ACLS: 2020 AHA ACLS Review

C. Defibrillation The correct answer is C. Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. Both are treated with high-energy unsynchronized shocks. The interval from collapse to defibrillation is one of the most important determinants of survival from cardiac arrest. Early defibrillation is critical for patients with sudden cardiac arrest (ventricular fibrillation/pulseless ventricular tachycardia). [ACLS Provider Manual, Part 3: High-Performance Teams >Cardiac Arrest: VF/pT > Applying the Adult Cardiac Arrest Algorithm: VF/pVT Pathway > Defibrillate (Shockable Rhythm: VF/pVT);page 1201

A patient has a witnessed loss of consciousness. The lead I ECG reveals this rhythm. Which is the appropriate treatment? A. Administration of adenosine 6 mg IV push B. Administration of epinephrine 1 mg VI push C. Defibrillation D. Synchronized cardioversion

B. Performing synchronized cardioversion The correct answer is B. Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. Synchronized cardioversion use a lower energy level than attempted defibrillation. Low-energy shocks should always be delivered as synchronized shocks to avoid precipitating ventricular fibrillation. [ACLS Provider Manual, Part 2: Preventing Arrest >Tachycardia: Stable and Unstable > Cardioversion > Recommendations; page 82]

A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the lead I ECG rhythm shown here. Which is the appropriate treatment? A. Administering adenosine 6 mg IV push B. Performing synchronized cardioversion C. Performing vagal maneuvers D. Performing defibrillation

B. 12mg The correct answer is B. Adenosine is indicated for most forms of stable narrow-complex supraventricular tachycardia. fI the patient is not responsive to the first dose, a second dose of adenosine (12 mg rapidIV push) should be given. [ALS Provider Manual, Part 2: Preventing Arrest > Tachycardia: Stableand Unstable >Applying the Adult Tachycardia With a Pulse Algorithm ot the Stable Patient > Narrow QRS, Regular Rhythm; page 88]

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

D. "I have an order to give 500 mg of amiodarone IV. Is this correct?" The correct answeris D. Unclear communication can lead to unnecessary delays in treatment or to medication errors. Team members should question an orderif theslightestdoubt exists. [ACLS Provider Manual, Part 3: High-Performance Teams > Elements ofEffective Team Dynamics as Part of a High-Performance Team > How to Communicate > Closed-Loop Communications; page 98]

A patient is being resuscitated in a very noisy environment. A team member thinks he heard an order for 500 mg of amiodarone IV. Which is the best response from the team member? A."OK." B. "Are you sure?" C. "Amiodarone 500 mg VI has been given." D. "I have an order to give 500 mg of amiodarone IV. Is this correct?"

A. Ask for a new task or role The correct answer is A. Not only should everyone on the team knowhis orher own limitations and capabilities, but the Team Leader should also be aware of them. This allows the Team Leader to evaluate team resources and call for backup of team members when assistance isneeded. High-performance team members should anticipate situations in which they might require assistance and in form the Team Leader. [ACLS ProviderManual, Part 3: High-Performance Teams >Elements of Effective Team Dynamics as Part of aHigh-Performance Team > Role > Clear Roles and Responsibilities; pages 95-96]

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? A. Ask for a new task or role B. Assign it to an other team member C. Do it anyway D. Seek expert advice

D. Unstable supraventricular tachycardia The correct answer is D. This ECG rhythm strip shows supraventricular tachycardia, and the patient is showing signs and symptoms of unstable tachycardia. [ A L S Provider Manual, Part 2: Preventing Arrest > Tachycardia: Stable and Unstable; pages 75-77]

Aresponder 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 I ECG is displayed here. Which best characterizes this patient's rhythm? A. Perfusing ventricular tachycardia B. Sinus tachycardia C. Stable supraventricular tachycardia D. Unstable supraventricular tachycardia

B. At least 24 hours The correct answer is B. For targeted temperature management, healthcare providers should select and maintain a constant target temperature between 32°C and 36°C for a period of at least 24 hours. [ALS Provider Manual, Part 3: High-Performance Teams > Post-Cardiac Arrest Care > Application of the Adult Post-Cardiac Arrest Care Algorithm > Targeted Temperature Management; page 1571

