ACLS Practice

True (AHA ACLS provider manual pg. 117. Under the subtitle "When in Doubt." Ventricular Fibrillation whether fine or pronounced should be defibrillated.)

Fine Ventricular Fibrillation may appear as asystole. If this is unclear an initial attempt at defibrillation may be warranted. 1. True 2. False

2 (During cardiac arrest, the bolus doses can be pushed as fast as you can push syringe plunger without compromising the IV catheter. )

For the pulseless VF/VT algorithm, the proper first dose of IV Amiodarone is ________. 1. 150 mg 2. 300 mg 3. 200 mg 4. 100 mg

2 (thrombosis. )

The "T" in PEA representing Acute MI or massive pulmonary embolism stands for _______. 1. tamponade 2. thrombosis 3. thoracic 4. tension pneumothroax

false ( AHA ACLS provider manual pg. 136. "Synchronized cardioversion uses a lower energy level than attempted defibrillation. Low-energy shocks should always be delivered as synchronized shocks to avoid precipitating VF.")

(Tachycardia) (True or False) Synchronized cardioversion uses a higher energy level than used with unsynchronized cardioversion (defibrillation).

2 (> 100 BPM)

(Tachycardia) A tachyarrhythmia is defined as "any rhythm other than sinus tachycardia with a rate greater than ______." 1. 60 2. 100 3. 80 4. 150

2 (facial droop)

(Tachycardia) Symptoms that may be due to tachycardia include all the following except: 1. hypotension 2. facial droop 3. altered mental status 4. chest pain

4 (AHA ACLS Provider Manual pg. 137. Monomorphic VT with a pulse respond well to cardioversion at an initial dose of 100J. If there is no response to the first shock then increase the dose in a stepwise fashion.)

(Tachycardia) Which is the correct treatment of unstable regular monomorphic VT with a pulse? 1. treat as VF with high-energy unsynchronized shocks 2. treat with 3 stacked shocks 3. treat with medications only 4. treat with synchronized cardioversion and an initial shock of 100 J

True (AHA ACLS provider manual pg. 143. "Vagal maneuvers and adenosine are the preferred initial interventions for terminating narrow-complex tachycardias that are symptomatic and supraventricular in orgin (SVT). Vagal maneuvers alone will terminiate about 25% of SVTs. Adenosine is required for the remainder.)

(Tachycardia) (True or False) Two interventions that can be performed for a regular narrow-complex tachyarrhythmias are vagal maneuvers and adenosine administration?

true

(Tachycardia) (True or False) Unstable tachycardia exists when the heart rate is too fast for the patient's clinical condition and the excessive heart rate causes symptoms. True False

3 (VF. AHA ACLS provider manual pg. 136 "Low-energy shocks should always be delivered as synchronized shocks to avoid precipitating VF.")

(Tachycardia) Low-energy shocks are always delivered synchronized due to the fact that low energy shocks have the potential to produce which rhythm if delivered unsynchronized? 1. VT 2. Asystole 3. VF 4. Atrial flutter

FALSE ( AHA ACLS provider manual pg. 137. Unstable polymorphic tachycardia is treated with an unsynchronized shock. If a patient has polymorphic VT and is unstable, treat the rhythm as VF and deliver high-energy unsynchronized shocks (ie, defibrillation doses). Although synchronized cardioversion is preferred for treatment of an organized ventricular rhythm, for some irregular rhythms, such as polymorphic VT, synchronization is not possible.)

(Tachycardia) Unstable Monomorphic VT and Polymorphic VT are treated with the same interventions? True False

1

(Tachycardia) Which is the correct definition of unsynchronized shock? 1. The electrical shock is delivered as soon as the operator pushes the SHOCK button to discharge the machine. The shock can fall randomly anywhere within the cardiac cycle. 2. The electrical shock is delivered with a peak of the R wave in the QRS Complex thus avoiding the delivery of a shock during cardiac repolarization (t-wave).

