Cardiac Arrest - ACLS

Question 1

______ is a certification course designed for
healthcare providers who either direct or participate in the management of
cardiopulmonary arrest or other cardiovascular emergencies

Answer 1

Advanced Cardiovascular Life Support (ACLS)

Question 2

two distinct system-specific Chains of
Survival:

Answer 2

○ In-Hospital Cardiac Arrest
(IHCA)
○ Out-of-Hospital Cardiac
Arrest (OHCA)

Question 3

The ______ assesses, attempts to stabilize the
patient, and initiates the Code Team
if necessary

Answer 3

Rapid Response Team (RRT)

Question 4

More than half of IHCAs result from _____,
and changes in physiology such as tachypnea, tachycardia, and hypotension
foreshadow most of these events.

Answer 4

respiratory failure or hypovolemic shock

Question 5

Ideally, a full code team will have ____ members, including a team leader who is
at the helm

Answer 5

6

Question 6

Critical Concepts for BLS assessment:

Answer 6

■ Minimizing interruptions: Limit interruptions to chest compressions
to less than 10 seconds to maximize CCF.
■ High-quality CPR:
● Compression the chest hard and fast (100-120 per minute)
● Compress at least 2 inches and allow for complete recoil
● Switch compressor about every 2 min or earlier if fatigued

Question 7

What is Agonal Breathing (AKA Agonal Gasps)?

Answer 7

○ Agonal gasps are not normal breathing and may be present in the first
minutes after sudden cardiac arrest.
○ The mouth may be open and the head, neck, or jaw may move with the
gasps, and you may hear a snort, snore, or groan

Question 8

Starting CPR when you are not sure about a pulse

Answer 8

○ If you are unsure about the presence of a pulse, begin chest
compressions and ventilations.
○ Failing to provide compressions when needed is more harmful that
providing unnecessary compressions

Question 9

In the Primary Assessment, we address the following (ABCDE)

Answer 9

○ Airway
○ Breathing
○ Circulation
○ Disability
○ Exposure

Question 10

Primary assessment: Airway

Answer 10

○ Maintain patent airway in unconscious patients.
■ Head tilt-chin lift, OPA, and/or NPA.
○ Use advanced airway management if needed.
■ LMA, ET tubes, etc.

Question 11

The Primary Assessment: Breathing

Answer 11

○ Give supplemental oxygen when indicated.
■ For those in cardiac arrest, 100% oxygen should be administered.
○ Monitor the adequacy of ventilation and oxygenation.
■ Clinical assessment (Good chest rise? Any cyanosis?)
○ Avoid excessive ventilation (what is the proper rate?)

Question 12

The Primary Assessment: Circulation

Answer 12

○ Monitor CPR quality.
■ Quantitative waveform capnography (PETCO2 of at least 10 mmHg
suggests high-quality chest compressions
○ Attach monitor/defibrillator to monitor/address rhythm.
■ Provide defibrillation/cardioversion as indicated
○ Obtain IV (or IO) access, provide fluids if indicated.
○ Administer appropriate, indicated drugs (for rhythms and BP).
■ Discussed with the specific algorithms
○ Check glucose, temperature, and perfusion issues.

Question 13

The Primary Assessment: Disability

Answer 13

○ Quickly assess neurologic function.
■ Check for responsiveness, level of consciousness, pupil dilation, etc.
○ Consider using AVPU.
■ Alert, Voice, Painful, Unresponsive

Question 14

The Primary Assessment: Exposure

Answer 14

○ Remove clothing to perform a physical examination.
■ Check for obvious signs of trauma, bleeding, burns, other unusual markings, and medical alert bracelets.

Question 15

The Secondary Assessment involves:

Answer 15

● The Secondary Assessment involves the differential diagnosis. Includes:
○ Focused medical history (SAMPLE)
○ Searching for and treating underlying causes (H’s and T’s

Question 16

Secondary assessment: SAMPLE

Answer 16

○ Signs and symptoms
○ Allergies
○ Medications (including last dose taken)
○ Past medical history (especially relating to current illness)
○ Last meal consumed
○ Events

Question 17

The _____ remind us of the most common causes of cardiac arrest

Answer 17

H’s and T’s

Question 18

The H’s and T’s

Answer 18

H’s
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypo/Hyperkalemia
Hypothermia

T’s
Tension pneumothorax
Tamponade (cardiac)
Toxins
Thrombosis (pulmonary)
Thrombosis (coronary)

