ACLS practice questions (Edited) 2021-05-12
What is your initial impulse setting for transcutaneous pacemaker use in the management of unstable bradycardia?
60-80/min
demand rat efor transcut pacer?
60-80/min
When you use a bag-mask device, you should deliver approximately 500 to ___ mL tidal volume
600
what is the MAP target when administering epi to pts in cardiac arrest who achieve ROSC and need vasopressor support?
65 mm Hg
Which are examples of mutual respect? Select all that apply: Acknowledging correctly completed task in a positive way Requesting a clear response and eye contact from the team member Giving drugs only after verbally confirming the order Ensuring that only 1 person talks at a time
Acknowledging correctly completed tasks in a positive way Ensuring that only one person talks at a time
What is the first link in the out-of-hospital cardiac arrest (OHCA) chain of survival? Activation of emergency response Defibrillation Advanced resuscitation High-quality CPR
Activation of emergency reponse
Vagal is unsuccessful. Now what?
Adenosine 6 mg IV (follow w/ saline flush)
Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of myocardial ischemia, what will your first actions include? Select all that apply Administer epinephrine 1 mg IV Administer a blood thinner Administer aspirin Assess airway, breathing, and circulation (ABCs) If considering prehospital fibrinolysis, use fibrinolytic checklist Provide prehospital notification to the receiving hospital Consider oxygen, nitroglycerin, and morphine if needed Obtain a 12 lead ECG
Administer aspirin Assess ABCs If considering prehospital fibrinolysis, perform fibrinolytic checklist Provide prehospital notification to the reveiving hospital Consider 02, nitro and morphine Obtain a 12 lead ECG
Is the patient stable?
Yes
after applying pads and turning defibrillator on, what do you do?
activate sync control button
When should you occlude the side opening of a suction catheter when performing oropharyngeal suctioning?
While withdrawing the catheter
What is the recommended window after symptoms onset for early fibrinolytic therapy or direct catheter based reperfusion for patients ST segment elevation myocardial infarction and no contraindications? Within 18 hours Within 12 hours Within 24 hours Within 48 hours
Within 12 hours
What do fibrinolytic meds end in?
"ase"
What are the contraindications of nitroglycerin?
-If patient has a confirmed inferior wall stemi or right ventricular infarction -avoid nitro if patient has hypotension, bradycardia, or tachycardia -if patient recently has taken sildenafil, vardenafil, or tadalafil in the past 24-48 hrs
norepinephrine dose for hypotensive pts during post-cardiac arrest phase?
0.1 to 0.5 mcg/kg per minute
after ET tube, what ratio?
1 breath/6 sec
What is the recommended first dose of IV atropine for the management of bradycardia?
1 mg IV
You determine pt has poor perfusion. What is your next step?
1 mg IV atropine
Dose for epi during resuscitation?
1 mg IV q 3-5min
What is the recommended first IV/IO dose of lidocaine for patients in cardiac arrest with VF/pVT that is unresponsive to defibrillation
1 to 1.5 mg/kg
what's the order?
1) shock 2) CPPR 3) 1 mg IV epi 4) consider advanced airway
Recommended fluid bolus dose for pts who are hypotensive during post-cardiac arrest phase?
1-2 L
What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department? 30 min 10 min 20 min 15 min
10 min
What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department?
10 minutes
how quickly should you complete a fibrinolytic checklist once pt gets to the ED?
10 minutes
What is the maximum amount of time you should simultaneously perform pulse and breathing checks? 10 seconds 5 seconds 20 seconds 15 seconds
10 seconds
What is the lower heart rate limit for a patient with sinus tachycardia?
100
Identify the diastolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke. 110 105 115 100
110
Obtaining a what is the most important assessment tool for a patient displaying signs and symptoms of acute coronary syndrome?
12 lead ekg
What is the recommended follow-up dose of adenosine for the management of supraventricular tachycardia unresponsive to the first adenosine dose?
12 mg IV
What is the upper heart rate limit for a patient with sinus tachycardia? 200/min 130 180 150
130
What is the time for neurological assessment by the stroke team or designee and noncontrast computed tomography or magnetic resonance imaging performed after the hospital arrival? 20 min 25 min 15 min 10 min
20 min
Cardioversion is not recommended as initial therapy unless HR is above....
