ACLS

Question 0

Actions performed for an unconscious apneic patient who you are uncertain has a pulse

Answer 0

Begin cycles of compressions and ventilations

Of 30-2

Question 1

Advantage of using hands free defibrillation pads

Answer 1

• Reduces transthoracic impedance, or resistance that chest structures have on electrical current
• Reduce the risk of arching, allowing monitoring of underlying rhythm and rapid defib

Question 2

Problem associated with delivering high concentrations of O2 during ROSC

Answer 2

Avoid complications associated with oxygen toxicity
Avoid hyperventilation may lead to adverse hemodynamic effects when intra-thoracic pressures are increased because of potential decreases in cerebral blood flow when PaCO2 decreases

Question 3

During post cardiac arrest the lowest level required to achieve an arterial oxygen saturation of

Answer 3

> _ 94%

Question 4

In hospital Resuscitative efforts can be terminated if

Answer 4

Cannot identify reversible cause
Patient fails to respond to BLS and ACLS surveys 
Time from collapse to CPR 
Time from collapse to defib
Comorbid disease 
Perarrest state 
Initial arrest rhythm 
Response to resuscitative measures

Question 5

Most reliable method of confirming and monitoring placement of Endotracheal tube

Answer 5

Continuous waveform capnography

Question 6

What is the role of quantitative waveform in an intubated patient

Answer 6

Insures correct tube placement and monitoring
Monitors CPR quality, optimize chest compressions, and detect ROSC during compressions
Displays PETCO2 in mm of Hg on the vertical axis

Question 7

Pharmacologic treatment for patient with stable SVT

Answer 7

6mg Adenosine rapid IV
20-50 mg of Procainamide IV
150 mg Amiodarone over 10 min
100mg Sotalol IV over 5 min

Question 8

Significance of a PETCO2 level of 8 mmHg

Answer 8

• Need to improve CPR if less than 10

- In intubated patient it suggests that ROSC is unlikely normal value is 35-40

Question 9

What is the desired post cardiac arrest PETCO2 range for a patient is ROSC

Answer 9

35-40 mmHg

Question 10

What is the second dose of adenosine for a patient in refractory, but stable narrow complex tachycardia

Answer 10

12mg rapid IV push

Question 11

Best strategy for performing high quality CPR on a patient with advanced airway

Answer 11

8-10 breaths per minute with continuous chest compressions

Question 12

An organized rhythm without a pulse is defined as

Answer 12

PEA

Question 13

PEA rhythms can include

Answer 13

IVR
Ventricular escape
Post defib IVR
Sinus rhythm

Question 14

Rhythms which require synchronized cardioversion

Answer 14

Unstable SVT
Unstable atrial fib
Unstable atrial flutter
Unstable regular monomorphic tachycardia with pulses

Question 15

Desired minimum systolic blood pressure in hypotensive post-cardiac arrest who has ROSC

Answer 15

> 90 mm Hg

Question 16

Emergency departments priority for a patient with a positive prehospital stroke assessment

Answer 16

Door (appropriate triage to stroke center)
Data (rapid triage, evaluation, and management with ED)
Decision (stroke expertise and therapy selection)
Drug (fibrinolytic therapy, intra-arterial strategies)
Disposition (rapid admission to the stroke unit)

Question 17

Out of hospital resuscitative efforts can be terminated when

Answer 17

Restoration of effective, spontaneous circulation and ventilation
Transfer of care to senior medical
Presence of reliable criteria indicating irreversible death
Unable to continue due to exhaustion or dangerous environment
Valid DNR
Online authorization from medical control

Question 18

Identify the condition which is contraindication to hypothermia during the post cardiac arrest period for patient with ROSC

Answer 18

Patient must be responsive/conscious

Question 19

Continued electrical rhythmicity of the heart in the absence of mechanical function

Answer 19

PEA

Question 20

The actions in which increase the chance of successful conversion of ventricular fibrillation

Answer 20

Restoring a perfusing rhythm is optimized with early defibrillation and CPR

Question 21

Treatment for patient for a patient with unstable wide complex tachycardia

Answer 21

Treat as V tachycardia until proven other
Synchronized cardioversion 100 J 
CPR 5 cycles 
1mg Epinephrine 
Analyze rhythm if same 
Cardioversion at 150 J

Question 22

Actions of high quality chest compressions

Answer 22

Compress chest hard and fast  >100 per min
Allow complete chest recoil 
Minimize interruptions 10sec or less 
Switch providers every 2minutes 
Avoid excessive ventilation