Question 19

What is Cardiac Arrest

Answer 19

Cardiac Arrest is an abrupt, sudden loss of heart function in a person who
may or may not have diagnosed heart disease.
○ Occurs most commonly in those with known heart disease, whether it’s
coronary artery disease, heart failure, cardiomyopathy, etc.
○ Can occur in individuals in whom no heart disease diagnosis has ever
been established (can be the presenting sign of a heart problem

Question 20

Cardiac Arrest presents with a classic clinical triad

Answer 20

○ Loss of consciousness (LOC)
○ Apnea (no breathing or agonal gasps)
○ Loss of apical or central pulses (carotid or femoral)

Question 21

____% or more of individuals who suffer OHCA do not survive.

Answer 21

90

Question 22

About ____% of those who suffer IHCA do not survive.

Answer 22

75

Question 23

____, especially if performed within the first few minutes of cardiac arrest, can double or triple a individual’s chance of surviva

Answer 23

CPR

Question 24

There has been a gradual improvement
in the survival rate in recent years.
○ Studies show that this is due to two
main factors:

Answer 24

■ Minimizing interruptions of
high-quality chest compressions
■ Early defibrillation

Question 25

During cardiac arrest, ____% oxygen
should be administered.

Answer 25

100

Question 26

If an advanced airway is present, ventilation
rate is one breath every ____ seconds.

Answer 26

6

Question 27

T/F As soon as possible during ACLS, the lead should determine whether or not the rhythm is shockable

Answer 27

T

Question 28

Shockable Rhythms include:

Answer 28

V-Fib
Pulseless V-tach

Question 29

Nonshockable rhythms

Answer 29

Asystole
Pulseless Electrical Activity (PEA)

Question 30

Pulseless Electrical Activity

Answer 30

● PEA is sometimes called Electromechanical Dissociation.
● This is when the monitor of a patient in cardiac arrest shows some form of a
rhythm besides VF, pVT, and Asystole, AND there is still no detectable pulse.
○ Most common potentially reversible causes are hypovolemia and hypoxia

Question 31

If monitor shows VF or pVT, what should you do next?

Answer 31

immediate defibrillation is indicated and important.

Question 32

There are two types of defibrillation that can be used:

Answer 32

○ Monophasic- Current moves in one direction (old)
○ Biphasic - Current moves back and forth (new

Question 33

Monophasic shock:

Answer 33

give a single 360 J shock every
time you administer a shock.

Question 34

Biphasic shock:

Answer 34

○ If biphasic, it depends on the manufacturer
recommendation.
■ Ex: Initial dose of 120-200 J
■ Generally visible on the face of machine
■ If unknown, use the maximum dose each time

Question 35

T/F In the first few minutes after successful defibrillation, any new rhythm is
typically slow and may not create pulses or adequate perfusion

Answer 35

T

Question 36

If the patient is intubated, PETCO2
will abruptly increase to _____

Answer 36

35-45 mmHg

Question 37

A _____is preferred for drug and fluid administration unless a
central line is already available.

Answer 37

peripheral IV

Question 38

When a drug is administered through an IV, it should be followed by _____

Answer 38

a 20 mL fluid bolus and 10-20 seconds of extremity elevation

Question 39

Once IV or IO access is established, give _____

Answer 39

a dose of Epinephrine without
interrupting CPR.

Question 40

Studies have shown that Epi improves
_____

Answer 40

cerebral and coronary perfusion pressure during
CPR, and does increase rate of ROSC

Question 41

antiarrhythmic medications as
an adjunct treatment to ACLS

Answer 41

● Amiodarone was historically preferred, but the
2020 update indicates either can be used.
○ First dose: 300 mg IV/IO bolus
○ If VF/pVT persists, a second dose can be given
3-5 minutes later at 150 mg IV/IO
● Lidocaine is also an option
○ First dose: 1-1.5 mg/kg IV/IO bolus
○ If repeat is indicated, 0.5-0.75 mg/kg in 5-10
minute intervals (to a max of 3 mg/kg)

Question 42

Treating Asystole and PEA

Answer 42

d, efforts are focused on high-quality chest compressions and
periodic administration of Epinephrine.
○ Dose: 1 mg every 3-5 minutes
● Because defibrillation is not an option and antiarrhythmic medications
are not effective, considering underlying causes (H’s & T’s) is very
important, especially with PEA.