150 BPM
What is the recommended first dose of amiodarone for the management of stable wide complex tachycardia?
150 mg IV
Symptoms of instability are not usually caused by heart rates less than _____ unless ventricular function is impaired
150/min
What blood glucose level should trigger administration of IV or subq insulin for a patient with acute ischemic stroke? 170 160 150 180
180
Identify the systolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke. 185 180 177 190
185
How long should the second rescuer squeeze the bag mask device when providing 2-rescuer ventilation? 1 sec 3 sec 4 sec 2 sec
1sec
How much of a safety margin (energy above the dose at which consistent capture is observed) should you allow when using the transcutaneous pacemaker?
2 mA
starting IV infusion dose of epi for pts in cardiac arrest who achieve ROSC and need vasopressor support?
2-10 mcg per min
maximum time from last known normal when endovascular therapy can be performed?
24 hours
What is the maximum time for last known normal when endovascular therapy can be performed? 3hrs 12hrs 6hrs 24hrs
24hrs
rhythm?
2nd degree type II
Evidence suggest 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? 12 hours 3 hours 24 hours 6 hours
3 hrs
What is the longest acceptable emergency door to needle time when fibrinolysis is the indented reperfusion strategy? 15 min 30 min 45 min 60 min
30 min
Recommended first IV/IO dose of amiodarone for patients in cardiac arrest with VF/pVT that is unresponsive to defibrillation?
300 mg
what target temperature range?
32C to 36C
When adjusting ventilation rates, which PETCO2 value lies within the recommended range for a patient who achieves return of spontaneous circulation?
40 mm Hg
What is the time goal for initiation of fibrinolytic therapy for patients w/o contraindications after hospital arrival
45 min
What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindications after hospital arrival? 30 min 45 min 35 min 40 min
45 min
how quickly should resuscitation Team Leaders consider perimortem c-section after beginning resuscitation efforts if ROSC has not been achieved?
5 minutes
What is the recommended infusion rate for dopamine in the management of symptomatic bradycardia unresponsive to atropine?
5 to 20 mcg/kg per minute
Patients with perfusing rhythms should receive ventilations once every __ seconds
6
What is the recommended initial dose of adenosine for the management of supraventricular tachycardia unresponsive to vagal maneuvers?
6 mg IV
How much tidal volume must you provide with a bag-mask device to produce visible chest rise for an adult patient in respiratory arrest?
6-7 mL/kg
What tidal volume typically maintains normal oxygenation and elimination of carbon dioxide? 12-14 ml/kg 6-8 ml/kg 9-11 ml/kg 3-5 ml/kg
6-8
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 the maximum time from last known normal when intra arterial thrombolysis for select patients can be used for treatment? 12hrs 3hrs 6hrs 4hrs
6hrs
How quickly does the chance of survival decline for every minute of defibrillation delay in patients with ventricular fibrillation who do receive bystander CPR? 3-4% 5-6% 11-13% 7-10%
7-10%
how long to wait for neurologic prognosis of pt?
72 hours
What is the estimated probability of the Cincinnati prehospital stroke scale with 1 abnormal finding when scored by prehospital providers? 72% 88% 80% 50%
72%
What is the door-to device time for direct-arriving patients with acute ischemic stroke treated with endovascular therapy?
90 min
What is the goal for first medical contact-to-balloon inflation time for a patient receiving percutaneous coronary intervention? 120 min 45 min 30 min 90 min
90 min
Oxygen should be delivered to a patient who has obvious signs of heart failure if the oxygen saturation is less than?
90%
when titrating inspired oxygen, which arterial oxyhemoglobin saturation value lies w/in the recommended range for a pt who achieves ROSC?
95%
If someone starts developing hypotension after giving morphine or nitroglycerin?
Administer fluids
The initial assessment reveals a conscious patient. The patients airway is patent and an advanced airway is not indicated. Which action in the primary assessment should you perform next? Remove clothing to perform a physical examination Check for neuro function Administer oxygen as needed Check for the presence of a pulse
Administer oxygen as needed
How do you calculate Coronary Perfusion Pressure (CPP)?
