ACLS: Pre-test (plus some extra q's)

Fibrinolytics should be administered for ACS within...

30 min

What is the standard initial dose of Adenosine?

6mg as a rapid IV push followed by a 20mL saline flush. If patient does not cardiovert, give 12mg

What drug is indicated next for a patient who remains in VF cardiac arrest after defibrillation & epinephrine 1 mg IV? a. amiodarone 300 mg IV b. Lidocaine 1 to 1.5 mg/kg IV push c. Procainamide 50 mg/min, up to a total dose of 17 mg/kg d. Magnesium 1 to 2 g, appropriately diluted, IV push

A

Which of the below patients should receive Adenosine for initial treatment of their condition? a. 44 y/o alert female with PSVT with rate of 170/minute b. 65 y/o male complaining of chest pain, with ECG showing atrial tachycardia with rate of 140/minute c. 60 year old female with dizziness, chest pain, BP of 88/60 with ECG showing atrial fibrillation with ventricular response of 115/minute d. 70 y/o male with palpitations, agitation and ECG wthat shows wide complex tachycardia with rate of 200/minute

A

Which of the following are most likely signs of a stroke? a. Trouble speaking, dizziness, sudden severe headache, sudden confusion b. Sudden numbness, shortness of breath, sudden severe headache, sudden confusion c. Trouble seeing in one eye, dizziness, vomiting, sudden confusion d. Trouble speaking, dizziness, sudden severe headache, memory loss

A

Which of the following is indicated in the treatment of a patient with hypotension and a Mobitz type 2 heart block? a. Atropine b. Synchronized cardioversion c. Transcutaneous pacing d. Epinephrine 1 mg IV

A

Within 45 minutes of arrival in your ED, which of the following evaluation sequences should be performed for a 56-year-old woman with facial droop, garbled speech, rapid onset of headache, and right arm and leg weakness? a. history, physical and neurologic exams, noncontrast head CT with radiologist interpretation b. history, physical and neurologic exams, noncontrast head CT, start of fibrinolytic treatment if scan is positive for hemorrhagic stroke c. history, physical and neurologic exams, lumbar puncture, contrast head CT if LP is negative for blood d. history, physical and neurologic exams, contrast head CT, start of fibrinolytic treatment when improvement in neurologic signs is noted

A

A stable patient with narrow-complex Supraventricular tachycardia is best treated with...

Adenosine

The following drug is to be the first drug of choice for treatment of bradycardia...

Atropine

The medication that should NOT be given via endotracheal tube is: a. Atropine b. Dopamine c. Lidocaine d. Epinephrine

B

You are talking with a patient in the ED when suddenly she becomes unresponsive and you see the below rhythm on the monitor (V.fib). You first action is:

Begin CPR

A patient in VF cardiac arrest has failed to respond to defibrillation & epinephrine 1 mg IV. You give the nurse an order to administer epinephrine every 3 minutes during the code. Which of the following dose regimens is recommended? a. epinephrine 1 mg, 3 mg, 5 mg, and 7 mg (escalating regimen) b. epinephrine 0.2 mg/kg per dose (high-dose regimen) c. epinephrine 1 mg IV push, repeated every 3-5 minutes d. epinephrine 1 mg IV push, followed in 3 minutes by vasopressin 40 U IV

C

The most common reversible causes of PEA are called the "H's and T's" and include all of the following EXCEPT: a. Hypoxia b. Hypovolemia c. Hypocalcemia d. Tamponade

C

What drug-dose combination is recommended as the first line medication to give to a patient in asystole? a. epinephrine 3 mg IV b. atropine 3 mg IV c. epinephrine 1 mg of a 1:10 000 solution IV d. atropine 0.5 mg IV

C

When using vasopressin on a patient who remains in persistent VF arrest, which of the following guidelines for use of vasopressin is true? a. Give vasopressin 40 U every 3 to 5 minutes b. Give vasopressin for better vasoconstriction and ß-adrenergic; stimulation than provided by epinephrine c. Give vasopressin as an alternative to epinephrine in the first or second dose of a vasopressor agent as treatment for ventricular fibrillation d. give vasopressin as the first-line pressor agent for clinical shock caused by hypovolemia

