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ACLS > Practice questions > Flashcards

Practice questions Flashcards

1
Q

What are the 4 cardiac arrest rhythms?

A
  1. Ventricular Fibrillation
  2. Ventricular Tachycardia
  3. Asystole
  4. Pulseless electrical activity
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2
Q

What are the shockable cardiac arrest rhythms?

A

Ventricular fibrillation and ventricular tachycardia

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3
Q

How do you determine the size of the airway?

A

From the corner of the mouth to the tip of the earlobe or the angle of the jaw

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4
Q

When do you use atropine?

A

To treat symptomatic bradycardia

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5
Q

WHat’s the appropriate intervention for acute coronary syndrome?

A

MONA - morphine, oxygen (if indicated - cyanotic, oxygen saturation less than 94%), nitroglycerin, aspirin
IV access should also be made

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6
Q

What’s the correct ratio of compressions to ventilations in adult CPR?

A

30:2

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7
Q

What is the typical dose given by the tracheal route?

A

2 - 2.5 times the recommended IV dose

Dilute the recommended dose in 5-10 ml of sterile water or normal saline and administer

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8
Q

What drugs can be absorbed via the trachea?

A

Naloxone, atropine, vasopressin, epinephrine and lidocaine

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9
Q

What are the first line antiarrhythmics for a stable wide QRS tachycardia that is most likely VT?
(monomorphic VT)

A

Procainamide, amiodarone, sotalol

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10
Q

What drugs would be used in the management of narrow QRS tachycardias?

A

Adenosine, diltiazem, and verapamil

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11
Q

What drug can be used in diagnosis when the origin of a wide-QRS tachycardia is unclear?

A

Adenosine

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12
Q

What drugs can be used in the management of symptomatic bradycardias?

A

Atropine and isoproterenol

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13
Q

What is the first antiarrhythmic administered in the management of a patient in pulseless VT or VF?

A

Amiodarone

- you can use lidocaine if amiodarone is unavailable

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14
Q

What is a common cause of excessive intrathoracic pressure during CPR?

A

Hyperventilation

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15
Q

when is supplemental oxygen therapy indicated?

A

if the patient is hypoxic, cyanotic, having difficulty breathing, has obvious signs of heart failure or shock, or if her O2 saturation declines to less than 94%

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16
Q

If breath sounds are absent on both sides of the chest after placing a trachea tube, what should you assume?

A

Esophageal intubation

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17
Q

If breath sounds are diminished on the left after intubation but present on the right, what should you assume?

A

Right primary bronchus intubation

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18
Q

What might you see if a mucus plug presents in the tracheal tube?

A

increased resistance during positive pressure ventilation

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19
Q

What drugs can improve perfusion pressures during cardiac arrest?

A

Vasopressors like epinephrine to constrict blood vessels

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20
Q

What acronym is used to quickly assess a patients level of responsiveness (used in primary survey)?

A

AVPU

ALERT
responds to VERBAL stimuli
responds to PAINFUL stimuli
UNRESPONSIVE

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21
Q

What acronym is used for the primary survey in a responsive patient?

A

ABCD

AIRWAY
BREATHING
CIRCULATION
DEFIBRILLATION/DISABILITY
EXPOSURE
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22
Q

What is done in a primary survey of an unresponsive patient?

A

Circulation
Airway
Breathing
Defibrillation/Disability

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23
Q

What rhythms do you use defibrillation for?

A

Pulseless VT
Pulseless VF
Sustained polymorphic VT

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24
Q

What rhythms do you use synchronized cardioversion?

A

Unstable narrow-QRS tachycardia
Unstable atrial flutter
Unstable atrial fibrillation
Unstable monomorphic VT

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25
Q

What rhythms do you use transcutaneous pacing for?

A

Symptomatic bradycardia

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26
Q

In acute stroke management, what phrase reflects the need for rapid assessment and intervention?

A

Time is brain

delays in DX and TX can leave the patient neurologically impaired and disabled

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27
Q

what is the most reliable method for confirmation and monitoring of tracheal tube placement?