Aortic diastolic pressure "minus" Right Atrial Diastolic Pressure
Which is an example of knowledge sharing by a team leader? Changing a treatment strategy when supported by new information Maintaining an ongoing record of treatments Asking for suggestions about interventions Asking the compressor to decrease or increase rate
Asking for suggestions about interventions
What initial actions should be taken?
Assess airway, breathing, and circulation (ABCs) Check for responsiveness Call for additional help
When is recommended to administer the first dose of epinephrine for a patient in a shockable rhythm?
B/w the second and third shocks
Because this patient is no longer a candidate for fibrinolytic therapy, what are your next steps for him?
Begin the stroke pathway Support ABCs Admit pt to ICU
What is the main determinant of end-tidal carbon dioxide (ETCO2) measurement during CPR?
Blood delivery to the lungs
Pt w/ VAD is not breathing, has inadequate perfusion, and is unconscious. VAD is working properly. Wyd?
CPR
What is the first line treatment for unstable tachycardia? Lidocaine Cardioversion Amiodarone Adenosine
Cardioversion
What is the benefit of morphine when given for management of acute coronary syndrome? Increases left ventricular preload Vasoconstriction Central nervous system preload Increases systemic vascular resistance
Central nervous system analgesic
What invasive CPR performance measure reflects changes in cardiac output due to chest compressions, if oxygen consumption, arterial oxygen saturation, and hemoglobin remain constant?
Central venous oxygen saturation
What is the most appropriate destination for patients with suspected acute ischemic stroke? Certified stroke center Trauma center Hospital catheterization lab Closest emergency department
Certified stroke center
What is the highest level of stroke center certification? Comprehensive stroke center Thrombectomy-capable stroke center Primary stroke center Acute stroke ready hospital
Comprehensive stroke center
What are the components of high quality CPR? Select all that apply: Synchronous ventilation with chest compressions Avoiding excessive ventilation Compression rate around 10/min Complete chest recoil after each compression Interruptions limited to less than or equal to 10 seconds Low coronary perfusion pressure Switching compressors every 2 minutes Compression depth of at least 2 inches (5cm)
Compression depth of at least 2 inches (5cm) Switching compressors every 2 minutes Avoiding excessive ventilation Complete chest recoil after each compression Interruption limited to under 10 seconds
Which clinical findings represents a contraindication to the administration of nitroglycerin? Anterior wall infarction Posterior wall infarction Lateral wall infarction Confirmed right ventricular infarction
Confirmed right ventricular infarction
Which is a step of closed-loop communication? Confirming task completion before assigning another task Encouraging all team members to speak clearly Abandoning ego Using distinctive speech and a controlled voice
Confirming task completion before assigning another task
What is a contraindication of the use of an oropharyngeal airway? Bag mask ventilation Conscious patient Pediatric patient Absent gag reflex
Conscious patient
How do interruptions in chest compressions negatively impact survival after cardiac arrest? Increase intracranial pressure Decrease coronary perfusion pressure Reduce right ventricular period Increase intrathoracic pressure
Decrease coronary perfusion pressure
In addition to decreased IHCA, what are some other benefits of implementing a rapid response system? Select all that apply Decreased ICU length of stay Decreased emergency department admissions Increased ICU admissions Increased Hospital Length of Stay Decreased in total hospital length of stay
Decreased ICU length of stay Decrease in total hospital length of stay
While performing the BLS Assessment, you initiate high- quality CPR and assist ventilation with a bag mask device. The AED does not recommend a shock. Which action in the Primary assessment should you perform first? Determine if the patients airway is patent Asses the patients oxygen status Perform fluid resuscitation Attach a quantitative waveform capnography device
Determine is the patients airway is patent
How do you calculate the chest compression fraction (CCF)? What is ideal percentage?
Divide actual chest compression time by total code time. You want this at least 60% but ideally greater than 80%
Which is the main advantage of effective teamwork? Early defibrillation Division of tasks Mastery or resuscitation skills Immediate CPR
Division of tasks
Does not respond to atropine. Responsive but dizzy. What options do you have to treat the patient?
