziness and bouts of palpitations after exercising last night. His symptoms reappeared and worsened this am. The pt is conscious and alert, has a HR of 180/min, a weak radial pulse, BP 110/78 mmHg, and SpO2 of 96% What are the most appropriate initial interventions? -----------CORRECT ANSWER: Maintain a patent airway and monitor Attach a 12-lead EKG Would you consider the pt stable or unstable? -----------CORRECT ANSWER: Stable Longer, longer, longer, drop, then you have a Wenkebach(2nd degree AV block 1) if some P's don't get through then you have Mobitz II if P's and Q's don't agree then you have 3rd degree The patient does not respond to treatments. The vital signs are HR 40/min with a weak pulse, BP 66/43, RR 18/min, and SpO2 91%. The patient is responsive but states feels tired. What should you consider? Seek expert consultation Rhythms for unstable tachycardia Sinus tachycardia Atrial fibrillation Atrial flutter SVT Monomorphic VT Polymorphic VT Wide-complex tachycardia of uncertain type Sinus Tachycardia atrial fibrillation Atrial flutter SVT Monomorphic ventricular tachycardia Polymorphic Ventricular Tachycardia Narrow-QRS (SVT) tachycardias (QRS less than 0.12 seconds) in order of frequency Sinus tachycardia Atrial fibrillation Atrial flutter AV nodal reentry Wide-QRS complex tachycardias (QRS 0.12 or more) Monomorphic VT Polymorphic VT SVT with aberrancy Irregular narrow-complex tachycardia's are probably Atrial fibrillation Serious symptoms of unstable tachycardia Hypotension Acutely altered mental status Signs of shock Ischemic chest discomfort Acute heart failure The two keys to managing unstable tachycardia are rapidly recognizing that 1. The patient is significantly symptomatic or even unstable 2. The signs and symptoms are caused by the tachycardia The presence or absence of pulses is considered the key to managing patients with any tachycardia If pulseless tachycardia, manage the patient according to the PEA pathway of the Adult Cardiac Arrest Algoritm If tachycardia has pulses present, determine The stability of the patient Assess clinical condition Look for signs of increased work of breathing Adult Tachycardia with a Pulse Algorithm Assess clinical condition Identify and treat underlying cause Tachycardia is unstable if symptoms persist after patient receives supplemental O2 and airway and circulation support and if signs or symptoms are due to the tachycardia. Tachycardia is stable if Control of RVR Conversion of unstable A-fib to sinus rhythm or both Seek exper consultation Monomorphic V-tach Polymorphic V-Tach (Torsades de Pointes) Management of VF and pulseless VT Give 1 shock Resume CPR Establish IV/IO access Rhythm check after 2 mins CPR If organized rhythm, Post arrest care If Rhythm but no pulse, PEA algorithm If shockable, give 1 shock, resume CPR Epinephrine after 2nd shock What is the 1st dose of lidocaine for patients in cardiac arrest while unresponsive to defibrlloation? 1 - 1.5 mg/kg An organized rhythm without a pulse PEA PEA (pulseless electrical activity) includes Idioventricular or ventricular escape rhythms Sinus rhythm A-fib or A-flutter Bundle Branch Blocks What are the 2 most common underlying, potentially reversible causes of PEA? Hypovolemia Hypoxia Management of Asystole/PEA Resume compressions immediately Establish IV/IO access (before advanced airway! Unless bag-mask is ineffective or hypoxia caused the arrest) Check rhythm and 2 mins CPR after administering drugs Do not exceed 10 secs for the pause Administer Epinephrine q 3-5 mins or every 4 mins-every other rhythm check) Treat rhythm PEA nonshockable rhythm with no electrical activity Repeat CPR/drug sequence PEA nonshockable with organized electrical activity Try to feel for a pulse PEA nonshockable with organized electrical activity but no pulse Resume CPR and repeat sequence PEA nonshockable with organized rhythm and pulse Begin post-cardiac arrest care PEA shockable rhythm Resume CPR while defibrillator is charging Switch to the VF/pVT sequence in algorithm, starting with a shock Asystole/PEA identification of underlying cause Use H's and T's (hypovolemia and hypoxia most common underlying, potentially reversible causes of PEA) H's Hypovolemia Hypoxia Hydrogen ion (acidosis) Hypo/Hyperkalemia Hypothermia T's Tension pneumothorax Tamponade (cardiac) Toxins Thrombosis (pulmonary) Thrombosis (coronary) What are the 2 most common underlying and potentially reversible causes of PEA? Hypovolemia Hypoxia When should determining neurologic prognosis in patients treated with TTM occur? 72 hours after patient returns to normothermia What is TTM? Targeted Temperature Management Patience ventilation and BP have responded to treatment. What other lab or diagnostic tests would be appropriate to consider at this time for reversible causes? Troponin 12-lead ECG Temperature You are attempting to resuscitate a 70 year old woman who suffered a sudden cardiac arrest. She has showing signs of return of spontaneous circulation (ROSC). She is intubated and has an IV established. She has a palpable pulse of 65, SpO2 94%, ETCO2 of 38 mm Hg and BP 82/55 mm Hg. What are your highest priorities? a. Hyperventilation b. Maintaining SpO2 92-98% c. Maintaining PaCO2 45-55 d. Maintaining PaCO2 35-45 e. Ventilating patient-10 breaths/minute b. Maintaining SpO2 92-98% d. Maintaining PaCO2 35-45 e. Ventilating patient-10 breaths/minute In addition to managing the airway and respiratory parameters, which step is also prioritized during the initial stabilization phase? a. Performing percutaneous coronary intervention b. Administering alteplase c. Initiating TTM d. Treating hypertension Norepinephrine 0.1 - 0.5 mcg/kg/min NS or lactated ringers 1-2 L Dopamine 5-20 mcg/kg/min Epinephrine 2-10 mcg/min The patient's ventilation and BP have responded to treatment. What other lab or diagnostic tests would be appropriate to consider at this time for reversible causes? (SATA) What are the elements of a system of care? Processes Structure Patient Outcome System Coronary Perfusion Pressure (CPP) equals aortic diastolic pressure minus right atrial diastolic pressure A patient is in cardiac arrest. The cardiac monitor shows asystole. In