ACLS 2021
Patient's HR 84 BP 124/73 SPO2 66% Cyanotic around the mouth and extremities what is the recommended rate for rescue breaths
1 breath every 6 seconds
how long should the second rescuer squeeze the bag mask device when providing 2 rescuer ventilation
1 second
What is the time goal for how quickly you should complete a fibronolytic checklist once the patient arrives in the emergency department
10 minutes
What is the lower HR limit for a patient with stach
100
What is the DBP threshold for withholding fibrinolytic to otherwise eligible patients with acute ischemic stroke
110mmHg
What is the recommended time window after symptom onset for early fibrinolytic therapy or direct catheter based reperfusion for patients with STEMI and no contraindications
12 hours
What is the upper HR limit for a patient with stach?
130/min
electrical cardioversion is not recommended as the initial therapy for patients unless the HR is above
150
Symptoms of instability are not usually caused by HR less than ______bpm unless ventricular function is impaired
150/min
What is the recommended first dose of amio for mgmt of stable wide complex tachycardia
150mg
What BG should trigger the administration of IV or subQ insulin for a patient with acute ischemic stroke
180
ID the SBP threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke
185mmHg
What is the most effective way to deliver bag mask ventilation
2 person technique
What is the recommended infusion rate for epi in management of symptomatic bradycardia unresponsive to atropine
2-10mcg/min
What is the time goal for neurologic assessment by the stroke team or designee and noncontrast computed tomography or MRI performed after hospital arrival
20 minutes
What is the maximum time from last known normal when endovascular therapy can be performed
24 hours
How much of a safety margin should you allow when using the transcutaneous pacemaker
2mA
Evidence suggests that there is a higher likelihood of good to excellent functional outcome when alteplase is given to adults with an acute ischemic stroke within what time frame
3 hours
What is the longest acceptable emergency department door-to-needle time when fibrinolysis is the intended reperfusion strategy
30 minutes
more p waves than QRS. absence of relationship between the P wave and QRS
3rd degree
What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindication after hospital arrival
45 minutes
What is the recommended infusion rate for dopamine in the management of symptomatic bradycardia unresponsive to atropine
5-20mcg/kg/min
patients with perfusing rhythms should receive ventilation once every _____ seconds
6
What is the max time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment
6 hours
How much tidal volume must you provide with a bag mask device to produce visible chest rise for an adult patient in respiratory arrest
6-7mL/kg
What tidal volume typically maintains normal oxygenation and elimination of carbon dioxide
6-8mL/kg
What is the door-to-needle time goal for 85% or more of acute ischemic stroke patients treated with IV thrombolytics
60 minutes
What is your initial impulse setting for transcutaneous pacemaker use in the management of unstable bradycardia
60-80
During CPR, CCF should be at least ______% and ideally greater than _____%
60/80
When you use a bag mask device you should deliver 500- _______mL tidal volume
600
What is the recommended initial dose of adenosine for the mgmt of SVT unresponsive to vagal maneuvers?