A

Clinical assessment and continuous quantitative waveform capnography

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28
Q

What can be used to replace either the first or second dose of epinephrine in the TX of pulseless arrest?

A

One dose of Vasopressin 40 U IV/IO bolus

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29
Q

when are the incidence of dysrhythmias the highest after the onset of symptoms after a STEMI?

A

Highest during the first 4 hrs after onset of symptoms and remains an important contributing factor to death in the first 24 hrs after a STEMI

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30
Q

If a patient wakes from sleep or is found with symptoms of a stroke, whats the time of onset of symptoms defined as?

A

The last time the patient was last known to be symptom-free

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31
Q

what are the most common adverse effects of amiodarone administration?

A

Hypotension and bradycardia

32
Q

What drug may be used to treat torsades de pointes?

A

Magnesium sulfate

33
Q

What beta adrenergic agent may be used in the treatment of symptomatic bradycardia?

A

Isoproterenol

34
Q

What drug is an indirect inhibitor of thrombin

A

Heparin

35
Q

What is the drug of choice for most narrow-QRS tachycardias?

A

Adenosine

36
Q

What alternative antiarrhythmic is used in the treatment of stable monomorphic VT?

A

Sotalol

37
Q

What is one reperfusion therapy option for patients with a STEMI?

A

Fibrinolytics

38
Q

What inhibitors prevent fibrinogen binding and platelet clumping?

A

Glycoprotein IIb/IIIa inhibitors

39
Q

What drug is given IV bolus in cardiac arrest and IV infusion in symptomatic bradycardia?

A

Adenosine

40
Q

What drug can be used in place of the first or second dose of epinephrine in cardiac arrest?

A

Vasopressin

41
Q

What vasodilator is used in normotensive patients with ischemic chest discomfort?

A

nitroglycerin

42
Q

What catecholamine has both alpha and beta adrenergic dose related actions and is used in the treatment of symptomatic bradycardia?

A

Dopamine

43
Q

What is the first line drug used in the treatment of symptomatic bradycardia?

A

Atropine

44
Q

What drug may be used as an alternative to amiodarone in pulseless VT/VF arrest?

A

Lidocaine

45
Q

What’s the maximum dose you can give of epinephrine in ACLS?

A

no limit

46
Q

with two-rescuer adult cardiopulmonary resuscitation, how long should switching compressor and ventilator roles take?

A

in 5 s or less

47
Q

If there are no contraindications, what can be performed first as an initial action in a stable but symptomatic patient with a narrow QRS tachycardia?

A

vagal maneuvers

48
Q

How much epinephrine do you administer during cardiac arrest?

A

1 mg epinephrine 1:10,000 solution should be given rapid IV push every 3 to 5 min

49
Q

what are some situations that require a reduction in the initial dose of IV adenosine?

A

giving adenosine through a central IV line, giving it to a patient who has a transplanted heart and giving it to a patient that’s taking carbamazepine and a patient that’s taking dioyridamole

50
Q

what are some situtations that require an increase in the initial dose of IV adenosine?

A

patients on theophylline, caffeine, or theobromine

51
Q

what is a finding that would indicate inadvertent esophageal intubation?

A

gurgling sounds heard over the epigastrum

52
Q

in the management of symptomatic bradycardia, if max dose of atropine had been given and a pacemaker wasn’t immediately available, whats a possible next course of action?

A

dopamine infusion of 2-10mcg/kg/min

53
Q

at doses used in cardiac arrest, what do vasopressin and epinephrine cause?

A

significant peripheral vasoconstriction

54
Q

a 62 yo man is complaining of palpitations that came on suddenly after walking up a short flight of stairs. his symptosm have been present for about 20 minutes. he denies chest pain and is not short of breath. his ski is warm and dry and his breath sounds are clear. BP is 144/88, pulse is 186, R 18, the cardiac monitor reveals sustained monomorphic ventricular tachycardia. an IV is established. what meds would be appropriate for him?