3 (AHA ACLS provider manual pg. 136. "Synchronized shocks are recommended for patients with unstable SVT, unstable atrial fibrillation, unstable atrial flutter, unstable regular monomorphic tachycardia with pulses. Unsynchronized shocks are recommended for a patient who is pulseless, for a patient demonstrating clinical deterioration (in prearrest) when you think a delay in converting the rhythms will result in cardiac arrest, and when you are unsure whether monomorphic or polymorphic VT is present in the unstable patient.")

(Tachycardia) Which of the following cases is unsynchronized shock NOT advised? 1. for the patient who is pulseless 2. for a patient who is unstable with polymorphic VT 3. for a patient who has unstable tachycardia with a pulse 4. for the patient who is unstable and you are unsure what type of VT exists

True (AHA ACLS provider manual pg. 96. AHA now recommends continuing chest compressions while the defibrillator is charging: "Shortening the interval between the last compression and the shock by even a few seconds can improve shock success.")

(True or False) Chest compressions should be continued while the defibrillator is charging. True False

True (Special Circumstances of Resuscitation Pulmonary Embolism: "routine fibrinolytic treatment given during CPR shows no benefit and is not recommended." also "In patients with cardiac arrest due to presumed or known pulmonary embolism, it is reasonable to administer fibrinolytics.")

(True or False) In patients with PEA/cardiac arrest and without known pulmonary embolism (PE), routine fibrinolytic treatment given during CPR shows no benefit and is not recommended.

4 (AHA ACLS provider manual pg. 98 & 99. After a rhythm check and seeing an organized rhythm, you should always perform a pulse check. Seeing an organized rhythm does not always mean that the rhythm will be a perfusing rhythm. If no pulse is felt after 5-10 seconds, you should resume CPR and treat using the PEA/asystole algorithm.)

(VF/pVT) You have given a patient the 1st shock, CPR for 5 cycles, and now they have an organized rhythm. Your next step is to ___________. 1. place the patient in rescue position 2. start the patient on an antiarrhythmic drug 3. search for possible causes of the VF/VT 4. palpate for a pulse

1 (AHA ACLS provider manual pg. 99: The primary desired effect is vasoconstriction which increases cerebral and coronary blood flow during CPR. )

(VT/pVF) Epinephrine is used during resuscitation primarily for its ability to ______________________________________. 1. increase in coronary blood flow resulting from vasoconstriction 2. increase cerebral blood flow resulting from vasodilation 3. increase oxygenation resulting from bronchoconstriction 4. increase renal blood flow resulting from vasoconstriction

1

(VT/pVF) The H's of treatable contributing factors are: 1. hypovolemia, hypoxia, hydrogen ion, hypo-/hyperkalemia, hypothermia 2. hypovolemia, hydrogen ion, hypo-/hyperkalemia, hyperglycemia, hypothermia 3. hypovolemia, hypoxia, hydrogen ion, hypo-/hypercalcemia, hypoglycemia, hypothermia 4. hemophilia, hypoxia, hydrogen ion, hypo-/hyperkalemia, hypoglycemia

2 (80, AHA ACLS provider manual pg. 92. Chest compression fraction is the proportion of time during cardiac arrest resuscitation when chest compressions are performed. CCF should be at least 60% and ideally greater than 80%. Clinical data suggests that a lower CCF correlates with decreased ROSC and survival to hospital discharge.)

(VT/pVF) The chest compression fraction (CCF) during cardiac arrest should be at least 60% and ideally ____% 1. 65 2. 80 3. 70 4. 90

1 (Give the pt a second shock. AHA ACLS provider manual pg. 94. For the patient with pulseless VT, the intervention that comes after the rhythm check is the shock (defibrillation)

(VT/pVF) You have shocked the patient, given 5 cycles of CPR and have done a rhythm check. Now, the patient remains in VT with no pulse. What should you do next: 1. give the patient a second shock 2. give the patient 1 mg epinephrine 3. continue CPR for 5 cycles 4. consider giving antiarrhythmics

false

(VT/pVF) (True or False) The drug Vasopressin can be used as a substitute for epinephrine for the first or second dose during resuscitation. True False