During post-cardiac arrest care, which is therecommended duration of targeted temperature management after reaching the correct temperature range? A. At least 8 hours B. At least 24 hours C. At least 36 hours D. At least 48 hours

A. Provide prehospital notification The correct answer is A. Prearrival notification allows the hospital to prepare to evaluate and manage the patient effectively. [ALS Provider Manual, Part :2 Preventing Arrest >Acute Stroke >Identification ofSigns of Possible Stroke and Activate Emergency Response >Activate EMS System Immediately; page 50]

EMS providers are treating a patient with suspected stroke. According to the Adult Suspected Stroke Algorithm, which critical action performed by the EMS team wil expedite this patient's care on arrival and reduce the time to treatment? A. Provide prehospital notification B. Establish IV access C. Review the patient's history D. Treat hypertension

D. 90 minutes The correct answer is D. For the patient with STEMI, the goals of reperfusion are to give fibrinolvtics within 30 minutes of arrival or perform percutaneous coronary intervention within 90 minutes of arrival. The goal for first medical contact-to-balloon inflation time is 90 minutes. [ALS ProviderManual, Part 2: Preventing Arrest >Acute Coronary Syndromes >Immediate ED Assessment and Treatment; page 37]

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

A. Charge the defibrillator 15 seconds before conducting a rhythm check The correct answer is A. Shortening the interval betweenthe last compression and the shock by even a few seconds can improve shock success (defibrillation and return of spontaneous circulation). Thus, it is reasonable for healthcare providers to practice efficient coordination between CPR and defibrillation to minimize the hands-off interval between stopping compressions and administering the shock. For example, after verifying a shockable rhythm and initiating the charging sequence on the defibrillator, another provider should resume chest compressions and continue until the defibrillator is fuly charged. The defibrillator operator should deliver the shock as soon asthe compressor removes his or her hands from the patient's chest and all providers are "clear" of contactwith the patient. [ALS Provider Manual, Part 3: High-Performance Teams >Critical Concepts: Ways to Increase Chest Compression Fraction; page 92]

How can you increase chest compression fraction during a code? A. Charge the defibrillator 15 seconds before conducting a rhythm check B. Interchange the Ventilator and Compressor during a rhythm check C. Administer epinephrine during the 2-minute cycle D. Initiate intravenous or intraosseous access during the 2-minute cycle

C. Address the team member immediately The correct answer is C. During a resuscitation attempt, the leader or a member of a high-performance team may need to intervene if an action that is about to occur may be inappropriate at the time. Team members should question a colleague who is about to make amistake. [ ACLS Provider Manual, Part 3: High-Performance Teams > Elements ofEffective Team Dynamics as Part o fa High-Performance Team > Role ems > Constructive Interventions; pages 96-97]

If a team member is about to make a mistake during a resuscitation attempt, which best describes the action that the Team Leader or otherteam members should take? A. Conduct a debriefing after the resuscitation attempt B. Reassign the team tasks C. Address the team member immediately D. Remove the team member from the area

C. Continuous waveform capnography The correct answer is C. The AHA recommends continuous wave form capnography in addition to clinical assessment as the most reliable method of confirming and monitoring correct placement of an endotracheal tube. [ACLS Provider Manual, Part 3: High-Performance Teams > Respiratory Arrest > Primary Assessment > Airway Management ni Respiratory Arrest; page 102]

In addition to clinical assessment, which is the most reliable method to confirm and monitor correct placement or an endotracheal tube? A. Arterial blood gases B. Chest radiography C. Continuous waveform capnography D. Hemoglobin levels

A. Chest compressions may not be effective The correct answer is A. PETCO2 values less than 10 mm Hg in intubated patients indicate that cardiac output is inadequate to achieve return of spontaneous circulation. It is reasonable to consider trying to improve quality of CPR by optimizing chest compression parameters. [ALS Provider Manual, Part 3: High-Performance Teams > Cardiac Arrest: VF/pVT > Physiologic Monitoring During CPR; page 125]

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. What 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)