Dopamine 5-20mcg/kg per minute infusion Transcutaneous pacing Epi 2-10mcg per min infusion
You obtain a 12-lead ECG in a patient with retrosternal chest pain. Which ECG finding is suggestive of high risk non-ST-segment elevation acute coronary syndrome? ST-depression less than 0.5mm New left Bundle branch block ST-segment elevation Dynamic T-wave inversion
Dynamic t wave inversion????
75-year-old man fainted at home about 45 minutes ago.... What should your next steps be to assess and treat this patient?
ECG Airway and O2 if needed IV access
72-year-old male suffering from progressive dizziness and bouts of palpitations... What are the most appropriate initial interventions?
ECG patent airway and monitor
only CPR performance monitor outside of the hospital?
ETCO2
What is the only intervention that can restore an organized rhythm in patients with ventricular fibrillation (VF)?
Early and effective defibrillation
What is the only intervention that can restore an organized rhythm in patients with ventricular fibrillation (VF)? High-quality CPR Epinephrine administration Early and effective defibrillation Advanced airway insertion
Early and effective defibrillation
what now?
Epi 1 mg IV
Which of the following patients can NPAs be used in? Unconscious Patient with nasal trauma Conscious Semiconscious
Everything but nasal trauma
What are the 3 components of the Cincinnati Prehospital stroke scale?
Facial droop Arm drift Abnormal speech
Which demographic group experiencing acute coronary syndromes is more likely to present without chest pain? Smokers Patients taking B-blockers Females Adolescents
Females
Which action is part of the secondary assessment of a conscious patient? Attach a monitor/defibrillator Formulate a different diagnosis Determines patients LOC Give IV/IO fluids if needed
Formulate a different diagnosis
Which action is part of secondary assessment of a conscious patient? Give IV/IO fluids if needed Formulate a differential diagnosis Determine the patients level of consciousness Attach a monitor defibrillator
Formulate a differential diagnosis
Which action is part of the secondary assessment of a conscious patient? Determine the patients LOC Formulate a differential diagnosis Give IV/IO fluids if needed Attach a monitor/defibrillator
Formulate a differential diagnosis
What is a complication of IV atropine when administered in doses of less than 0.5 mg?
Further slowing of heart rate
If a patient with stable ventricular tachycardia does not response to vagal maneuvers, what drug and dose regimen is to be given?
Give Adenosine 6mg over 1 second followed by a flush in a large vein and elevate arm quickly after If they don't response in 1-2 minutes, Administer 12 mg IV followed by a flush and elevate arm quickly
What is the first line treatment for bradycardia?
Give atropine 1mg IV may repeat for a total does of 3mg IV If this is ineffective provide transcutaneous pacing and/or dopamine 5 to 20 mcg/kg per minute or epinephrine 2 to 10 mcg/min
What type of stroke occurs when a blood vessel in the brain suddenly ruptures into the surrounding tissue? Hemorrhagic stroke Transient ischemic attack Cryptogenic stroke Ischemic stroke
Hemorrhagic stroke
You are treating a patient with a heart rate of 186/min. Which symptom (if present) suggest unstable tachycardia? SOB Weakness Hypotension Fatigue
Hypotension
Which of the following are the "H's" causes of reversible cardiac arrest? Select all that apply: Hyperkalemia/hypokalemia Hypertensive crisis Acidosis HELLP syndrome Hyperventilation Hypoxia Hypothermia Heydes syndrome Hypocalcemia Hypovolemia
Hypothermia Hypoxia Hyperkalemia/hypokalemia Hypovolemia H+ ions (Acidosis) Hypocalcemia Hyperventilation Hypertensive crisis
post-cardiac arrest pt after reperfusion + initiation of targeted temp mgmt?
ICU
initial steps of primary assessment?
IV access VS ECG ABCs
what now?
IV/IO access
When should oxygen be administered?
If the patient is dyspneic or hypoxemic, has obvious signs of heart failure, or has an arterial o2 saturation that is less than 90% or unknown.