1 ( 150 mg IV push)

(VT/pVF) A second dose of ________IV Amiodarone can be given. 1. 150 mg 2. 300 mg 3. 200 mg 4. 100 mg

2 (AHA ACLS provider manual pg. 96 CPR should be immediately resumed after a shock. Reducing the amount of time without chest compressions is essential for improving the chances of ROSC (return of spontaneous circulation)

(VT/pVF) After the first shock for pulseless VF/VT you should: 1. give 1 mg epinephrine IV/IO 2. immediately resume CPR 3. check for a pulse 4. check for a rhythm

3. (AHA ACLS provider manual pg. 94 & 100. See Diagram for the left pathway of the pulseless arrest algorithm. After the 3rd shock you should consider giving an antiarrhythmic medication. The first line antiarrhythmic is amiodarone 300 mg IV push. Lidocaine may be given if amiodarone is not available.)

(VT/pVF) After the third shock during CPR in the pulseless VF/VT algorithm, you should __________. 1. get a different defibrillator 2. check for a pulse 3. give antiarrhythmic drugs 4. consider giving a beta-blocker

1 (AHA ACLS provider manual pg. 99 & 100. Magnesium is used in the treatment of polymorphic VT and Lidocaine is used if the primary antiarrhythmic, amiodarone, is not available.)

(VT/pVF) Drugs used in the VF/Pulseless VT Algorithm include: 1.epinephrine, amiodarone, lidocaine, and magnesium sulfate 2. epinephrine, vasopressin, atropine, and magnesium sulfate 3. epinephrine, vasopressin, amiodarone, lidocaine, magnesium sulfate 4.epinephrine, amiodarone, lidocaine, and atropine

1 (2 minutes. AHA ACLS provider manual pg. 101. One cycle consists of 30 chest compressions to 2 ventilations when no advanced airway is in place. )

(VT/pVF) Five cycles of CPR should take about ____ minutes. 1. 2 2. 3 3. 1 4. 4

1 (AHA ACLS provider manual pg. 96. After each rhythm check if the patient remains in VF or pulseless VT, a single shock should be given. Also, the shock dose should be incrementally increased if conversion is not obtained.)

(VT/pVF) For VF/pulseless VT how many shocks should initially be given? 1. 1 shock 2. 3 stacked shocks 3. none, shocks are not indicated 4. it depends whether the rhythm is VF or VT

1 (shock at the previously successful energy level)

(VT/pVF) If VF is initially terminated by a shock but recurs later in the resuscitation attempt you should: 1. shock at the previously successful energy level 2. increase energy level 20J for subsequent shocks 3. increase energy level to maximum dose that defibrillator can deliver 4. use medications to reverse VF

4 (All of the above. AHA ACLS provider manual pg. 96 & 98. All three actions should be completed prior to the shock. (See Foundational Facts on respective pages)

(VT/pVF) Prior to defibrillation which of the following should be done? 1. ensure all team members are clear 2. charge the defibrillator 3. minimize time delay between chest compressions and shock delivery 4. all of the above

3 (AHA ACLS provider manual pg. 94. A shock is always followed by 5 cycles of CPR. Also, there are no longer any stacked shocks given to treat pulseless VT/VF.)

(VT/pVF) Select the sequence that is in the correct order? 1. give 1 shock, 5 cycles CPR, check rhythm, give 1 shock, 5 cycles CPR, after 2nd shock give 40 U Vasopressin IV push 2. give 1 shock, 3 cycles CPR, check rhythm, give 1 shock, 3 cycles CPR, after 2nd shock give 1mg epinephrine IV push 3. give 1 shock, 5 cycles CPR, check rhythm, give 1 shock, 5 cycles CPR, check rhythm after 2nd shock give 1mg epinephrine IV push 4. give 1 shock, check rhythm, 5 cycles CPR, give 1 shock, check rhythm, 5 cycles CPR, after 2nd shock give 1mg epinephrine IV push

3 (120-200 J. AHA ACLS provider manual pg. 96. 120-200 J is the standard initial energy dose for the treatment of VF or pulseless VT.)