B. Once every 6 seconds The correct answer is B. For a patient in respiratory arrest with a pulse, deliver ventilations once every 6 seconds with a bag-mask device or any advanced airway. [ACLS Provider Manual, Part 3: High-Performance Teams >Respiratory Arrest> BLS Assessment >Ventilationand Pulse Check; page 102]

To properlyventilate a patient with a perfusing rhythm, how often do you squeeze the bag? A. Once every 3 seconds B. Once every 6 seconds C. Once every 10 seconds D. Once every 12 seconds

A. Epinephrine 1 mg The correct answer is A. For persistent ventricular fibrillation/pulseless ventricular tachycardia, give 1 shock and resume CPR immediately for 2 minutes after the shock. When IV/IO access is available, give epinephrine 1mg IV/O during CPR after the secondshock and repeat epinephrine 1mg IV/O every 3to5 minutes. [ACLS Provider Manual, Part 3: High-Performance Teams > Cardiac Arrest: V F / p T > Applying the Adult Cardiac Arrest Algorithm: VF/pVT Pathway >Vasopressors; page 123]

Use this scenario to answer A 45-year-old man had coronary artery stents placed 2days ago. Today, he is ni severe distress and is reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool ot the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths per minute, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventriculartachycardia, which then quickly changed to ventricular fibrillation. Question: Despite 2 defibrillation attempts, the patient remains in ventricular fibrillation. Which drug and dose should you administer first to this patient? A. Epinephrine 1 mg B. Amiodarone 300 mg C. Lidocaine 1mg/kg D. Atropine 1 mg

D. Lidocaine 1to 1.5 mg/kg The correct answer is D. Administer either lidocaine or amiodarone for treatment of ventricular fibrillation or pulseless ventricular tachycardia unresponsive to shock delivery, CPR, and a vasopressor. During cardiac arrest, consider amiodarone 300 mg IV/O push for the first dose. [ACLS Provider Manual, Part 3: High- Performance Teams > Cardiac Arrest: VF/pT > Applying the Adult Cardiac Arrest Algorithm: VF/pVT Pathway >Antiarrhythmics >pages 123-124]

Use this scenario to answer A 45-year-old man had coronary artery stents placed 2days ago. Today, he is ni severe distress and is reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool ot the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths per minute, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventriculartachycardia, which then quickly changed to ventricular fibrillation. Question: Despite the drug provided above and continued CPR, the patient remains ni ventricular fibrillation. Which other drug should be administered next? A. Epinephrine 1 m g B. Atropine 1mg C. Magnesium sulfate 1g D. Lidocaine 1to 1.5 mg/kg

C. Chest compressions The correct answer is C. Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. [ A L S Provider Manual, Part 3: High-Performance Teams > Cardiac Arrest: VF/pVT >Managing VF/pVT: The Adult Cardiac Arrest Algorithm >VF/pVT Path; page 116, and Applying the Adult Cardiac Arrest Algorithm: VF/pVT Pathway >Defibrillate (Shockable Rhythm: VF/pVT); page 120]

Use this scenario to answer A 45-year-old man had coronary artery stents placed 2days ago. Today, he is ni severe distress and is reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool ot the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths per minute, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventriculartachycardia, which then quickly changed to ventricular fibrillation. Question: In addition to defibrillation, which intervention should be performed immediately? A. Advanced airway insertion B. Vasoactive medication administration C. Chest compressions D. Vascular access

A. Acute coronary syndrome The correct answer is A. Acute life-threatening complicationsof acute coronary syndromes include ventricular fibrillation, pulseless ventricular tachycardia, symptomatic bradycardias, and unstable tachycardias. [ACLS Provider Manual, Part 2: Preventing Arrest > Acute Coronary Syndromes > Goals for ACS Patients; page 29]

Use this scenario to answer A 45-year-old man had coronary artery stents placed 2days ago. Today, he is ni severe distress and is reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool ot the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths per minute, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventriculartachycardia, which then quickly changed to ventricular fibrillation. Question: On the basis of this patient's initial presentation, which condition do you suspect led to the cardiac arrest? A. Acute coronary syndrome B.Acute heart failure C. Acute ischemic stroke D. Supraventricular tachycardia with ischemic chest pain