addition to providing continuous high-quality CPR, what is the other priority intervention for this patient? Administering epinephrine as early as possible A patient has experienced return of spontaneous circulation (ROSC) after cardiac arrest. The healthcare team is conducting a secondary assessment to determine the possible cause of the patient's cardiac arrest. Before the arrest, the patient exhibited jugular venous distension, cyanosis, apnea and hyperresonance on percussion. The patient was also difficult to ventilate during the response. The team would most likely suspect which condition as the cause? Tension Pneumothorax A patient with suspected stroke arrives at the emergency department. The patient is diagnosed with acute ischemic stroke and is a candidate for fibrinolytic therapy. To achieve the best outcomes, this therapy should be initiated within what time frame? Within 1 hour of patient's arrival. A patient in the telemetry unit is receiving continuous cardiac monitoring. The patient has a history of myocardial infarction. The patient's ECG rhythm strip is shown in the following figure. The provider interprets this strip as indicating which arrhythmia? Third-degree AV block A 28-year-old pregnant patient who resides in transitional housing presents to the emergency department with complaints of feeling feverish and very faint. The patient tells the emergency nurse that she does not know when she became pregnant. Upon palpation, the fundus is not at or above the umbilicus. The patient's condition quickly deteriorates and she goes into cardiac arrest. If available and able to be used without impeding or delaying the resuscitation effort, what diagnostic tool could be used to guide decision-making in the care of this patient? Point-of-care ultrasound Cardiac monitoring indicates that a patient has a ventricular tachyarrhythmia. The patient has a pulse and is not showing any signs of hemodynamic compromise. A 12-lead ECG reveals an irregular rhythm with QRS complexes greater than 0.12 second in duration. Which action would be appropriate at this time? Consider an antiarrhythmic medication A responsive patient is choking. What method should the provider use first to clear the obstructed airway? Back blows What is the priority intervention for a patient with a narrow-complex tachycardia (160 bpm) and a blood pressure of 72/48 mmHg? Perform immediate synchronized cardioversion A patient is admitted to the emergency department with signs and symptoms of stroke. The stroke team should complete a comprehensive neurologic assessment and obtain brain imaging results within what time frame? Within 20 minutes Cardiac monitoring of a patient in cardiac arrest reveals ventricular fibrillation. In addition to high-quality CPR, what intervention should be a priority for the team? Defibrillation. A patient with suspected acute coronary syndromes (ACS) has a pulse oximetry reading of 86% and is given supplemental oxygen. The provider determines that the supplemental oxygen dose is correct based on which SaO2 level? 93% After cardiac arrest and successful resuscitation, the patient has a return of spontaneous circulation. The patient is unable to follow verbal commands. Targeted temperature management is initiated. Which method(s) would be appropriate for the resuscitation team to use? -Applying cooling blankets to the patient's body -Using an endovascular catheter -Giving an ice-cold IV fluid bolus A patient comes to the emergency department complaining of palpitations and "some shortness of breath." Cardiac monitoring is initiated and reveals the following ECG rhythm strip. The provider interprets this strip as indicating which arrhythmia? Atrial flutter A 35-year-old female patient's ECG is consistent with STEMI. The ECG reveals a new ST-segment elevation at the J point in leads V2 and V3 of at least which size? 0.15 mV The following capnogram is from a patient experiencing respiratory distress. At which point in the waveform would the patient's ETCO2 level be measured? D For a patient with third-degree atrioventricular (AV) block and a blood pressure of 70/48 mmHg, what interventions should be considered? -Initiate a dopamine infusion -Administer atropine -Initiate transcutaneous pacing A patient arrives at the emergency department complaining of shortness of breath. The patient has a long history of chronic obstructive pulmonary disease. Assessment reveals respiratory failure. Which action would be the initial priority to address the respiratory failure? Assisted ventilation with BVM resuscitator The ECG rhythm strip of a patient who arrived in the emergency department complaining of dizziness, syncope and shortness of breath reveals sinus bradycardia. When reviewing the patient's medication history, the healthcare provider identifies which agent(s) as a potential cause of the patient's current condition? -Verapamil -Digoxin -Metoprolol A patient with acute renal failure experiences cardiac arrest. Just before the cardiac arrest, the patient's ECG showed peaked T waves. What might be causing the patient's cardiac arrest? Hyperkalemia A patient is experiencing respiratory distress secondary to an exacerbation of chronic obstructive pulmonary disease. The patient begins to exhibit signs and symptoms of worsening respiratory function and experiences respiratory arrest. The team intervenes, delivering ventilations via BVM resuscitator. The team should provide ventilations at a rate of 1 ventilation: Every 6 seconds A patient is being treated in the emergency department and is determined to have NSTE-ACS. Invasive management is planned based on which finding? Ventricular tachycardia A patient's ECG reveals a narrow QRS complex with a regular rhythm, indicating a narrow-complex supraventricular tachyarrhythmia. The patient is not showing signs of hemodynamic compromise. Which intervention would be initiated first if it does not delay other interventions? Vagal maneuvers A resuscitation team is debriefing following a recent event. A patient experienced cardiac arrest, and advanced life support was initiated. The patient required the placement of an advanced airway to maintain airway