Question 23

List common mistakes in cardiac arrest management

Answer 23

Stopping CPR for more than 10sec
Over ventilation
Fatigue
Inadequate depth and rate

Question 24

Treatment for PEA

Answer 24

``` CPR O2 Epinephrine Advanced airway Treat reversible causes ```

Question 25

What do you do when AED doesn't analyze heart rhythm

Answer 25

Resume compressions and ventilations | Check all connections between AED and patient

Question 26

Identify second degree type 1 heart block

Answer 26

The electrical signals are delayed more and more with each heart beat until the heart skips a beat

Question 27

Identify treatment for a patient in unstable second degree type 1 heart block

Answer 27

Atropine .5 mg Transcutaneous pacing Dopamine infusion 2-10 mcg/kg/min Epinephrine infusion 2-10 mcg/min

Question 28

Describe procedure for endotracheal tube suctioning

Answer 28

Use sterile technique to reduce contamination Insert catheter into ET tube Not deeper than the end of the ET tube Apply suctioning by occluding the side opening only while withdrawing catheter with rotating motion Suction attempts to not exceed 10sec

Question 29

What is the preferred method of medication delivery during cardiac arrest

Answer 29

IV/IO

Question 30

When a 12 lead EKG should be obtained for a patient with acute coronary syndrome

Answer 30

As soon as possible when signs and symptoms suggest ischemia or infarction Analyze rhythm within 10 minutes of arrival of ED

Question 31

Initial BLS treatment for patient in cardiac arrest

Answer 31

``` Tap shout are you alright Analyze breathing Activate emergency response get AED Check pulse CPR Check for shockable rhythm Defibrillate ```

Question 32

Treatment for patient with unstable bradycardia

Answer 32

0.5 mg Atropine Transcutaneous pacing Dopamine infusion 2-10mcg/kg/min Epinephrine infusion 2-10 mcg/min

Question 33

Recommended action to help minimize interruptions in chest compressions during CPR

Answer 33

The team leader assigns roles and responsibilities and organizes interventions to minimize interruptions in chest compressions

Question 34

What to do if a hospital does not have a CT scan available for the stroke patient you're transporting

Answer 34

Stabilize and promptly transfer the patient to a facility with CT capability Do not give aspirin, heparin, or rtPA until ruled out hemorrhage

Question 35

Treatment for a patient with stable SVT

Answer 35

``` IV 12 lead Vagal maneuvers Adenosine 6mg Beta blocker or calcium channel blocker Consider expert consultation ```

Question 36

List components of BLS survey

Answer 36

``` Check responsiveness Activate EMS Get AED Circulation Defibrillation ```

Question 37

Pharmacologic agents/doses for patient in refractory V Fib

Answer 37

1mg epinephrine 3-5 min 300mg Amiodarone 40 U vasopressin

Question 38

Appropriate interval for interrupting chest compressions during CPR

Answer 38

No more than 10 sec during defib Advanced airway Only in dangerous environments is more than 10 acceptable

Question 39

Identify the lab values consistent with effective CPR

Answer 39

-End-tidal CO2 (PETCO2 35-40) | <30 improve compressions

Question 40

Action that improves the quality of chest compressions

Answer 40

``` Compress chest hard and fast Allow complete recoil Minimize interruptions Switch providers Avoid excessive ventilation Monitor CPR on quantitative capnography ```

Question 41

Primary purpose of medical emergency team or rapid response team

Answer 41

Improve patient outcomes by identifying and treating early clinical deterioration

Question 42

Appropriate ventilation strategy for patient in respiratory arrest with a pulse

Answer 42

1 breath every 5-6 seconds (10-12 per min) check pulse every 2min

Question 43

Pharmacologic treatment for patient in unstable bradycardia

Answer 43

``` 0.5 Atropine Transcutaneous pacing Dopamine infusion 2-10 mcg/kg/min Epinephrine 2-10 mcg/min Expert consultation ```

Question 44

Dopamine dose for unstable bradycardia

Answer 44

2-10 mcg/kg/min

Question 45

Treatment for patient with suspected stroke if no hemorrhage

Answer 45

may be candidate for Fibrinolytic therapy not candidate for therapy Administer aspirin

Question 46

Drugs for non hemorrhage stroke

Answer 46

Fibrinolytic therapy rtPA Aspirin