A. Initiate targeted temperature management The correct answer is A. To protect the brain and other organs, the high-performance team should start targeted temperature management in patients who remain comatose (lack of meaningful response to verbal commands) with return of spontaneous circulation after cardiac arrest. [ACLS Provider Manual, Part 3: High- Performance Teams > Post-Cardiac Arrest Care >Application of the Adult Post-Cardiac Arrest CareAlgorithm > Targeted Temperature Management; page 157]

Use this scenario to answer A 45-year-old man had coronary artery stents placed 2days ago. Today, he is ni severe distress and is reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool ot the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths per minute, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventriculartachycardia, which then quickly changed to ventricular fibrillation. Question: The patient has return of spontaneous circulation and is not able to follow commands. Which post- cardiac arrest care intervention do you choose for this patient? A. Initiate targeted temperature management B. Check the glucose level C. Administer epinephrine D. Extubate

D. Performed synchronized cardioversion The correct answer is D. Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. [ACLS Provider Manual, Part 2: Preventing Arrest > Tachycardia: Stable and Unstable >Cardioversion > Recommendations; page 82]

Use this scenario to answer A 45-year-old man had coronary artery stents placed 2days ago. Today, he is ni severe distress and is reporting "crushing" chest discomfort. He is pale, diaphoretic, and cool ot the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths per minute, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventriculartachycardia, which then quickly changed to ventricular fibrillation. Question: Which would you have done first if the patient had not gone into ventricular fibrillation? A. Established IV access B. Obtained a 12-lead ECG С. Given atropine 1 mg D. Performed synchronized cardioversion

A. Decreased cardiac output The correct answer is A. Excessive ventilation can be harmful because it increases intrathoracic pressure, decreases venous return to the heart, and diminishes cardiac output and survival. [ACLS Provider Manual, Part 3: High-Performance Teams > Identifying Respiratory Problems by Severity > Respiratory Arrest > Critical Concepts: Avoiding Excessive Ventilation; page 102]

What is an effect of excessive ventilation? A. Decreased cardiac output B. Decreased intrathoracic pressure C. Increased perfusion pressures D. increased venous return

D. 90mmHg The correct answer is D. fI the patient's volume status is adequate, infusions of vasoactive agents may be initiated and titrated to achieve a minimum systolic blood pressure of 90 m Hg or greater or a mean arterial pressure of 65 m Hg or more. [ALS Provider Manual, Part 3: High-PerformanceTeams >Post-Cardiac Arrest Care >Multiple System Approach toPost-Cardiac Arrest Care; page 152]

What is the minimum systolic blood pressure one should attempt to achieve with fluid administration or vasoactive agents in a hypotensive post-cardiac arrest patient who achieves return of spontaneous circulation? A. 75 mmHg B. 80 mmHg C. 85mmHg D. 90mmHg

C. 32°C to 36°C The correct answer is C. For targeted temperature management, healthcare providers should select and maintain a constant target temperature between 32°C and 36°C for a period of at least 24 hours. [ACLS Provider Manual, Part 3: High-Performance Teams > Post-Cardiac Arrest Care > Application of the Adult Post-Cardiac Arrest Care Algorithm > Targeted Temperature Management; page 157]

What is the recommended range from which a temperature should be selected and maintained constantly to achieve targeted temperature management after cardiacarrest? A. 26°C to 28°C B. 29°C to 31°C C. 32°C to 36°C D. 35°C to37°C

B. To ensure high-quality CPR The correctanswer is B. The goal of the CPR Coach to ensure high-quality CPR by providing feedback about the rate, depth, and recoil of chest compressions, delivery of ventilations (rate and volume), and compression pauses. [ALS Provider Manual, Part 3: High-Performance Teams > Roles in a High-Performance Team > Team Member Role: CPR Coach > Critical Concepts: CPR Coach Role; page 95]

What should be the primary focus of the CPR Coach on a resuscitation team? A. To convey positive feedback B. To ensure high-quality CPR C. To resolve team arguments D. To document CPR outcomes