patency. Which statement indicates that the team performed high-quality CPR? "We provided chest compressions at a rate of 100 to 120 compressions per minute while giving 1 ventilation every 6 seconds without pausing compressions." A patient experiences cardiac arrest, and the resuscitation team initiates ventilations using a bag-valve- mask (BVM) resuscitator. The development of which condition during the provision of care would lead the team to suspect that improper BVM technique is being used? Pneumothorax An ECG strip of a patient in the emergency department reveals the following rhythm. Which feature would the healthcare provider interpret as indicating atrial fibrillation? -SaO2 90% -PaCO2 48 mmHg -ETCO2 55 mmHg A patient enters the emergency department in respiratory compromise. The team is monitoring the patient using capnography and identifies that ETCO2 levels are initially 33 mmHg and later 40 mmHg. From these readings, the team identifies that the patient is progressing in what stage of respiratory compromise? Respiratory distress A patient with dyspnea, inadequate blood pressure and a change in mental status arrives at the emergency department. The healthcare team completes the necessary assessments and begins to care for the patient, including initiating cardiac monitoring and pulse oximetry; providing supplemental oxygen and ensuring adequate ventilation; and obtaining vascular access. The team reviews the patient's ECG rhythm strip, as shown in the following figure. Which agent would the team most likely administer? Atropine 1 mg every 3 to 5 minutes Assessment of a patient reveals an ETCO2 level of 55 mmHg and an arterial oxygen saturation (SaO2) level of 88%. The provider would interpret these findings as indicative of which condition? Respiratory failure Which statement accurately reflects the management of cardiac arrest in a pregnancy of 26 weeks' gestation? Resuscitative cesarean delivery (RCD) should be performed within 5 minutes from the time of arrest. Assessment of a patient in the emergency department reveals that the patient is experiencing respiratory compromise. From the assessment, the team identifies that the patient is in the earliest stage of this condition. Which stage would this be? Respiratory distress A person suddenly collapses while sitting in the sunroom of a healthcare facility. A healthcare provider observes the event and hurries over to assess the situation. The healthcare provider performs which assessment first? Rapid assessment A patient is admitted to the emergency department of a large medical center. The patient is diagnosed with STEMI. The facility is capable of administering PCI. To achieve the best outcomes, therapy should be administered to this patient within what time frame? Within 90 minutes of the patient's first medical contact Cardiac monitoring reveals a tachyarrhythmia. The patient is hemodynamically stable and has a regular heart rate ranging from 120 to 135 beats per minute. Which statements by the patient could the team interpret as contributing to the tachyarrhythmia? -"I've been so anxious lately because I just lost my job." -"I've had a terrible cold with a horrible cough for the past week and today I developed a fever." -"I've been vomiting for the past 2 days from a gastrointestinal bug." Which class of medications commonly given to patients with acute coronary syndromes may be adversely affected by morphine administration A. Phosphodiesterase inhibitors B. Oral antiplatelet medications C. Beta blockers D. Calcium channel blockers -----------CORRECT ANSWER: Oral antiplatelet medications What is a benefit of morphine when given for the management of acute coronary syndromes? A. Central nervous system analgesia B. Increases systemic vascular resistance C. Increases left ventricular preload D. Vasoconstriction -----------CORRECT ANSWER: A. Central nervous system analgesia You obtain a 12-lead ECG in a patient with restrosternal chest pain. Which ECG finding is suggestive of high risk non ST segment elevation acute coronary syndromes A. ST depressions less than 0.5mm B. Dynamic T-wave inversion C. ST-segment elevation D. New bundle branch block -----------CORRECT ANSWER: B. Dynamic T-wave inversion Upon reviewing a patient's 12 lead ECG, you note ST-segment elevation of 2mm in leads II,III, and aVF How would you classify the electrocardiographic findings A. Normal B. STEMI C. Non-STEMI D. Non-diagnostic -----------CORRECT ANSWER: b. STEMI What happens when teams rapidly assess and intervene when patients have abnormal vital signs - ----------CORRECT ANSWER: The number of in hospital cardiac arrests decreases What is the goal for first medical contact-to-ballon inflation time for a patient receiving PCI ----- ------CORRECT ANSWER: 90 minutes What is the longest acceptable emergency department door-to-needle time when fibrinolysis is the intended reperfusion strategy -----------CORRECT ANSWER: 30 minutes What is the time goal for how quickly you should complete a fibronolytic checklist once the patient arrives in the emergency department -----------CORRECT ANSWER: 10 minutes What is the recommended time window after symptom onset for early fibronolytic therapy or direct catheter-based reperfusion for patients with STEMI and no contraindication ----------- CORRECT ANSWER: Within 12 hours a 49 yo says that he has had chest discomfort and excessive sweating for the past 25 minutes. Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of MI, what will your first actions include? -----------CORRECT ANSWER: Provide prehospital notification to the receiving hospital Administer aspirin if considering prehospital fibrinolysis, use the fibrinolytic checklist assess ABC Obtain EKG consider oxygen, nitroglycerin, and morphine if needed His initial vital signs are HR 120/min BP 135/88 RR 23 O2 87% When considering oxygen saturation, what is your course of actions? -----------CORRECT ANSWER: Start oxygen at 4L What additional questions help you determine next steps -----------CORRECT ANSWER: When did the symptoms start Do you take any medication Do you have any allergies Your patient continues to say that he has chest discomfort What treatment can you repeat as long as it is not contraindicated by vital signs ----------- CORRECT ANSWER: Nitroglycerin sublingual every 3-5min What is your interpretation of the patient's EKG tracing STEMI in V2-6 -----------CORRECT ANSWER: Anterior STEMI With the possible diagnosis of STEMI, what is the most probable treatment ----------- CORRECT ANSWER: Admission for PCI/fibrinolysis After you give report to the hospital, staff advise you to proceed to the cath lab for PCI what are some of the general questions you need to ask -----------CORRECT ANSWER: when did the symptoms start do you have any allergies do you take any medications what other symptoms do you have within 45 minutes, the neuroimaging interpretation of the CT scan of the brain suggests an acute ischemic infarction. There is no signs of hemorrhage or mass lesions Is this patient a potential candidate for fibrinolytic therapy? -----------CORRECT ANSWER: Yes What actions should the hospital staff take to determine whether the patient is a candidate for fibrinolytic therapy -----------CORRECT ANSWER: Repeat neurologic exam You find that the patient's neurologic function is rapidly improving. Is this patient still a candidate for fibrinolytic therapy? -----------CORRECT ANSWER: No Because the patient is no longer a candidate for fibrinolyic therapy, what are your next steps for him? -----------CORRECT ANSWER: Support ABC Begin stroke pathway Admit to ICU What tidal volume typically maintains normal oxygenation and elimination of carbon dioxide ---- -------CORRECT ANSWER: 6-8mL/kg an 18yo is reporting difficulty breathing and is displaying increased respiratory effort b/l wheeze RR 28 O2 91% PETCO2 44mmHg -----------CORRECT ANSWER: Respiratory distress a 59yo is reporting difficulty breathing nasal flaring, intercostal retractions, and use of accessory muscles RR 28 O2 92% PETCO2 36mmHg -----------CORRECT ANSWER: Respiratory distress 75yo patient difficulty breathing emphysema drowsy b/l wheeze, difficult to appreciate RR 38 O2 85% PETCO2 49mmHg -----------CORRECT ANSWER: Respiratory failure What is the term for the rise in arterial carbon dioxide levels typically associated with respiratory failure -----------CORRECT ANSWER: hypercapnia How much tidal volume must you provide with a bag mask device to produce visible chest rise for an adult patient in respiratory arrest -----------CORRECT ANSWER: 6-7mL/kg What device on a resuscitation bag mask device may prevent sufficient tidal volume in patients with poor lung compliance -----------CORRECT ANSWER: pressure relief valve patients with perfusing rhythms should receive ventilation once every _____ seconds ----------- CORRECT ANSWER: 6 What is the most effective way to deliver bag mask ventilation -----------CORRECT ANSWER: 2 person technique how long should the second rescuer squeeze the bag mask device when providing 2 rescuer ventilation -----------CORRECT ANSWER: 1 second When performing the jaw thrust maneuver on patients with suspected cervical spine injury where should you place your fingers -----------CORRECT ANSWER: just under the angle of the lower jaw When you use a bag mask device you should deliver 500- _______mL tidal volume ----------- CORRECT ANSWER: 600 in which of the following patients can nasopharangeal airways be used -----------CORRECT ANSWER: unconscious, semi, conscious Select the first step in the use of an oropharyngeal airway -----------CORRECT ANSWER: Clear the mouth and pharynx What is a potential complication of inserting an oropharyngeal airway -----------CORRECT ANSWER: Pushing the base of the tongue back The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patient's nose to the -----------CORRECT ANSWER: earlobe What is a potential complication using a nasopharyngeal airway that is too long ----------- CORRECT ANSWER: entering the esophagus What is the most serious potential complication of nasopharyngeal aiway insertion into a patient with facial trauma -----------CORRECT ANSWER: Misplacement into the cranial cavity What is the max length of suction catheter that should be inserted into the patient's oropharynx beyond the tongue -----------CORRECT ANSWER: tip of nose to earlobe What is the most reliable method of confirming and monitoring correct placement of an ET tube -----------CORRECT ANSWER: Quantitative waveform capnography What is the recommended ventilation rate for an adult in cardiac arrest with an advanced airway device in place -----------CORRECT ANSWER: Once every 6 seconds EMS brings a 54 year old patient to the ED who had been experiencing severe SOB and difficulty breathing. The patient loses consciousness on arrival What initial actions should be taken -----------CORRECT ANSWER: Assess ABC Call for help Check for responsiveness the patient is unresponsive and not breathing but has a strong pulse What should your initial actions include -----------CORRECT ANSWER: Open the patient's airway via a head tilt chin lift or jaw thrust Initiate ventilation with a bag mask device attached to supplemental oxygen Patient's HR 84 BP 124/73 SPO2 66% Cyanotic around the mouth and extremities what is the recommended rate for rescue breaths -----------CORRECT ANSWER: 1 breath every 6 seconds What is the single most reliable method of confirming and monitoring correct placement of the ET tube -----------CORRECT ANSWER: Quantitative waveform capnography Which S/S indicate symptomatic bradycardia -----------CORRECT ANSWER: Chest pain SOB Symptoms of instability are not usually caused by HR less than ______bpm unless ventricular function is impaired -----------CORRECT ANSWER: 150/min What is the first line treatment for unstable tachycardia -----------CORRECT ANSWER: Cardioversion The width of the QRS in a patient presenting with tachycardia is .16 seconds. Each QRS complex has a visible p wave. how would you classify this tachycardia -----------CORRECT ANSWER: wide complex tachycardia The width of the QRS in a patient presenting with tachycardia is .10 second. There are no clearly discernable P waves How would you classify this tachycardia -----------CORRECT ANSWER: Narrow complex tachycardia What is the upper HR limit for a patient with stach? -----------CORRECT