A

Procainamide or amiodarone

55
Q

T or F Most resuscitation efforts result in a return of spontaneous circulation

A

False

56
Q

what is a complication associated with inferior wall MI?

A

Bradydysrhythmia

57
Q

What are some drugs that can be administered tracheally?

A

vasopressin, epinephrine and lidocaine

58
Q

what’s the correct dose of epinephrine when given tracheally?

A

2 - 2.5 mg

59
Q

in a patient presenting with an ACS, ST segment depression of more than 0.5 mm in leads V2 and V3 and more than 1 mm in all other leads is suggestive of myocardial ____ when viewed in two or more anatomically contiguous leads

A

ischemia

60
Q

During a cardiac arrest, at what rate should positive pressure ventilation be delivered after insertion of an advanced airway?

A

8 to 10 breaths per min

61
Q

when does synchronized cardioversion deliver its shock?

A

during ventricular depolarization

62
Q

a 48 yo M became unresponsive shortly after presenting to you with nausea and generalized chest discomfort. you observe gasping breathing and are unsure if you feel a pulse. what should you do?

A

call for help and begin chest compressions

63
Q

what’s the recommended energy to deliver for a unstable regular narrow QRS tachycardia with a biphasic defibrillator?

A

perform synchronized cardioversion with 50 - 100 J for the initial shock

64
Q

T or F cricoid pressure eliminates the risk of aspiration during bag mask ventilation or tracheal intubation

A

FALSE

65
Q

what should ya think about cricoid pressure use?

A

cricoid pressure can impede advanced airway placement.
use of cricoid pressure in adult cardiac arrest is NOT recommended
cricoid pressure is often applied incorrectly with too much or too little pressure

66
Q

who commonly has atypical symptoms or unusual presentations of ACS?

A

older adults, women, and diabetic individuals

67
Q

when should you consider amiodarone use in cardiac arrest?

A

Amiodarone can be considered if pulseless VT/VF continues despite two to three shocks, SPR and administration of a vasopressor

68
Q

an 84 yo m presents with acute onset altered mental status. cardiac monitor shows complete AV block with wide QRS complexes at a rate of 30 bpm. patients BP is 58/30 ventilations are 14. skin is cool, moist and pale. His SpO2 on room air is 95% and IV has been established. what should you do?

A

prepare for transcutaneous pacing

69
Q

What is the drug of choice for most forms of narrow QRS tachycardia

A

adenosine

70
Q

what are the three major physical findings evaluated with the Cincinnati prehospital stroke scale?

A

facial droop, arm drift and speech abnormalities

71
Q

hypotension (systolic less than 90 mm) after return of spontaneous circulation may necessitate the use of what?

A

epinephrine, dopamine or norepinephrine

72
Q

what are the three groups you can be grouped into after your EKG is viewed?

A

ST elevation, ST depression, normal/nondiagnostic EKG

73
Q

in a patient presenting with an ACS, ST segment elevation of more than ____ _____ _____ in men 40 yo and older is suggestive of Myocardial injury and warrants further evaluation

A

2 mm in leads V2 and V3 and 1 mm in all other leads

74
Q

who is nitroglycerin contraindicated in?

A

hypotension patients

also be cautious in a inferior MI! you don’t want to give to someone with a RV MI

75
Q

a patients chest discomfort was unrelieved after max recommended dosage of NTG tablets. morphine sulfate was ordered and a 4 mg dose was given IV. the pts blood pressure is now 80/60 and his skin is cool, moist and pale. his breath sounds are clear. what should you do?

A

give a 250 mL IV fluid bolus of normal saline

76
Q

An IV is in place for a pt, the pts 12 lead EKG reveals ST segment elevation in leads II, III and aVF - what should ya do?

A

because an inferior MI is suspected, right chest leads should be quickly used to rule out RV infarction before giving meds for pain relief

77
Q

A stable patient with a racing heart has an SpO2 of 90% what do you do

A

supplemental oxygen is indicated and should be delivered using a nasal cannula at 4 L/min

ACLS (5 decks)

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