6mg/ 12mg follow up
What is the estimated probability of the CPSS with 1 abnormal finding when scored by prehospital providers
72%
What is the door-to-device time goal for direct arriving patients with acute ischemic stroke treated with endovascular therapy
90 minutes
What is the goal for first medical contact-to-ballon inflation time for a patient receiving PCI
90 minutes
What is a benefit of morphine when given for the management of acute coronary syndromes? A. Central nervous system analgesia B. Increases systemic vascular resistance C. Increases left ventricular preload D. Vasoconstriction
A. Central nervous system analgesia
You are preparing to provide electrical cardioversion you are monitoring the patient's EKG and have applied defib pads, sedation, and defib on. What is the next step
Activate the sync control button
With the possible diagnosis of STEMI, what is the most probable treatment
Admission for PCI/fibrinolysis
What is your interpretation of the patient's EKG tracing STEMI in V2-6
Anterior STEMI
EMS brings a 54 year old patient to the ED who had been experiencing severe SOB and difficulty breathing. The patient loses consciousness on arrival What initial actions should be taken
Assess ABC Call for help Check for responsiveness
You determine patient has poor perfusion. What is your next step
Atropine 1mg
First line of treatment for unstable bradycardia
Atropine 1mg every 3-5 min for max dose of 3mg
You obtain a 12-lead ECG in a patient with restrosternal chest pain. Which ECG finding is suggestive of high risk non ST segment elevation acute coronary syndromes A. ST depressions less than 0.5mm B. Dynamic T-wave inversion C. ST-segment elevation D. New bundle branch block
B. Dynamic T-wave inversion
What is the first line treatment for unstable tachycardia
Cardioversion
Which S/S indicate symptomatic bradycardia
Chest pain SOB Altered MS Pulmonary edema Hypotension
What validated, abbreviated out of hospital neurologic evaluation tool contains 3 components: facial droop, arm drift, and abormal speech test
Cincinnati Prehospital Stroke scale
Select the first step in the use of an oropharyngeal airway
Clear the mouth and pharynx
75yo male present to the ED. He fainted 45 min ago HR 30 BP 66/43 RR 20 O2 89% Alert and responsive What should your next steps be to assess and treat this patient
Establish IV Obtain 12 lead Maintain airway and administer O2 as needed
A 74 yo man was brought to the hospital by his wife. She states that her husband started having sudden left arm weakness and left sided paralysis during lunch. He has a past medical history or poorly controlled hypertension HR 92 RR 14 BP 130/86 SPO2 97% Afib on monitor What additional assessment and stabilization activities should be completed?
Establish time of symptom onset (last known normal) perform validated prehospital stroke screen and stroke severity tool provide prehospital notification to the receiving hospital initiate stroke protocol check glucose
After you give report to the hospital, staff advise you to proceed to the cath lab for PCI What is the goal for PCI when treating this patient
First medical contact to balloon inflation time of 90 minutes
Which action is part of the secondary assessment of a conscious patient
Formulate a differential diagnosis
What is a complication of IV atropine when administered in doses of less than 0.5mg
Further slowing of HR
Definition of bradycardia
HR <50
You are treating a patient with a HR 186/min. Which symptom if present suggests an unstable tachycardia
Hypotension
Patient does not respond to atropine HR 34 BP 66/43 RR 18 O2 91% Responsive, but dizzy. What option do you have
Initiate transcutaneous pacing administer epi 2-10mcg/min adminster dopa 5-20 mvg/kg/min
What is the most common type of stroke
Ischemic stroke
What is the primary advantage of using a stroke severity tool?
It helps ID large vessel occlusion stroke
Which is a stroke severity tool that helps EMS differentiate large vessel occlusion stroke from non-large vessel occlusion stroke
Los Angeles Motor Scale
What is the most serious potential complication of nasopharyngeal aiway insertion into a patient with facial trauma
Misplacement into the cranial cavity
The width of the QRS in a patient presenting with tachycardia is .10 second. There are no clearly discernable P waves How would you classify this tachycardia
Narrow complex tachycardia
Your patient continues to say that he has chest discomfort What treatment can you repeat as long as it is not contraindicated by vital signs
Nitroglycerin sublingual every 3-5min
You find that the patient's neurologic function is rapidly improving. Is this patient still a candidate for fibrinolytic therapy?
No
What is the recommended ventilation rate for an adult in cardiac arrest with an advanced airway device in place
Once every 6 seconds
the patient is unresponsive and not breathing but has a strong pulse What should your initial actions include
Open the patient's airway via a head tilt chin lift or jaw thrust Initiate ventilation with a bag mask device attached to supplemental oxygen
Which class of medications commonly given to patients with acute coronary syndromes may be adversely affected by morphine administration A. Phosphodiesterase inhibitors B. Oral antiplatelet medications C. Beta blockers D. Calcium channel blockers
Oral antiplatelet medications
Which is a contraindication to the use of procainamide infusion in the mgmt of stable wide complex tachycardia
Prolonged QT interval
a 49 yo says that he has had chest discomfort and excessive sweating for the past 25 minutes. Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of MI, what will your first actions include?