C. Clearly delegate tasks The correct answer is C. To avoid inefficiencies, the Team Leader must clearly delegate tasks. [ACLS Provider Manual, Part :3 High-Performance Teams > Elements of Effective Team Dynamics as Part of a High-Performance Team > Roles > Clear Roles and Responsibilities; page 95]

Which best describes an action taken by the Team Leader to avoid inefficiencies during a resuscitation attempt? A. Assign most tasks to the more experienced team members B.Perform the most complicated tasks C. Clearly delegate tasks D.Assign the same tasks to more than one team member

B. 5 to 10 seconds The correct answer is B. Check the pulse for 5 to 10 seconds. If there is no pulse within 10 seconds, start CPR, beginning with chest compressions. [ A L S Provider Manual,Part :1 Overview of ACLS >Systematic Approach > BLS Assessment > Table 2: BLS Assessment; page 18]

Which best describes the length of time it should take to perform a pulse check during the BLS Assessment? A. 1 to 4 seconds B. 5 to 10 seconds C. 1 to 15 seconds D. 16 to 20 seconds

D. Third-degree atrioventricular block The correct answer is D. This ECG rhythm strip shows third-degree atrioventricular block. JACLS ProviderManual,Part2:PreventingArrest>Bradycardia>RhythmsforBradycardia;pages06-07

Which best describes this rhythm? A. First-degree atrioventricular block B. Second-degree atrioventricular block type I C. Second-degree atrioventricular block type I D. Third-degree atrioventricular block

A. Monomorphic ventricular tachycardia The correct answer is A. This ECG rhythm strip shows a monomorphic ventricular tachycardia. [ACLS Provider Manual, Part 2: Preventing Arrest > Tachycardia: Stable and Unstable > Rhythms for Unstable Tachycardia; pages 75-76]

Which best describes this rhythm? A. Monomorphic ventricular tachycardia B. Polymorphic ventricular tachycardia C. Supraventricular tachycardia D. Ventricular fibrillation

D. Coronary reperfusion-capable medical center The correct answer is D. After return of spontaneous circulation ni patients ni whom coronary artery occlusion is suspected, providers should transport the patient to a facility capable of reliably providing coronary reperfusion (eg, percutaneous coronary intervention) and other goal-directed post-cardiac arrest care therapies. [ACLS Provider Manual, Part 3: High-Performance Teams > Post-Cardiac Arrest Care > Multiple System Approach to Post-Cardiac Arrest Care; pages 151-152]

Which facility is the most appropriate EMS destination for a patient with sudden cardiac arrest who achieved return of spontaneous circulation in the field? A. Comprehensive stroke care unit B. Acute rehabilitation care unit C. Acuteond-termcareunit D. Coronary reperfusion-capable medical center

A. Measure from the corner of the mouth to the angle of the mandible The correct answer is A. To select the appropriate size for an oropharyngeal airway (OPA), place the OPA against the side of the face. When the flange of the OPA is at the corner of the mouth, the tip is at the angle of the mandible. Aproperly sized and inserted OPA results ni proper alignment with the glottic opening. [ACLS Provider Manual, Part :3 High-Performance Teams > Respiratory Arrest > Basic Airway Adjuncts: OPA > Technique of O P A Insertion: pace 1071

Which is an acceptable method of selecting an appropriately sized oropharyngeal airway? A. Measure from the corner of the mouth to the angle of the mandible B. Measure from the thyroid cartilage to the bottom of the earlobe C.Estimate by using the formula weight (kg)/8 + 2 D.Estimate by using the size of the patient's finger

A. 10 seconds The correct answer is A. ACLS providers must make every effort to minimize any interruptions in chest compressions. Try to limit interruptions in chest compressions (eg, defibrillation and rhythm analysis) to nolonger than 10 seconds. When you stop chest compressions, blood flow tothe brain and heart stops. [ACLS Provider Manual, Part :1 Overview of ACLS > Systematic Approach > BLS Assessment > Critical Concepts: Minimizing Interruptions ni Chest Compressions; page 19]

Which is the maximum interval you should allow for an interruption in chest compressions? A. 10 seconds B. 15 seconds C. 20 seconds D. 25 seconds