(VT/pVF) The initial energy dose delivered in Pulseless Arrest (VF/VT) with a biphasic defibrillator is typically _________: 1. 180-240 J 2. 150-220 J 3. 120-200 J 4. 90-110 J

3 ( Initial shock dose for Biphasic is 120-200 J and the initial shock dose for monophasic is 360 J. Second, and "subsequent dose of energy for the biphasic should be equivalent, and higher doses may be considered.")

(VT/pVF) The initial energy dose used during defibrillation is dependent upon ____________. 1. whether the patient has an internal pacemaker 2. whether the arrest was witness or unwitnessed 3. whether the defibrillator is monophasic or biphasic 4. none of the above

2 (AHA ACLS provider manual pg. 97. Successful conversion from VF and Pulseless VT is accomplished by the use of high-energy unsynchronized shocks. )

(VT/pVF) The primary ACLS treatment for VF and Pulseless VT is: 1. lidocaine 2. high-energy unsynchronized shocks 3. synchronized shocks 4. epinephrine

4 (All of the above. AHA ACLS provider manual pg. 101. See the diagram of the simplified adult cardiac arrest algorithm on pg. 101. Pushing Hard and fast at 100 compressions per minute with full chest recoil ensures optimal movement of blood through the circulatory system. Also, searching for contributing factors improves outcomes by treating the root causes of cardiac arrest.)

(VT/pVF) When treating pulseless VF/VT remember to __________. 1. ensure full chest recoil 2. push hard and fast (100/min) 3. search for treatable contributing factors (H and T's) 4. all of the above

3 (check rhythm →shock →epinephrine 1 mg IV/IO push)

(VT/pVF) You have given a patient the 1st shock and CPR for 5 cycles, your next step is to __________ 1. check breathing 2. give the patient epinephrine 1 mg IV 3. check rhythm 4. give a second shock

4 (non shockable, no pulse. AHA ACLS provider manual pg. 99. The PEA/Asystole or right branch of the pulseless arrest algorithm should be used for a nonshockable rhythm that has no pulse. This would include any rhythm except for VF or VT that does not have a pulse.)

(VT/pVT) If during VF/VT after a shock, the rhythm check reveals a __________ rhythm and _______, you then should proceed with the asystole/PEA pathway of the ACLS Pulseless Arrest. 1. ventricular, no pulse 2. slow, weak pulse 3. shockable, strong pulse 4. nonshockable, no pulse

3 ( AHA ACLS Provider Manual pg. 137. Rate increases have been noted when cardioversion has been attempted on sinus tachycardia.)

(tachycardia) Tachyarrhythmias respond to cardioversion. Sinus tachycardia will not respond to cardioversion. What will often occur if a shock is delivered with sinus tachycardia? 1. heart rate decreases 2. asystole 3. heart rate increases 4. ventricular fibrillation

1 (AHA ACLS Provider Manual pg. 134. Intervention with cardioversion is indicated if the patient has a persistent tachyarrhythmia that is causing serious signs and symptoms. )

(tachycardia) The decision point for performing immediate synchronized cardioversion is: 1. The patient is unstable and no other reversible causes are identified 2. The patient's heart rate is greater than 150 3. Advised by expert consultation 4. Adenosine does not convert the patient's rhythm

5 (All of the above. AHA ACLS provider manual pg. 133. All of these questions will help guide you to the appropriate intervention in the tachycardia algorithm.)