When is morphine indicated?
In STEMI patients with severe chest discomfort that does not respond to nitrates
What is the primary purpose of the CPR coach on a resuscitation team? Recording CPR data Resolving team conflicts Increasing CPR quality Giving encouragement
Increasing CPR quality
Which is an example of summarizing and reevaluating? "1mg of epinephrine given" Questioning a colleague who is about to make a mistake "Compressions are at a good rate" Increasing monitoring if the patients condition deteriorates
Increasing monitoring if the patient's condition deteriorates
What is the first step in the systematic approach to patient assessment? BLS assessment Initial impression Primary assessment Secondary assessment
Initial impression
What is the most common type of stroke?
Ischemic stroke
What is the primary advantage of using a stroke severity tool? It helps identify large vessel occlusion stroke It helps determine the last known normal time It helps identify level of weakness It helps EMS providers identify signs of a stroke
It helps identify large vessel occlusion stroke
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 Behind the patients ears Under the patients chin On top of the patients jaw
Just under the angle of the lower jaw
After activating the sync control button in preparation for delivering electrical cardioversion, what is the most important next step?
Look for markers on the R wave indicating sync mode
What is a stroke severity tool that helps EMS differentiate a large vessel occlusion stroke from a non-large vessel occlusion stroke? Miami emergency neurologic deficit score Cincinnati prehospital stroke scale Melbourne ambulance stroke screen Los Angeles Motor Scale
Los Angela's motor scale
What is the most serious potential complication of nasopharyngeal airway insertion into a patient with facial trauma
Misplacement into the cranial cavity
Which is the best example of a role of the team leader? Proficient at endotracheal intubation Does not over ventilate the patient Performs within scope of practice Models excellent team behavior
Models excellent team behavior
What should you always monitor after giving morphine?
Monitor BP and respiratory rate
Which high performance team member is part of the resuscitation triangle? Timer/recorder Monitor/defibrillator/Cpr coach IV/IO/medications Team leader
Monitor/defibrillator/cpr coach
What needs to be completed for this patient within 20 minutes after hospital arrival?
Neurological assessment
The patient is unresponsive and note 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 syndrome may be adversely affected by morphine administration? B-blockers Calcium channel blockers Phosphodiasterase inhibitors Oral anti platelet meds
Oral anti platelet meds
what is it now?
PEA
highest priority per adult post-cardiac arrest care algorithm?
PaCO2 b/w 35-45 SpO2 92-98 10 breaths/min
HR 92, RR 14, BP 130/86, O2 97, afib What additional assessment and stabilization activities should be completed?
Perform validated prehospital stroke screen and stroke severity tool Initiate stroke protocol Provide prehospital notification to the receiving hospital Establish time of symptom onset (last known normal) Check glucose
The pat doesn't respond to treatments. What should you consider?
Prepare for transvenous pacing Seek expert consultation
Which is the best example of a role of a team member? Monitors individual team members Helps train future team leaders Focuses on comprehensive patient care Prepared to fulfill their role responsibilities
Prepared to fulfill their role responsibilities
What device on a resuscitation bag-mask device may prevent sufficient tidal volume in patients with poor lung compliance?
Pressure-relief valve
What role does ECPR fill in the management of cardiac arrest?
Provides vital organ support while treating reversible causes Serves as a bridge for LVAD implantation
What is the potential complication of inserting an oropharyngeal airway that is too small?
Pushing the base of the tongue back
Which component of effective high-performance teams is represented by the use of real-time feedback devices? Quality Administration Timing Coordination
Quality
Most reliable method of confirming and monitoring correct placement of an endotracheal tube?
Quantitative waveform capnography
Which is a contraindication to the administration of aspirin for the management of a patient with acute coronary syndromes? Shortness of breath Recent GI bleeding Nausea Vomitting
Recent GI bleeding
What is a physiological effect of nitroglycerin? Bronchodilation Reduces preload Binds to opioid receptors Platelet aggregation inhibition
Reduces preload
What is the advantage of a systematic approach to patient assessment? Reduces the need for secondary assessment Reduces the chance of missing important signs and symptoms Permits assessment modification based on patient symptoms Standardizes treatment across systems of care
Reduces the chances of missing important signs and symptoms
What actions should the hospital staff take to determine whether the patient is a candidate for fibrinolytic therapy?