B. Improving patient outcomes by identifying and treating early clinical deterioration The correct answer is B. Many hospitals have implemented the use of medical emergency teams or rapid response teams. The purpose of these teams is to improve patient outcomes by identifying and treating early clinical deterioration. [ALS Provider Manual, Part 2: Preventing Arrest >Recognition: Signs of Clinical Deterioration > Rapid Response >RRTs and METs; page 28]

Which is the primary purpose of a medical emergency team or rapid response team ? A. Improving care for patients admitted to critical care units B. Improving patient outcomes by identifying and treating early clinical deterioration C. Providing diagnostic consultation to emergency department patients D. Providing online consultation to EMS personnel in the field

D. 300 mg The correct answer is D. Consider amiodarone for treatment of ventricular fibrillation or pulseless ventricular tachycardia unresponsive to shock delivery, CPR, and a vasopressor. During cardiacarrest, consider amiodarone 300 mg IV/O push for the first dose. [ A L S Provider Manual, Part 3: High-Performance Teams > Cardiac Arrest: VF/pVT > Antiarrhythmics; page 124]

Which is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation? A. 100 mg B. 150 mg C. 250 mg D. 300 mg

D. Resume CPR, starting with chest compressions The correct answer is D. Follow each shock immediately with CPR, beginning with chest compressions. [ACLS ProviderManual, Part 1: Overview of ACLS > Systematic Approach > BLS Assessment; page 181

Which is the recommended next step after a defibrillation attempt? A. Check the ECG for evidence of a rhythm B. Open the patient's airway C. Determine fi a carotid pulse is present D. Resume CPR, starting with chest compressions

C. 162 to 325 mg The correct answer is C. If the patient has not taken aspirin and has no history of true aspirin allergy and no evidence of recent gastrointestinal bleeding, give the patient aspirin (162 to 325 mg) to chew. In the initial hours of an acutecoronary syndrome, aspirin is absorbed better when chewed than when swallowed. [ALS Provider Manual,Part 2: Preventing Arrest >Acute Coronary Syndromes >EMS Assessment,Care, and Hospital Preparation > Administering Oxygen and Drugs > Aspirin (Acetylsalicylic Acid); page 35]

Which is the recommended oral dose of aspirin for a patient with a suspected acute coronary syndrome? A.40 mg B. 81mg C. 162 to 325 mg D. 350to650mg

C. Agonal gasps The correct answer is C. Agonal gasps are not normal breathing.They are a sign of cardiac arrest. Agonal gasps may be present ni the first minutes after sudden cardiac arrest. [ACLS Provider Manual, Part 3: High- Performance Teams > Cardiac Arrest: VF/pVT > Applying the Adult Cardiac Arrest Algorithm: VF/pVT Pathway > Caution: AgonalGasps; page 118]

Which of the following signs is a likely indicator of cardiac arrest in an unresponsive patient? A. Slow, weak pulse rate B. Cyanosis C. Agonal gasps D. Irregular, weak pulse rate

D. Noncontrast CT scan of the head The correct answer is D. A critical decision point in the assessmentof the patient with acute stroke is the performance and interpretation of a noncontrast CT scan to differentiate ischemic from hemorrhagic stroke. The CT scan should be completed within 20 minutes of the patient's arrival in the emergency department and should be read within 45 minutes from emergency department arrival. [ALS Provider Manual, Part 2: Preventing Arrest > Acute Stroke > Immediate Generaland Neurologic Assessment > Decision Point: Hemorrhage or No Hemorrhage; page 57]

Which of these tests should be performed for a patient with suspected stroke as soon as possible but no more than 20 minutes after hospital arrival? A . 12-Lead ECG B. Cardiac enzymes C. Coagulation studies D. Noncontrast CT scan of the head

B. Second-degree atrioventricular block type I The correct answer is B. This ECG rhythmstrip shows second-degree atrioventricular block type .I [ACLS ProviderManual, Part 2: Preventing Arrest> Bradycardia > Rhythms for Bradycardia; pages 66-67]