ANSWER: 130/min What is the lower HR limit for a patient with stach -----------CORRECT ANSWER: 100 What is the recommended initial therapy for a patient with stable narrow complex tachycardia, after establishing an IV and acquiring a 12 lead EKG -----------CORRECT ANSWER: Vagal maneuvers What procedure used in the management of stable narrow complex tachycardia forces a patient to strain against a closed glottis? -----------CORRECT ANSWER: valsalva maneuver What is the recommended initial dose of adenosine for the mgmt of SVT unresponsive to vagal maneuvers? -----------CORRECT ANSWER: 6mg/ 12mg follow up if a patient is conscious, establish IV access prior to synchronized cardioversion and administer - ----------CORRECT ANSWER: sedation electrical cardioversion is not recommended as the initial therapy for patients unless the HR is above -----------CORRECT ANSWER: 150 You are preparing to provide electrical cardioversion you are monitoring the patient's EKG and have applied defib pads, sedation, and defib on. What is the next step -----------CORRECT ANSWER: Activate the sync control button Which is a contraindication to the use of procainamide infusion in the mgmt of stable wide complex tachycardia -----------CORRECT ANSWER: Prolonged QT interval What is the recommended first dose of amio for mgmt of stable wide complex tachycardia ------- ----CORRECT ANSWER: 150mg A 72yo male has been suffering from progressive dizziness and bouts of palpitations after exercising last night. His symptoms reappeared and worsened this morning The patient is conscious and alert, HR 180 weak radial pulse BP 110/78 O2 96% What are the most appropriate initial interventions -----------CORRECT ANSWER: In addition to CPR with minimal interruptions in chest compressions, what is the most critical intervention during the first few minutes of arrest for a patient in vfib -----------CORRECT ANSWER: defibrillation during the management of a patient in cardiac arrest, you have initiated CPR, attached the defibrillator, delivered first shock, and resumed CPR. What is your next intervention ----------- CORRECT ANSWER: establish IV/ IO When is the recommended point to administer the first dose of epi for a patient in a shockable rhythm -----------CORRECT ANSWER: between second and third shocks What is the recommended first dose of amio for patient with VF/pVT that is unresponsive to defibrillation -----------CORRECT ANSWER: 300mg what is the recommended first IV dose of lido for patients in cardiac arrest with VF/pVT that is unresponsive to defibrillation -----------CORRECT ANSWER: 1-1.5mg/kg PEA can present as which of the following organized rhythm -----------CORRECT ANSWER: afib sr bbb when is the recommended point to administer epi to a patient with asystole -----------CORRECT ANSWER: as soon as IV access available in addition to hypoxia, what is the most common underlying, potentially reversible causes of PEA -----------CORRECT ANSWER: hypovolemia which therapy is not supported by evidence for use in patients with cardiac arrest secondary to hypothermia -----------CORRECT ANSWER: antiarrhythmics which alteration to the standard ACLS algorithm is appropriate for patients whose cardiac arrest is caused by hypothermia -----------CORRECT ANSWER: medications spaced at longer intervals a patient with suspected opioid poisoning is not breathing normally but has a pulse. What is your next step -----------CORRECT ANSWER: provide rescue breathing and give naloxone How can rescuers administer naloxone -----------CORRECT ANSWER: intranasally IV IM what roles does ECPR fill in the management of cardiac arrest -----------CORRECT ANSWER: Provides vital organ support while treating reversible causes serve as a bridge for LVAD how will the current generation of continuous flow left ventricular assist devices complicate the BLS assessment -----------CORRECT ANSWER: the devices will not produce a pulse you are assessing an unresponsive patient known to have LVAD. Patient is not breathing, skin pale and cook and cap refill inadequate how do ou assess whether the LVAD is functioning -----------CORRECT ANSWER: listen for device hum patient with VAD is not breathing, has signs of inadequate perfusion, and is unconscious. VAD is functioning. After intubation, PETCO 12. What is next step -----------CORRECT ANSWER: perform external chest compressions CPR position for 3rd trimester patient -----------CORRECT ANSWER: supine with manual left lateral uterine displacement what alterations are recommended for resuscitation to 3rd trimester gravid patients in cardiac arrest -----------CORRECT ANSWER: no dosing alterations recommended when should resuscitation TL activate protocol for perimortem CS delivery ----------- CORRECT ANSWER: as soon as cardiac arrest ID in pregnant patient how quickly should TL consider perimortem CS delivery after beginning efforts if ROSC has not been achieved -----------CORRECT ANSWER: 5 min When adjusting ventilation rates, which PETCO2 value lies within the recommended range for a patient who achieves ROSC -----------CORRECT ANSWER: 40mmHg What is the purpose of obtaining an EKG early during post cardiac arrest care phase ----------- CORRECT ANSWER: to detect STEMI or LBBB monitor rhythm and vital signs IV access 12 lead EKG first line drug for symptomatic bradycardia -----------CORRECT ANSWER: atropine pacing steps -----------CORRECT ANSWER: attach electrodes sedative/ analgesic turn pacer on set demand rate set current appropriate demand rate -----------CORRECT ANSWER: 60-80 Unable to palpate pulse that matches capture. do you have mechanical capture ----------- CORRECT ANSWER: no Pt went into -----------CORRECT ANSWER: vfib, 1mg epi pt has ROSC. post cardiac arrest care algorithm -----------CORRECT ANSWER: ventilate patient with 10 breaths/ min, 92-98% sat, paco2 35-45 which component of effective high performance team is represented by the use of real time feedback devices -----------CORRECT ANSWER: quality initial assessment reveals conscious patient patient's airway is patent and advanced airway is not indicated which action in the primary assessment should you perform next -----------CORRECT ANSWER: administer oxygen as needed Which are the elements of a system of care? -----------CORRECT ANSWER: Structure, processes, system, patient outcome What element of a system of care is represented by properly functioning resuscitation equipment? -----------CORRECT ANSWER: Structure Among others, which factor has been associated with improved survival in patients with cardiac arrest? -----------CORRECT ANSWER: Immediate high- quality CPR What is the first link in the out-of-hospital cardiac arrest (OHCA) chain of survival? ----------- CORRECT ANSWER: Activation of emergency response What are signs of clinical deterioration that would prompt the activation of a rapid response system? -----------CORRECT ANSWER: Systemic hypertension, unexplained agitation, seizure What is the primary purpose of a rapid response team (RRT) or medical emergency team (MET)? -----------CORRECT ANSWER: To improve patient outcomes by identifying and treating early clinical deterioration What happens when teams rapidly assess and intervene when patients have abnormal vital signs? -----------CORRECT ANSWER: The number of in-hospital cardiac- arrest decreases In addition to decreased IHCA, what are some other benefits of implementing a rapid response system? -----------CORRECT ANSWER: Decrease ICU length of stay, decreased in total hospital length of stay Which component of effective high-performance teams is represented by the use of real-time feedback devices? -----------CORRECT ANSWER: Quality What is the main advantage of effective teamwork? -----------CORRECT ANSWER: Division of tasks Which is the best example of a role of the team leader? -----------CORRECT ANSWER: Models excellent team behavior Which is the best example of a role of a team member? -----------CORRECT ANSWER: Prepared to fulfill their role responsibilities What is primary purpose of the CPR coach on a resuscitation team? -----------CORRECT ANSWER: Increasing CPR quality Which member of the high-performance team has the responsibility for assigning roles (positions)? -----------CORRECT ANSWER: Team leader Which high-performance team member is part of the resuscitation triangle? ----------- CORRECT ANSWER: Monitor/ defibrillator/ CPR coach Which is an example of knowledge sharing by a team leader? -----------CORRECT ANSWER: Asking for suggestions about interventions Which is an example of summarizing and reevaluating? -----------CORRECT ANSWER: Increasing monitoring of the patient's condition deteriorates Which is a step of closed-loop communication? -----------CORRECT ANSWER: Confirming task completion before assigning another task Which are examples of mutual respect? -----------CORRECT ANSWER: · Acknowledging correctly completed tasks in a positive way · Ensuring that only 1 person talks at a time What are the components of high-quality CPR? -----------CORRECT ANSWER: · Compression depth of at least 2 inches (5cm) · Complete chest recoil after each compression · Interruptions limited £ 10 seconds · Switching compressions every 2 minutes · Avoiding excessive ventilation Which of the following defines chest compression fraction (CCF)? -----------CORRECT ANSWER: CCF= actual chest compression time/ Total code time During CPR, chest compression fraction (CCF) should be at least --- and ideally greater than 80%. -----------CORRECT ANSWER: 60% How do interruptions in chest compressions negatively impact survival after cardiac arrest? ------ -----CORRECT ANSWER: Decrease coronary perfusion pressure Coronary perfusion pressure (CPP) equals aortic ---- pressure minus right atrial diastolic pressure. -----------CORRECT ANSWER: diastolic What is the only intervention that can restore on organize rhythm in patients with ventricular fibrillation (VF)? -----------CORRECT ANSWER: Early and effective defibrillation How quickly does the chance of survival describe for every minute of defibrillation delay in patients with ventricular fibrillation (VF) who do not receive bystander CPR? ----------- CORRECT ANSWER: 7-10% What is the advantage of a systematic approach to patient assessment? -----------CORRECT ANSWER: Reduces the chances of missing important signs and symptoms What is the first step in the systematic approach to patient assessment? -----------CORRECT ANSWER: Initial impression What is the maximum amount of time you should simultaneously perform the pulse and breathing checks? -----------CORRECT ANSWER: 10 seconds The BLS Assessment is a systematic approach to BLS for trained healthcare providers. This approach stresses: -----------CORRECT ANSWER: Early CPR and defibrillation What is the most common type of stroke? -----------CORRECT ANSWER: Ischemic stroke What type of stroke occurs when a blood vessel is the brain suddenly ruptures into the surrounding tissue? -----------CORRECT ANSWER: Hemorrhagic stroke What is the benefit of morphine when given for the management of ACS? -----------CORRECT ANSWER: Central nervous system analgesia Which is a sign of stroke? -----------CORRECT ANSWER: Trouble speaking Which is a symptom of stroke? -----------CORRECT ANSWER: Sudden trouble seeing What validated abbreviated out-of-hospital neurologic evaluation tool contains 3 components: the facial droop, arm drift, and abnormal speech tests? -----------CORRECT ANSWER: (CPSS) Cincinnati Prehospital Stroke Scale What is the estimated probability of the Cincinnati Prehospital Stroke Scale with 1 abnormal finding when scored by prehospital provides? -----------CORRECT ANSWER: 72% Which is a stroke severity tool that helps EMS differentiate occlusion from non-large-vessel occlusion stroke? -----------CORRECT ANSWER: Los Angeles Motor Scale What is the primary advantage of using a stroke severity tool? -----------CORRECT ANSWER: It helps identify large-vessel occlusion stroke What is the most appropriate destination for patients with suspected acute ischemic stroke? ------ -----CORRECT ANSWER: Certified stroke center What is the highest level of stroke center certification? -----------CORRECT ANSWER: Comprehensive stroke center which is an advantage of EMS transport to a stroke hospital for a patient with suspected acute ischemic stroke? -----------CORRECT ANSWER: Responding