(tachycardia) Which of the following are key questions that should be addressed during the assessment and management of a patient with tachycardia? 1. Are symptoms present or absent? 2. Is the patient stable? 3. Is the QRS narrow or wide? 4. Is the rhythm regular or irregular? 5. All of the above

1 (Cardioversion. AHA ACLS provider manual pg. 134. Tachycardia (tacyarrhytmia) which is the cause of unstable signs and symptoms should be treated with cardioversion. Cardioversion depolarizes a critical mass of the heart muscle, terminates the arrhythmia, and allows normal sinus rhythm to be reestablished in the sinoatrial node of the heart, the body's natural pacemaker. )

(tachycardia) If a tachyarrhythmia is causing a patient to become unstable what is the most important intervention? 1. cardioversion 2. IV fluids 3. expert consultation 4. antiarrhythmic medications

2 (AHA ACLS Provider Manual, in the tachycardia algorithm on pg. 133 (see green box #4). Adenosine has been found to be safe and effective for treating both stable and unstable narrow complex SVT. )

(tachycardia) If the patient is unstable with a narrow-complex SVT what IV medication can be given as you prepare for immediate synchronized cardioversion? (not shown in unstable pathway but can be given) 1. amiodarone 150 mg IV 2. adenosine 6 mg rapid IV push 3. atropine 1 mg IV 4. epinephrine 1 mg IV

1 (AHA ACLS Provider Manual pg. 137. Monomorphic and polymorphic ventricular tachycardia are the most common forms of life-threatening wide-complex tachycardias likely to deteriorate into VF. If prolonged delay of treatment due to inability to differentiate between rhythms should be avoided.)

(tachycardia) If there is any doubt about whether an unstable patient has monomorphic or polymorphic VT what should you do? 1. treat with high-energy unsynchronized shocks 2. treat with 3 stacked shocks 3. treat with medications only 4. treat with synchronized cardioversion and an initial shock of 100 J

True ( AHA ACLS provider manual pg. 134 Unless there is existing impaired ventricular function, tachycardia rates less than 150 do not usually cause serious signs or symptoms because, unlike rates greater than 150, the heart can maintain coordination between the atrium and ventricles and there form maintain adequate cardiac output.)

(tachycardia) Tachycardia rates less than 150 per minute usually do not cause serious signs or symptoms. True False

true (AHA ACLS Provider Manual pg. 134. Underlying illness or heart disease can have a great affect on cardiac output and if cardiac output is already decreased symptoms induced by tachycardia may be see at lower rates.)

(tachycardia) True or False With tachycardia, if a patient is seriously ill or has significant underlying heart disease or other conditions, symptoms may be present at a lower heart rate? True False

False (Shock delivery may be slightly delayed since the shock is delivered with the peak of the R-wave in the QRS complex. )

(tachycardia) When performing synchronized electrical cardioversion on a patient, the shock will occur at the exact time that you press the "deliver shock button." True False

1 (treat as VF. AHA ACLS Provider Manual pg. 137. Since the defibrillator will not be able to SYNC with the rhythm due to its variable nature, high energy unsynchronized shocks are indicated.)

(tachycardia) Which is the correct treatment for unstable polymorphic VT? 1. treat as VF with high-energy unsynchronized shocks 2. treat with 3 stacked shocks 3. treat with medications only 4. treat with synchronized cardioversion and an initial shock of 100 J

4 (AHA ACLS provider manual Pg. 134: All the interventions listed are appropriate for initial intervention for tachycardia with a pulse except vagal maneuvers. Vagal maneuvers occur in step 7 of the tachycardia algorithm and should be considered after initial interventions in the algorithm. )

(tachycardia) Which of the following is not an appropriate *initial* intervention when addressing tachycardia with a pulse? 1. give oxygen (if hypoxemic) 2. monitor ECG, blood pressure, and oximetry 3. identify and treat reversible causes 4. attempt vagal maneuvers

4 (All of the above. Atrial flutter, atrial fibrillation, and supraventricular tachycardia are all examples of tachyarrhythmias that will often times cause symptoms that are related to the tachycardia and not extrinsic factors as previously mentioned. Note: Technically, if sinus tachycardia has a rate ≥ 100, it can be called a tachyarrhythmia. However, rather than being the cause of symptoms, the symptoms will be causing the tachycardia.)

(tachycardia) Which of the following would be considered a tachyarrhythmia if the ventricular rate is greater than 100? 1. atrial flutter 2. atrial fibrillation 3. supraventricular tachycardia 4. all of the above

true ( AHA ACLS Provider Manual pg. 134. Rates ≥ 150 are more likely caused by an arrhythmia which will then be treated within the tachycardia algorithm.)