Provide prehospital notification to the receiving hospital Administer aspirin if considering prehospital fibrinolysis, use the fibrinolytic checklist assess ABC Obtain EKG consider oxygen, nitroglycerin, and morphine if needed
What is a potential complication of inserting an oropharyngeal airway
Pushing the base of the tongue back
What is the most reliable method of confirming and monitoring correct placement of an ET tube
Quantitative waveform capnography
What is the single most reliable method of confirming and monitoring correct placement of the ET tube
Quantitative waveform capnography
What actions should the hospital staff take to determine whether the patient is a candidate for fibrinolytic therapy
Repeat neurologic exam
a 59yo is reporting difficulty breathing nasal flaring, intercostal retractions, and use of accessory muscles RR 28 O2 92% PETCO2 36mmHg
Respiratory distress
an 18yo is reporting difficulty breathing and is displaying increased respiratory effort b/l wheeze RR 28 O2 91% PETCO2 44mmHg
Respiratory distress
75yo patient difficulty breathing emphysema drowsy b/l wheeze, difficult to appreciate RR 38 O2 85% PETCO2 49mmHg
Respiratory failure
PR intervals uniform but random QRS dropped
Second degree type II
Patient does not respond to treatments HR 40 BP 66/43 RR 18 O2 91%
Seek expert consultation prepare for TV pacing
Which action is not part of the acute stroke pathway
Seizure prophylaxis
His initial vital signs are HR 120/min BP 135/88 RR 23 O2 87% When considering oxygen saturation, what is your course of actions?
Start oxygen at 4L
Because the patient is no longer a candidate for fibrinolyic therapy, what are your next steps for him?
Support ABC Begin stroke pathway Admit to ICU
What is an advantage of EMS alerting the receiving facility of the impending arrival of a patient with suspected acute ischemic stroke
The hospital can perform more efficient evaluation and management
What happens when teams rapidly assess and intervene when patients have abnormal vital signs
The number of in hospital cardiac arrests decreases
What therapy is recommended alternative to vasopressor infusion in the management of unstable bradycardia unresponsive to atropine
Transcutaneous pacing
What is the recommended initial therapy for a patient with stable narrow complex tachycardia, after establishing an IV and acquiring a 12 lead EKG
Vagal maneuvers
What additional questions help you determine next steps
When did the symptoms start Do you take any medication Do you have any allergies
What is the recommended time window after symptom onset for early fibronolytic therapy or direct catheter-based reperfusion for patients with STEMI and no contraindication
Within 12 hours
within 45 minutes, the neuroimaging interpretation of the CT scan of the brain suggests an acute ischemic infarction. There is no signs of hemorrhage or mass lesions Is this patient a potential candidate for fibrinolytic therapy?
Yes
Upon reviewing a patient's 12 lead ECG, you note ST-segment elevation of 2mm in leads II,III, and aVF How would you classify the electrocardiographic findings A. Normal B. STEMI C. Non-STEMI D. Non-diagnostic
b. STEMI
The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patient's nose to the
earlobe
What is a potential complication using a nasopharyngeal airway that is too long
entering the esophagus
What is the term for the rise in arterial carbon dioxide levels typically associated with respiratory failure
hypercapnia
When performing the jaw thrust maneuver on patients with suspected cervical spine injury where should you place your fingers
just under the angle of the lower jaw
What needs to be completed for this patient within 20 min after hospital arrival
neurologic assessment
What device on a resuscitation bag mask device may prevent sufficient tidal volume in patients with poor lung compliance
pressure relief valve
if a patient is conscious, establish IV access prior to synchronized cardioversion and administer
sedation
What is the max length of suction catheter that should be inserted into the patient's oropharynx beyond the tongue
tip of nose to earlobe
in which of the following patients can nasopharangeal airways be used
unconscious, semi, conscious
What procedure used in the management of stable narrow complex tachycardia forces a patient to strain against a closed glottis?
valsalva maneuver
what are some of the general questions you need to ask
when did the symptoms start do you have any allergies do you take any medications what other symptoms do you have
The width of the QRS in a patient presenting with tachycardia is .16 seconds. Each QRS complex has a visible p wave. how would you classify this tachycardia
wide complex tachycardia