providers can stabilize critical issues What is the longest acceptable emergency department door-to-needle time when fibrinolysis is the intended reperfusion strategy? -----------CORRECT ANSWER: 30 minutes What is the advantage of EMS alerting the receiving facility of the impending arrival of a patient with suspected acute ischemic stroke? -----------CORRECT ANSWER: The hospital can perform more efficient evaluation and management What is the goal for neurologic assessment by the stroke team or design and noncontrast computed tomography or magnetic resonance imaging performed after hospital arrival? ----------- CORRECT ANSWER: 20 minutes What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindications after hospital arrival? -----------CORRECT ANSWER: 45 minutes What is the door-to-needle time goal for 85% or more of acute ischemic stroke patients treated with IV thrombolytics? -----------CORRECT ANSWER: 60 minutes What is the door-to-device time goal for direct-arriving patients with acute ischemic stroke treated with endovascular therapy? -----------CORRECT ANSWER: 90 minutes Evidence suggests that there is a higher likelihood of good to excellent functional outcome when alteplase is given to adults with an acute ischemic stroke within what time frame? ----------- CORRECT ANSWER: 3 hours What is the maximum time from last known normal when endovascular therapy can be performed? -----------CORRECT ANSWER: 24 hours What is the maximum time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment? -----------CORRECT ANSWER: 6 hours Identify the systolic BP threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke. -----------CORRECT ANSWER: 185mmHg What is the diastolic blood pressure times hold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke? -----------CORRECT ANSWER: 110mmHg Which action is NOT part of the acute stroke pathway? -----------CORRECT ANSWER: Seizure prophylaxis What blood glucose level should trigger the administration of IV or subcutaneous insulin for a patient with acute ischemic stroke? -----------CORRECT ANSWER: 180mg/dl What is the average RR for an adult at rest? -----------CORRECT ANSWER: 12 to 20/min What is tidal volume typically maintaining normal oxygenation and elimination of carbon dioxide? -----------CORRECT ANSWER: 6 to 8 mL/kg An 18 yo patient is reporting difficulty breathing and is displaying increased respiratory effort. Auscultation reveals bilateral wheezing; the respiratory rate is 28 breaths per minute. Oxygen saturations is 91%. PETCO2 is 44 mmHg. How would you categorize this patient's condition? --- --------CORRECT ANSWER: Respiratory distress A 59 yo patient is reporting difficulty breathing. Physical exam reveals nasal flaring, intercostal interaction and use of accessory muscles. RR is 28 breaths per minute. O2 sat is 92% PTCO2 is 36 mmHg. How would you categorize this patent's condition? -----------CORRECT ANSWER: Respiratory distress A 75 yo patient is having difficulty breathing, with increased respiratory effort. The patient has history of emphysema. The patient is drowsy, auscultation reveals bilateral wheezing, although the lung sounds are difficult to appreciate. RR is 38/min. O2 sat = 85%, PETCO2= 49mmHg. How would you categorize this patient's condition? -----------CORRECT ANSWER: Respiratory failure What is the term of the rise in arterial CO2 levels typically associated with respiratory failure? --- --------CORRECT ANSWER: Hypercapnia How much tidal volume must provide with a bag-mask device to produce visible chest rise for an adult patient in respiratory arrest? -----------CORRECT ANSWER: 6 to 7 mL/kg What device on a resuscitation bag-mask device may prevent sufficient tidal volume in patients with poor lung compliance? -----------CORRECT ANSWER: Pressure-relief value Patients with perfusing rhythms should receive ventilations once every -----------CORRECT ANSWER: 6 seconds What is the most effective way to deliver bag-mask ventilation? -----------CORRECT ANSWER: Using a 2 person technique How long should the second rescuer squeeze the bag mask device when providing 2-rescuer ventilation? -----------CORRECT ANSWER: 1 second When performing the jaw-thrust maneuver on patients with suspected cervical spine injury, where should you place your fingers? -----------CORRECT ANSWER: Just under the angel of the lower jaw When you use a bag-mask device, you should deliver approximately ---tidal volume. ----------- CORRECT ANSWER: 500 to 600 mL What is a contraindication to the use of an oropharyngeal airway? -----------CORRECT ANSWER: Conscious patient In which of the following patients can nasopharyngeal airways be used? -----------CORRECT ANSWER: Unconscious, semiconscious, conscious Select the first step in the use of an oropharyngeal airway -----------CORRECT ANSWER: Clear the mouth and pharynx What is a potential complication of inserting an oropharyngeal airway that is too small? ----------- CORRECT ANSWER: Pushing the base of the tongue back The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patient's nose to the -----------CORRECT ANSWER: earlobe What is the upper heart rate limit for a patient with sinus tachycardia? -----------CORRECT ANSWER: 130/min What is the lower heart rate limit for a patient with sinus tachycardia? -----------CORRECT ANSWER: 100/min What is the recommended initial therapy for a patient with stable narrow-complex tachycardia, after establishing an IV and acquiring a 12-lead EKG? -----------CORRECT ANSWER: Vagal maneuvers What procedure used in the management of stable narrow-complex tachycardia forces a patient to strain a closed glottis? -----------CORRECT ANSWER: Valsalva maneuver What is the recommended initial dose of adenosine for the management of supraventricular tachycardia unresponsive to vagal maneuvers? -----------CORRECT ANSWER: 6mg IV What is the follow up dose of adenosine for the management of supraventricular tachycardia unresponsive to the first adenosine dose? -----------CORRECT ANSWER: 12mg IV If the patient is conscious, establish IV access prior to synchronized cardioversion and administer -----------CORRECT ANSWER: sedation Generally speaking, electrical cardioversion