(tachycardia) The higher the rate, the more likely symptoms are due to tachyarrhythmia and not an underlying comorbidity. True False

2 (prolonged QT. Various effects can be seen on an ECG with drug overdose, but the most common ECG change is the prolongation of the QT interval.)

A clue that PEA could be caused by drug overdose "Toxins" is: 1. narrow QRS complex 2. prolonged QT interval 3. tachycardia 4. tracheal deviation

2 (Epinephrine, AHA ACLS provider manual pg. 116. Epinephrine is now the only medications used in the asystole pathway of the pulseless arrest algorithm.)

According to the 2015-2020 guidelines, drugs used in asystole include: 1. atropine, epinephrine, vasopressin 2. epinephrine 3. epinephrine, vasopressin 4. amiodarone, lidocaine

true

Adenosine can be considered for the diagnosis and treatment of stable undifferentiated wide-complex tachycardia when the rhythm is regular and the QRS waveform is monomorphic. True False

2 (AHA ACLS provider manual pg. 116. High quality CPR is first because it is the foundation for a successful resuscitation. IV access is next because IV access is needed for the administration of resuscitation medications that can help reverse cardiac arrest. Finally, advanced airway placement can help improve the patient's respiratory status during a resuscitation. )

All of the following are important in the asystole pathway of the cardiac arrest algorithm. Which is the correct order of importance? 1. advanced airway, gain IV/IO access, high quality CPR 2. high quality CPR, gain IV/IO access, advanced airway 3. advanced airway, high quality CPR, gain IV/IO access 4. gain IV/IO access, advanced airway, high quality CPR

True ( AHA ACLS provider manual pg. 140. "In sinus tachycardia, the goal is to identify and treat the underlying systemic cause." Treatment of sinus tachycardia with cardioversion will fail and the patient will continue to deteriorate. Cardioversion is contraindicated with sinus tachycardia.)

Cardioversion is contraindicated for *SINUS* tachycardia because the increased heart rate is being caused by an external influence such as fever, blood loss, or exercise. True False

True (Pauses in chest compressions cause a decrease in coronary perfusion pressure which results in decreased oxygenation of the myocardium. This reduction in oxygenation of the myocardium decreases the chances of successful termination of the VF or Pulseless VT.)

Even a 5- to 10-second pause in chest compressions can reduce the chance that a shock will terminate VF. True False

1 (AHA ACLS provider manual pg. 116. IV/IO access is a priority over advanced airway management unless bag-mask ventilation is ineffective or the arrest is caused by hypoxia. Defibrillation is not indicated for asystole and is not used in the asystole algorithm.)

For a patient in asystole which has the higher priority? 1. IV/IO access 2. advanced airway management 3. defibrillation 4. all are of equal importance

1

Four important aspects to the Pulseless VF/VT algorithm are: 1. early defibrillation, effective CPR(hard and fast), secure the airway, establish IV/IO access 2. stacked shocks with defibrillation, minimize delay in CPR, establish IV/IO access, avoid hyperventilation 3. use only biphasic defibrillator, avoid hyperventilation, establish IV/IO access, CPR immediately after shock 4. early defibrillation, atropine after first shock, consider antiarrhythmic use, establish IV/IO access

2 (prompt treatment of hypovolemia with fluid resuscitation can quickly reverse the pulseless state)

Hypovolemia which is a common cause of PEA can be rapidly reversed by ____________. 1. increasing core temperature 2. fluid resuscitation 3. epinephrine 4. all of the above

3 (replace AED. AHA ACLS provider manual pg. 95. The AHA does not recommend continued use of an AED when a manual defibrillator is available and the providers skills are adequate for rhythm interpretation.)