Repeat the neurologic exam
Which is an advantage of EMS transport to a stroke hospital for a patient with a suspected acute ischemic stroke? Family members can ride to the hospital with the patient Responding providers can stabilize critical issues Patients transported by ambulance are seen first EMS transport is faster than being driven by a friend
Responding providers can stabilize critical issues
What is the most common symptom of myocardial ischemia and infarction?
Retrosternal chest pain
which s/s indicate symptomatic bradycardia?
SOB htn AMS
Upon reviewing a patients 12 lead ECG, you note ST elevation of 2mm in leads II, III, and aVF. How would you classify these ECG findings? Non-st segment elevation MI ST-segment elevation myocardial infarction Normal findings
ST segment elevation MI
Upon reviewing a patients 12 lead ECG, you note ST segment elevation of 2mm in leads 2, 3, and aVF. How would you classify the ECG finding?
ST-segment elevation myocardial infarction
Upon reviewing a patients 12-lead ECG, you note ST-segment elevation of 2mm in leads II, III and aVF. How would you classify these ECG findings?
ST-segment elevation myocardial infarction
What rhythm is shown?
SVT
Which action is not part of the acute stroke pathway?
Seizure prophylaxis
When considering oxygen saturation, what is your course of action? (O2 87%, RR 23)
Start oxygen at 4L/min via nasal cannula
What element of a system of care is represented by properly functioning resuscitation equipment?
Structure
Which is a symptom of stroke? Diaphoresis Fever Sudden trouble seeing Diarrhea
Sudden trouble seeing
What are signs of clinical deterioration that would prompt the activation of rapid response system? Symptomatic hypertension Seizure Unexplained agitation Diastolic blood pressure greater than 60 mm Hg or less than 100 mm Hg
Symptomatic hypertension Seizure Unexplained agitation
After initial adenosine, pt is low bp and only responds to noxious stimuli. What now?
Synchronized cardioversion
Which are the elements of a system of care?
System Structure Process Patient outcome
Which member of the high performance team has the responsibility for assigning roles (positions)? Compressor Time/recorder Airway Team leader
Team leader
What are the 6 positions for high performance teams in resuscitation?
Team leader Airway Timer/recorder Compressor (rotate every 2 minutes) Monitor/defibrillator/cpr coach IV/IO/Medications
Which of the following are the "T" causes of reversible cardiac arrest? Cardiac tamponade Deep vein thrombosis Thyrotoxicosis Coronary thrombosis Tension pneumothorax Pulmonary thrombosis Toxins Simple pneumothorax Thoracic outlet syndrome Tachycardiomyopathy
Tension pneumothorax Toxins Cardiac tamponade Pulmonary thrombosis Coronary thrombosis
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 determine the most appropriate patient destination The hospital can have fibrinolytic drugs already prepared The emergency department can quickly determine glucose levels The hospital can perform more efficient evaluation and management
The hospital can perform more efficient evaluation and management
What happens when teams rapidly assess and intervene when patients have abnormal vital signs? Morbidity and mortality rates are maintained The number of out of hospital cardiac arrest increases The number of in hospital cardiac arrest decreases Morbidity and mortality rates increase
The number of in hospital cardiac arrest decreases
Why is it important to assess the patient's ability to follow commands
To determine the need for targeted temperature management
What is the primary purpose of a rapid response team (RRT) or medical emergency team (MET)? To provide diagnostic consultation to emergency department patients To improve care for patients admitted to critical care units To improve patient outcomes by identifying and treating early clinical deterioration To provide online consultation to emergency medical services personnel in the field
To improve patient outcomes by identifying and treating early clinical deterioration
Which is a sign of a stroke? Abdominal pain Shortness of breath Trouble speaking Retrosternal chest pain
Trouble speaking
When should you use caution when giving morphine?