is not recommended as the initial therapy for patients unless the heart rate is above -----------CORRECT ANSWER: 150/min You are preparing to provide electrical cardioversion. You are monitoring the patient's EKG and have applied the defibrillation pads to the patient's bare chest. You have delivered sufficient sedation and have turned the defibrillator on. What is the next step you should perform? ---------- -CORRECT ANSWER: Activate the sync control button Which is contraindicated to the use of procainamide infusion in the management of stable wide- complex tachycardia? -----------CORRECT ANSWER: Prolonged QT interval What is the recommended first dose of amiodarone for the management of stable wide-complex tachycardia? -----------CORRECT ANSWER: 150mg IV In addition to CPR with minimal interruptions in chest compressions what is the most critical intervention during the first minutes of arrest for a patient in ventricular fibrillation? ----------- CORRECT ANSWER: Defibrillation During the management of a patient in cardiac arrest, you have initiated CPR, attached the manual defibrillator, delivered the first shock, and immediately resumed high quality CPR, beginning with chest compressions. What is your next intervention? -----------CORRECT ANSWER: Establish IV or IO access What is the recommended first dose of amiodarone for the management of stable wide-complex tachycardia? -----------CORRECT ANSWER: 150 mg IV When is the recommended point to administer the first dose of epinephrine for a patient in a shockable rhythm? -----------CORRECT ANSWER: Between the second and third shocks What is the recommended dose for epinephrine during a resuscitation effort? ----------- CORRECT ANSWER: 1mg IV every 3 to 5 minutes What is the recommended first IV/ IO dose of amiodarone for patients in cardiac arrest with VF/PVT that is unresponsive to defibrillation? -----------CORRECT ANSWER: 300mg What is the recommended first IV/IO dose of lidocaine for patients in cardiac arrest with VF/PVT that is unresponsive to defibrillation? -----------CORRECT ANSWER: 1 to 1.5mg/kg What term best describes an organized rhythm without a pulse? -----------CORRECT ANSWER: PEA PEA can present as which of the following organized rhythms? -----------CORRECT ANSWER: Bundle brunch blocks, Atrial fibrillation or flutter, Sinus rhythm When is the recommended point to administer epinephrine to a patient with a systole? ----------- CORRECT ANSWER: As soon as IV/IO access is available In addition to hypoxia, what is the most common underlying, potentially reversible cause of pulseless electrical activity? -----------CORRECT ANSWER: Hypovolemia Which therapy is not supported by evidence for use in patients with cardiac arrest secondary to hypothermia? -----------CORRECT ANSWER: Antiarrhythmics Which alternation to be standard ACLS algorithm is appropriate for patients whose cardiac arrest is caused by hypothermia? -----------CORRECT ANSWER: Medications spared at longer intervals A patient with suspected opioid poisoning is not breathing normally but has a pulse. What is your next step? -----------CORRECT ANSWER: Provide rescue breathing and give naloxone Depending on training and individual circumstances how can rescuers administer naloxone? ----- ------CORRECT ANSWER: Intranasally, intravenously, intramuscularly What roles does ECPR fill in the management of cardiac arrest? -----------CORRECT ANSWER: Severe as a bridge for left ventricular assist device implantation, provides vital organ support while treating reversible causes How will the current generation of continuous-flow left ventricular assist devices complicate the BLS assessment? -----------CORRECT ANSWER: The devices will not produce a pulse You are assessing an unresponsive patient known to have an implanted left ventricular assist device (LVAD). The patient is not breathing, the patient's skin is pale and cool, and capillary refill is inadequate. How do you assess whether the LVAD is functioning? -----------CORRECT ANSWER: Listen for device hum A patient with ventricular assist device (VAD) is not breathing, has signs of inadequate perfusion, and is unconscious. You determine the VAD is functioning. After endotracheal intubation, the patient has a PETCO2 of 12 mmHg. What is your next action? ----------- CORRECT ANSWER: Perform external chest compressions What is the recommended CPR position for a third-trimester gravid patient? ----------- CORRECT ANSWER: Supine with normal left uterine displacement What alternations one recommended for resuscitation drug administration to 3rd trimester gravid patients in cardiac arrest? -----------CORRECT ANSWER: No dosing alternations are recommended When should resuscitation team leaders activate the protocol for perimortem cesarean delivery? - ----------CORRECT ANSWER: As soon as cardiac arrest is determined in a pregnant patient How quickly should resuscitation Team leaders consider perimortem cesarean delivery after beginning resuscitative efforts it returns of spontaneous circulation has not been achieved? ------- ----CORRECT ANSWER: 5 minutes When titrating inspired oxygen, which arterial oxyhemoglobin saturation value lies within the recommended range for a patient who achieves return of spontaneous circulation? ----------- CORRECT ANSWER: 95% When adjusting ventilation rales, with PETCO2 value lies within the recommended range for a patient who achieves return of spontaneous circulation? -----------CORRECT ANSWER: 40mmHg What is the recommended fluid bolus dose for patients who are hypotensive during the post- cardiac arrest phase? -----------CORRECT ANSWER: 1 to 2 L What is the recommended norepinephrine dose for hypotensive patients during the post-cardiac arrest phase? -----------CORRECT ANSWER: 0.1 to 0.5mcg/kg per minute What is the recommended starting IV infusion dose of epinephrine for patients in cardiac arrest achieve ROSC and need vasopressor support? -----------CORRECT ANSWER: 2 to 10 mcg per minute What is the mean arterial pressure target when administering epinephrine to patients in cardiac arrest who return of spontaneous circulation and have vasopressor support? ----------- CORRECT ANSWER: 65mmHg