If an AED is on the patient and a manual defibrillator is available you should ___________________________. 1.Use the AED because it reduces user error 2.Do not replace is the AED because replacing the AED with the manual defibrillator will interrupt chest compressions for to long 3.Replace the AED because continued use of the AED may result in unnecessary prolonged interruptions in chest compression for rhythm analysis and shock administration. 4.Replace the AED only after delivery of three shocks

4 ( Max energy dose. AHA ACLS provider manual Pg. 96. "If you do not know the effective dose range, deliver the maximal energy dose for the first and all subsequent shocks.)

If you do not know the effective biphasic dose range for the defibrillator that you are using, you should deliver a first shock and all subsequent shocks at _________. 1. 120 2. 200 3. the lowest energy dose that is available 4. the maximal energy dose that is available

1 (ten seconds. AHA ACLS provider manual pg. 116. "Interrupt CPR for 10 seconds or less while you perform rhythm check." The longer the interruption of CPR the less likely that the resuscitation will be successful. )

Interruption of chest compressions to conduct a rhythm check should not exceed ___seconds. 1. Ten 2. Five 3. Eight 4. Fifteen

3 (All of the following ECG changes can be seen in the patient with PEA caused by hyperkalemia: T waves that are taller and peaked, P waves that become smaller, Widened QRS, Sine-wave PEA (PEA rhythm has a sign-wave appearance)

PEA caused by HYPERkalemia may present with which of the following rhythm changes? 1. narrow QRS complex, smaller P-waves, and T- waves taller and peaked 2. wide QRS complex, taller P-waves, and T-waves taller and peaked 3. wide QRS complex, smaller P-waves, and T-waves taller and peaked 4. narrow QRS complex, smaller P-waves, and T-waves smaller and rounded

1 ( All of the following ECG changes can be seen with hypokalemia induced PEA: Flattened T-waves, prominent U waves, Wide QRS, prolonged QT, or wide complex tachycardia)

PEA caused by HYPOkalemia may present with which if the following symptoms? 1. flattened T-waves, prominent U waves, wide QRS, prolonged QT 2. peaked T-waves, prominent U waves, narrow QRS, prolonged QT 3. flattened T-waves, prominent U waves, narrow QRS, shortened QT 4. peaked T-waves, non-visible U waves, wide QRS, prolonged QT

3 (Elderly, Any condition that involves renal function can place a patient at a higher risk for hyperkalemia. Renal failure, diabetes, recent dialysis, dialysis fistulas, and certain medications can put patients at risk for hyperkalemia)

Patients that you might more commonly see with PEA caused by HYPERkalemia are all the following *except* which one? 1. renal failure 2. diabetes 3. elderly 4. dialysis recipient

2 (patients using diuretics. Many diuretics increase the excretion of potassium which can increase the risk of hypokalemia.)

Patients that you might more commonly see with PEA caused by HYPOkalemia are: 1. diabetic patients 2. patients using diuretics 3. patients with chest pain 4. all of the above

5-10 mcg/kg/min

Post Cardiac Arrest Dopamine dosage to treat hypotension is?

0.1-0.5 mcg/kg/min

Post Cardiac Arrest Epinephrine dosage to treat hypotension is?

0.1-0.5 mcg/kg/min

Post Cardiac Arrest Norepinephrine dosage to treat hypotension is?

4 (All of the above)

Pulmonary Thrombosis (massive pulmonary embolism) induced PEA may manifest itself with which symptoms? 1. no pulse with CPR 2. distended neck veins 3. narrow QRS complex on ECG 4. all of the above

2 (Providing adequate ventilation and administration of socium bicarbonate both can help reverse PEA related to acidosis)

Recommended treatment to reverse PEA caused by acidosis is: 1. adequate ventilation 2. sodium bicarbonate 3. normal saline bolus 4. both 1 and 2

4 (CPR & ECC Guidelines: Part 10 Special Circumstances, Hyperkalemia (11.2.1) These three medications shift potassium intracellularly and enhance potassium elimination)

Reversing HYPERkalemia is done using which of the following medications? 1. sodium bicarbonate 2. glucose and insulin 3. albuterol 4. any of the above

3 (pericardiocentesis. Cardiac tamponade is a condition in which an accumulation of fluid within the pericardium creates excessive pressure, which then prevents the heart from filling normally with blood. This can critically decrease the amount of blood that is pumped from the heart, which can be lethal. The removal of the excess fluid reverses this dangerous process.)

