ACLS 2020

Which is the maximum interval you should allow for an interruption in chest compressions?

10 sec

You are performing chest compressions during an adult resuscitation attempt. Which rate should you use to perform the compressions?

100 to 120/min

A patient in stable narrow-complex tachycardia with a peripheral IV in place is refractory to the first dose of adenosine. Which dose would you administer next? A. 3mg B. 12mg C. 20mg D. 40mg

12 mg

Which is the recommended oral dose of aspirin for a patient with suspected acute coronary syndrome?

160 to 325 mg

What is the recommended range from which a temperature should be selected and maintained constantly to achieve targeted temperature management after cardiac arrest?

32C to 36C

Which best describes the length of time it should take to perform a pulse check during the BLS Assessment?

5 to 10 seconds

Three minutes into a cardiac arrest resuscitation attempt, one member of your team inserts an endotracheal tube while another performs chest compressions. Capnography shows a persistent waveform and a PETCO2 of 8 mm Hg. Which is the significance of this finding? A. Chest compressions may not be effective B. The endotracheal tube is in the esophagus C. The patient meets the criteria for termination of efforts D. The team is ventilating the patient too often (hyperventilation)

A. Chest compressions may not be effective

As the team leader, when do you tell the chest compressors to switch?

About every 2 minutes

A 45yo man had coronary artery stents placed 2 days ago. Today,he is in severe distress and reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mmHg, respiratory rate is 28 breaths/min, and O2 sat is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. Based on this patient's initial presentation, which condition do you suspect led to the cardiac arrest?

Acute coronary syndrome

If a team member is about to make a mistake during a resuscitation attempt, which best describes the action that the team leader or other team members should take?

Address the team member immediately

Which of the following signs is a likely indicator of cardiac arrest in an unresponsive patient?

Agonal gasps

EMS providers are treating a pt with suspected stroke. According to the Adult Suspected Stroke Algorithm, which critical action performed by the EMS team will expedite this patient's care on arrival and reduce the time to treatment?

Alert the hospital

A 45yo man had coronary artery stents placed 2 days ago. Today,he is in severe distress and reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mmHg, respiratory rate is 28 breaths/min, and O2 sat is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. Despite the initial drug provided after two shocks and continued CPR, the patient remains in ventricular fibrillation. Which other drug should be administered next?

Amiodarone 300 mg

A 68 yo woman presents with lightheadedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm shown. The patient's pulse oximeter shows a reading of 84% on room air. Which initial action do you take?

Apply oxygen

A team member is unable to perform an assigned task because it is beyond the team member's scope of practice. Which action should the team member take?

Ask for a new task or role

During post-cardiac arrest care, which is the recommended duration of targeted temperature management after reaching the correct temperature range?

At least 24 hours

Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive and notice that he is taking agonal breaths. What is the next step in your assessment and management of this patient?

Check the patient's breathing and pulse

A 45yo man had coronary artery stents placed 2 days ago. Today,he is in severe distress and reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mmHg, respiratory rate is 28 breaths/min, and O2 sat is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. In addition to defibrillation, which intervention should be performed immediately?

Chest compressions

Which best describes an action taken by the team leader to avoid inefficiencies during a resuscitation attempt?

Clearly delegate tasks

Which is one way to minimize interruptions in chest compressions during CPR?

Continue CPR while the defibrillator charges

Which facility is the most appropriate EMS destination for a patient with sudden cardiac arrest who achieved return of spontaneous circulation in the field?

Coronary reperfusion-capable medical center

For STEMI patients, which best describes the recommended maximum goal time for emergency department door-to-balloon inflation time for percutaneous coronary intervention? A. 180 minutes B. 150 minutes C. 120 minutes D. 90 minutes

D. 90 minutes

What is an effect of excessive ventilation?

Decreased cardiac output

A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm: What is the appropriate next intervention?

Defibrillation

A 45yo man had coronary artery stents placed 2 days ago. Today,he is in severe distress and reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mmHg, respiratory rate is 28 breaths/min, and O2 sat is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. Despite 2 defibrillation attempts, the patient remains in vfib. which drug and dose should you administer first to this patient?

Epinephrine 1 mg

You have completed 2 min of CPR. The ECG monitor displays the lead below (PEA) and the pt. has no pulse. You partner resumes chest compressions and an IV is in place. What management step is your next priority?

Give epinephrine 1 mg IV

Which is the primary purpose of a medical emergency team or rapid response team?

Improving patient outcomes by identifying and treating early clinical deterioration

A 45yo man had coronary artery stents placed 2 days ago. Today,he is in severe distress and reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mmHg, respiratory rate is 28 breaths/min, and O2 sat is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. The patient has return of spontaneous circulation and is not able to follow commands. Which immediate post-cardiac arrest care intervention do you choose for this patient?

Initiate targeted temperature management

A 68 yo woman presents with lightheadedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm shown. If the pt became apnea and pulseless but the rhythm remained the same, which would take the highest priority?

Insert an advanced airway

Which is an acceptable method of selecting an appropriately sized oropharyngeal airway?

Measure from the corner of the mouth to the angle of the mandible

Your patient is in cardiac arrest and has been intubated. To assess CPR quality, which should you do?

Monitor the patient's PETCO2

This rhythm

Monomorphic ventricular tachycardia

Which of these tests should be performed for a patient with suspected stroke within 25 minutes of hospital arrival?

Noncontrast CT scan of the head

You are evaluating a 58 year old man with chest pain. The BP is 92/50 and a heart rate of 92/min, non-labored respiratory rate is 14 breaths/min and the pulse O2 is 97%. What assessment step is most important now?

Obtaining a 12-lead ECG

To properly ventilate a patient with a perfusing rhythm, what is the rate to squeeze the bag (BVM)

Once every 5 to 6 seconds

If the patient became apnea and pulseless but the rhythm remained the same, which would take the highest priority?

Perform defibrillation

A 45yo man had coronary artery stents placed 2 days ago. Today,he is in severe distress and reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mmHg, respiratory rate is 28 breaths/min, and O2 sat is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. Which would you have done first if the patient had not gone into vfib?

Performed synchronized cardioversion

A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the following lead II ECG rhythm: What is the appropriate next intervention?

Performing synchronized cardioversion

Which is the recommended next step after a defibrillation attempt?

Resume CPR, starting with chest compressions

Which type of AV block shown

Second-degree type II

You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The CT scan was normal, with no signs of hemorrhage. The patient does not have any contraindications to fibrinolytic therapy. Which treatment approach is best for this patient?

Start fibrinolytic therapy as soon as possible

A 68 yo woman presents with lightheadedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm shown. After your initial assessment of this pt, which intervention should be performed next?

Synchronized cardioversion

A 68 yo woman presents with lightheadedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm shown. Based on this patient's initial assessment, which adult ACLS algorithm should you follow?

Tachycardia

A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient's lead II ECG is displayed below.

Unstable supraventricular tachycardia