Which type of atrioventricular block best describes this rhythm? A. Third-degree atrioventricular block B. Second-degree atrioventricular block type I C.First-degree atrioventricular block D. Second-degree atrioventricular block type Il

С. Second-degree type Il The correct answer is C. This ECG rhythm strip shows second-degree type Il atrioventricular block. [ A L S Provider Manual, Part :2 Preventing Arrest > Bradycardia> Rhythms for Bradycardia; pages 66-67]

Which type of atrioventricular block best describes this rhythm? A. First-degree B. Second-degree type I С. Second-degree type Il D. Third-degree

B. Give fibrinolytic therapy as soon as possibleand consider endovascular therapy The correct answer is B. Administer fibrinolytic therapy within 3 hours from onset of symptoms, or within 4.5 hours in selected patients. Consider endovascular therapy, which can be administered up to 24 hours from onset of symptoms for patients with large vessel occlusion. [ACLS Provider Manual, Part 2: Preventing Arrest > Acute Stroke > Approach to Stroke Care > Critical Time Periods; page 47]

You are caring for a patient with a suspected stroke whose symptoms started 2hours ago. The CTscan 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? A. Hold fibrinolytic therapy for 24 hours B. Give fibrinolytic therapy as soon as possible and consider endovascular therapy C. Order an echocardiogram before fibrinolytic administration D. Wait for the results of the MRI

C. Obtaining a 12-lead ECG The correct answer is C. The 12-lead ECG is at the center of the decision pathway ni the management of ischemic chest discomfort and is the only means of identifying STEMI. [ACLS Provider Manual, Part 2: Preventing Arrest > Acute Coronary Syndromes > EMS Assessment, Care, and Hospital Preparation > Obtaining a 12-Lead ECG; page 37]

You are evaluatinga 58-year-old man with chest discomfort. His blood pressure is 92/50 m Hg, his heart rate is 92/min, his nonlabored respiratory rate is 14 breaths per minute, and his pulse oximetry reading is 97%. Which assessment step is most important now? A. Evaluating the PETCO2 reading B. Requesting a chest x-ray C. Obtaining a 12-lead ECG D. Requesting laboratory testing

C. 100 to 120/min The correctanswer is C. When performing chest compressions, you should compress at a rate of 10 ot 120/min. [ACLS Provider Manual, Part 1: Overview of ACLS > Systematic Approach > BLS Assessment > Critical Concepts: High-Quality CPR; page 17]

You are performing chest compressions during an adult resuscitation attempt. Which rate should you use to perform the compressions? A. Less than 80/min B. 80 to 90/min C. 100 to 120/min D. More than 120/min

C. Give epinephrine 1mg VI The correct answeris C. Give epinephrine as soon as IV/O access become available. A dose of 1 mg IV/10 should be given and repeated every 3 to 5 minutes. [ALS Provider Manual, Part 3: High-Performance Teams > Cardiac Arrest: PEA and Asystole > Managing Asystole/PEA: The Adult Cardiac Arrest Algorithm >The Asystole/PEA Pathway of the Cardiac Arrest Algorithm > Managing Asystole/PEA > Critical Concepts: Administer Epinephrine; page 133]

You have completed 2 minutes of CPR. The ECG monitor displays the lead I rhythm shown here, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. Which do you do next? A. Start a dopamine infusion B. Give atropine 0.5 mg C. Give epinephrine 1mg VI D. Insertan advanced airwav

C. "I'll draw up 1mg of atropine The correct answer is C. When communicating with high-performance team members, the Team Leader should use closed-loop communication. By receiving a clear response and eye contact, the Team Leader confirms that the team member heard and understood the message. [ACLS Provider Manual, Part 3: High-PerformanceTeams > Elements of Effective Team Dynamics as Part of a High Performance Team > How to Communicate > Closed- Loop Communications; page 98]

You instruct a team member to give 1mg atropine IV. Which response is an example of closed-loop communication? A. "I'll give it in a few minutes." B. "OK." C. "I'll draw up 1mg of atropine D. "Are you sure that si what you want given?"