Reversing PEA caused by Tamponade is performed by: 1. chest tube placement 2. emergency surgery 3. pericardiocentesis 4. needle decompression

1 (Recent trauma, think about H's and T's)

Some Some clues for PEA caused by acidosis (hydrogen ion) would be all of the below except:clues for PEA caused by acidosis (hydrogen ion) would be all of the below *except:* 1. recent trauma 2. history of diabetes 3. renal failure 4. smaller-amplitude QRS complexes

3 (Major symptoms of PEA associated with tension pneumothorax include unequal breath sounds, difficulty with ventilation and neck vein distention. Most common seen during CPR will be difficulty with ventilation. This will also more commonly be associated with chest trauma.)

Tension pneumothroax which can be a cause of PEA may be recognized by all of the following symptoms *except:* 1. unequal breath sounds 2. neck vein distension 3. wide QRS complex on ECG 4. tracheal deviation

1 (epinephrine, Intravenous Push/IO: 1mg epinephrine IV is given every 3-5 minutes.)

The only drug to be used in the pulseless arrest-PEA/asystole branch is ____________. 1. epinephrine 2. adenosine 3. atropine 4. any of the above

4 (AHA ACLS provider manual pg. 115. High quality CPR is the foundation of all successful resuscitations. )

The therapy pathway for asystole/PEA is designed around ________________. 1. first considering treatable symptoms 2. early intubation and use of iv access 3. rapid defibrillation 4. periods of uninterrupted (5 cycles or 2 minutes), high quality CPR

4 (hypovolemia and hypoxia)

The two most common and easily reversible causes of PEA are: 1. trauma and hydrogen ion (acidosis) 2. trauma and hypoxia 3. hypovolemia and hypothermia 4. hypovolemia and hypoxia

2

What are 4 reasons that BLS and ACLS should be stopped or withheld? 1. CPR lasts longer than 10 minutes, DNR status, patient has MRSA, physician is tired 2. rigor mortis, DNR status, living will directives, threat to safety of rescuers 3. DNR, CPR lasting longer than 12 minutes, patient has terminal cancer, rigor mortis 4. None of the above

4 (all of the above)

What are some causes of isoelectric ECG (false asystole)? 1. loose leads or leads not connected to the patient 2. no power to the monitor 3. low signal gain on the ECG monitor 4. all of the above

3 (other causes of asystole. check loose leads, low signal gain/ amplitude)

What must be ruled out before a patient's rhythm can be classified as "true asystole"? 1. if the patient is a DNR 2. causes of PEA 3. other causes of isoelectric ECG 4. all of the above

True

When starting an IV or administering drugs during CPR, do not stop CPR. 1. True 2. False

1 (thrombosis. PEA caused by thrombosis would require that the thrombosis be dissolved. If a patient is in PEA due to a thrombosis, the prognosis is very poor)

Which cause of PEA is least likely to benefit from treatment? 1. thrombosis (pulmonary/coronary) 2. tamponade 3. tension pneumothroax 4. hypovolemia

4 (AHA ACLS provider manual pg. 115 & 116. Electrical therapy is not an option with PEA/Asystole. If reversible causes have been ruled out, asystole is normally a sign of cardiac death and is the rhythm that is used to certify legal death.)

Which of the following is a consideration for a patient in asystole? 1. underlying causes for the asystole 2. possibility of termination of CPR 3. external pacing 4. both 1 and 2

true (AHA ACLS provider manual pg. 140. In the blue box titled Foundational Facts: Understanding Sinus Tachycardia. "In sinus tachycardia, the goal is to identify and treat the underlying systemic cause." Treatment of sinus tachycardia with cardioversion will fail and the patient will continue to deteriorate.)

With sinus tachycardia, the goal is to identify and treat the underlying systemic causes. True False