Use caution when patient is in NSTE-ACS because of the association of mortality
What is the recommended initial therapy for a patient with stable narrow-complex tachycardia, after establishing an IV and acquiring a 12-lead ecg? Adenosine B-blockers Cardioversion Vagal maneuvers
Vagal maneuvers
What do your next steps include?
Vagal maneuvers IV access ECG
What are some of the general questions you need to ask?
What other symptoms do you have? Do you take any medication? Do you have any allergies? When did the symptoms start?
* Initial assessment reveals a conscious patient * The patient's airway is patent, and an advanced airway is not indicated Which action in the Primary Assessment should you perform next?
administer oxygen as needed
how do you continue?
adult post-care arrest care algorithm
PEA can present as which of the following organized rhythms?
afib/flutter BBB sinus rhythm
what else can you give if still in v-fib?
amio 300 mg IV
what now?
amiodarone 300 mg IV
Which therapy is not supported by evidence for use in patients with cardiac arrest secondary to hypothermia?
antiarrhythmics
When should you give epi to pt w/ asystole?
as soon as IV/IO access is available
When should resuscitation Team Leaders activate the protocol for perimortem c-section?
as soon as cardiac arrest is identified in a pregnant woman
1st line for acute symptomatic brady?
atropine
What is the first-line treatment for unstable bradycardia?
atropine
pt has STEMI. what is the highest priority?
coronary angiography
Along with CPR, what is the most critical intervention in the first few minutes of arrest for pt w/ V-fib?
defibrillation
feedback for CPR?
depth rate recoil
what now?
epi 1 mg IV
After that, what?
establish IV or IO access
In addition to hypoxia, what is the most common underlying, potentially reversible cause of pulseless electrical activity?
hypovolemia
reversible causes?
hypovolemia hypoxia hydrogen ion (acidosis) hypo/hyperkalemia hypothermia tension pneumothorax tamponade, cardiac toxins thrombosis, pulmonary thrombosis, coronary
How do you assess whether the LVAD is functioning?
listen for device hum
The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patient's nose to the ___
mandible
What alteration to the standard ACLS algorithm is appropriate for patients whose cardiac arrest is caused by hypothermia?
medications spaced at longer intervals
do you have mechanical capture?
no
for third trimester gravid patient, what dosing alterations are recommended?
no dosing alterations are recommended
Ventilation rate for adult in cardiac arrest with an advanced airway device in place?
once every 6 seconds
what can confound neuroprognostication during post-cardiac arrest phase?
targeted temp mgmt
What is a contraindication to the use of procainamide infusion in the management of stable wide-complex tachycardia?
prolonged QT interval
treatment with dose
saline: 1-2L epi: 2-10 mcg/min NE: 0.1-0.5mcg/kg/min DA: 5-20mcg/kg/min
If the patient is conscious, establish IV access prior to synchronized cardioversion and administer
sedation
steps to start pacing?
set demand rate sedative/analgesic current attach elecrodes to chest turn on pacer
what do you do?
shock
wyd?
shock
Recommended CPR position for a third-trimester gravid patient?
supine w/ manual left lateral uterine displacement
pt doesn't follow commands
targeted temp mgmt
reversible causes?
temp ECG trop
how will the current generation of CVADs complicate BLS assessment?
the devices will not produce a pulse
adv of critical care bed after PCI?
timely neuro checks
What is the purpose of obtaining a 12-lead ECG early during the post cardiac arrest care phase?
to detect ST-segment elevation or LBBB
What therapy is a recommended alternative to vasopressor infusion in the management of unstable bradycardia unresponsive to atropine?
transcutaneous pacing
wyd?
transfer to cath lab for PCI
what is also prioritized during initial stabilization phase?
treating htn
which step is also prioritized during the initial stabilization phase?
treating hypotension
BLS team is bringing a 70-year-old woman, who suddenly collapsed... what is it?
v-fib
rhythm?
v-fib
what is it now?
v-tach
70-year-old woman suffered a sudden cardiac arrest. ROSC, intubated, IV established. highest priorities?
ventilate pt w/ 10 breaths/min maintaining target PaCO2 b/w 35 and 45 mm Hg maintaining SpO2 92-98