C

Which of the below are the proper sequence of events indicated for the performance of CPR and the operation of an AED. a. Send someone to call 911, attach AED electrode pads, open the airway, turn on the AED, provide, 2 breaths, check for a pulse b. Wait for the AED and barrier device to arrive, open the airway, provide 2 breaths, check for a pulse, if no pulse attach AED electrode pads, follow AED prompts c. Check scene safety, check the patient for responsiveness, send someone to call 911, check for a pulse, if no pulse start compressions until the AED arrives then attach the AED, follow AED prompts d. Provide 2 breaths, check for a pulse, if no pulse perform chest compressions for 1 minute, call for the AED, when the AED arrives attach electrode pads

C

Which of the following are true regarding the use of an oropharyngeal airway (OPA)... a. It may be used in conscious patients b. It is better to use an OPA that is too-large OPA, than one that is too small c. You should insert the OPA so that it curves upward and then rotate it 180 degrees to match the curve of the tongue and throat d. OPAs are safe to use in all patients

C

Your patient is in the ED with ACS. You know that the immediate goals of therapy include all of the following EXCEPT: a. Identify STEMI in order to provide early reperfusion therapy. b. Relieve chest pain c. Identify elevated cardiac markers d. Intervene early for life-threatening complications

C (?)

The correct sequence for basic life support is...

CAB

How does ventilation differ with cardiac arrest vs respiratory arrest?

Cardiac arrest: Give 1 ventilation every 6-8 seconds (8-10 breaths per min) Respiratory arrest: Give 1 ventilation every 5-6 seconds (10-12 breaths per min)

Early signs and symptoms of a stroke may include all of following EXCEPT: a. Speech difficulties b. Sudden confusion or disorientation c. Sudden weakness or numbness of the face d. Hypotension

D

The newest AHA ACLS guidelines discuss resuscitation team dynamics, including the roles of team of team leader and team member. A team member should possess which of the following? a. The ability to insert a central venous catheter b. The ability to insert an endotracheal tube c. A thorough understanding of all ACLS algorithms d. The ability to perform all ACLS skills

D

Your patient in the ED has a strong pulse and regular heart rate of 182 beats per minute with a normal QRS on the cardiac monitor. Her blood pressure is 112/56. She is awake and denies any pain. All of the following may be appropriate interventions EXCEPT: a. Administer adenosine b. Attempt vagal maneuvers c. 12 lead ECG d. Perform synchronized cardioversion

D

What are the 8 D's of stroke care?

Detection Dispatch Delivery Door Data Decision Drug Disposition

True or False: Cricoid pressure is recommended when performing an emergent adult airway intubation.

False

What are the H's and T's?

Hypoxia Hypoglycemia Hyperkalemia Hypokalemia H+ (acidosis) Hypothermia Toxins Tamponade Tension pneumothorax Thrombosis

What are two types of strokes?

Ischemic Hemorrhagic

What drugs are used in treatment of ACS?

Morphine Oxygen Nitro ASA Fibrinolytics Heparin

Meds you can give down an ET tube

NAVEL: Narcan Atropine Vasopressin Epinephrine Lidocaine

Recommended ED door to balloon inflation time for a STEMI patient is...

No longer than 90 minutes

In the course of a resuscitation, you obtain an organized rhythm on the monitor. How long should you pause to check for a pulse?

No more than 10 seconds

An 85 year male complains of dizziness and nearly passing out. His monitor strip is below (see test). What is the diagnosis?

Second degree AV block type 2

You are the PA in the emergency department seeing a 65-year-old female. The patient is connected to the monitor and you see this rhythm (see test) she has a palpable pulse. What is the rhythm?

Sinus Bradycardia

When would you use a soft vs rigid suction catheter?

Soft is for mouth or nose. Rigid is for oropharynx

During cardiopulmonary resuscitation, deliver oxygen at:

Titrated to keep oxygen saturation ≥ 94%

Why do you want to avoid excessive ventilation?

To avoid increasing intrathoracic pressure which decreases venous return to the heart and diminishes cardiac output. May also cause gastric inflation which can lead to vomiting

True or False: The initial recommended dose of atropine for symptomatic bradycardia is 0.5 mg IV.

True

Team resuscitation is a focus in the 2010 guidelines. The role of the team leader is different from the other team members in that a team leader is the person on the team who must:

Understand the ACLS sequences

The goal for initiation of fibrinolytic therapy in appropriate stroke patients is:

Within 3 hours of arrival to ED (up to 4.5 hours in select patients)

Drugs for stroke

rtPA Glucose Labetalol Nicardipine Enalaprilat ASA Nitroprusside