A. Monitor the patient's PETCO2 The correct answer is A. The AHA recommends using quantitative waveform capnography ni intubated patients to monitor CPR quality, optimize chest compressions, and detect return of spontaneous circulation during chest compressions. [ A L S Provider Manual, Part 3: High-Performance Teams > Cardiac Arrest: VF/pVT > Physiologic Monitoring During CPR >End-Tidal CO2; page 126]

Your patient is in cardiac arrest and has been intubated. To assess CPR quality, which should you do? A. Monitor the patient's PETCO2 B. Obtain a 12-lead ECG C. Check the patient's pulse D. Obtain a chest x-ray

B. Check the patient's breathing and pulse The correct answeri s B. After you determine that a patient is unresponsive and activate your emergency team, a breathing check and pulse check should be performed. Ideally, these checks are done simultaneously to minimize delay ni detectionof cardiac arrest and initiation of CPR. After determining that a patient is not breathing and has no pulse, start CPR, beginning with chest compressions. [ALS Provider Manual, Part 1: Overview of ACLS > Systematic Approach >BLS Assessment > Table 2: BLS Assessment; page 18]

Your rescue team arrives tofind a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive. Which is the next step ni your assessment and management of this patient? A. Apply the AED B. Check the patient's breathing and pulse C. Openthepatient'sairway D. Check for a medical alert bracelet

A. Synchronized cardioversion The correct answer is A. Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. [ A L S Provider Manual, Part 2: Preventing Arrest > Tachycardia: Stable and Unstable >Cardioversion >Recommendations; page 821

use this scenario to answer A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds herawakeand responsive but appearing ill, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain ablood 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 seen here. Question: After your initial assessment of this patient, which intervention should be performed next? A. Synchronized cardioversion B. Administration of amiodarone 150mg MI C. Immediate defibrillation D. Endotracheal intubation

D. Perform defibrillation The correct answer is D. Pulseless ventricular tachycardia is included in the algorithm because it is treated as ventricular fibrillation. Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. Both are treated with high-energy unsynchronized shocks. The interval from collapse to defibrillation is one of the most important determinants of survival from cardiac arrest. Early defibrillation is critical for patients with sudden cardiac arrest. [ACLS Provider Manual, Part 3: High- Performance Teams > Cardiac Arrest: VF/pVT > Managing VF/Pulseless VT: T h eAdult Cardiac Arrest Algorithm > VF/pVT Path; page 116]

use this scenario to answer A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds herawakeand responsive but appearing ill, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain ablood 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 seen here. Question: If the patient became apneic and pulseless but the rhythm remained the same, which would take the highest priority? A. Administer amiodarone 300 mg B. Administer atropine 0.5 mg C. Insert an advanced airway D. Perform defibrillation

B. Adult Tachycardia With a Pulse The correct answer is B. This ECG rhythm strip shows ventricular tachycardia. The Adult Tachycardia With a Pulse Algorithm outlines the steps for assessment and management of a patient presenting with symptomatic tachycardia with pulses. [ALS Provider Manual, Part :2 Preventing Arrest > Tachycardia: Stable and Unstable >Managing Unstable Tachycardia: TheAdult Tachycardia With a Pulse Algorithm; page 79]

use this scenario to answer A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds herawakeand responsive but appearing ill, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain ablood 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 seen here. Question: On the basis of this patient's initial assessment, which ACLS algorithm should you follow? A. Acute Coronary Syndromes B. Adult Tachycardia With a Pulse C. Adult Suspected Stroke D. Adult Cardiac Arrest

C. Give oxygen The correct answer is C. In the application of the Tachycardia Algorithm to an unstable patient, identify and treat the underlying cause. Give oxygen, if indicated, and monitor oxygen saturation. [ A L S Provider Manual, Part 2: Preventing Arrest >Tachycardia: Stable and Unstable> Applying theAdult Tachycardia With a Pulse Algorithm > Identify and Treat Underlying Cause; page 80]

use this scenario to answer A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds herawakeand responsive but appearing ill, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain ablood 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 seen here. Question: The patient's pulse oximeter shows a reading of 84% on room air. Which initial action do you take? A. Perform bag-mask ventilation B. Intubate the patient C. Give oxygen D. Check thepulse oximeter probe