ACLS

Six-Person High-Performance Resuscitation Team

A typical six-person high-performance resuscitation team includes team members who perform the three CPR/defibrillator roles, as well as team members who perform the three leadership and supportive roles.

Team Leader Responsibilities

The team leader: Assigns and understands team roles. Sets clear expectations. Prioritizes, directs and acts decisively. Encourages and allows team input and interaction. Focuses on the big picture. Monitors performance while providing support. Acts as a role model. Coaches the team. Re-evaluates and summarizes progress. Leads a debriefing session.

Chest compression fraction

The total percentage of time during a resuscitation attempt in which active chest compressions are being performed. needs to be at least 60% with a goal of 80

A bag ventalition device holds ______mL

700

Provide the minimal level of supplemental oxygen needed to maintain an oxygen saturation of at least _____

94%.

2 In a six-person high-performance resuscitation team, which tasks are responsibilities of the team members? Select all correct options that apply. Recording key data Sharing pertinent observations Ordering interventions Performing chest compressions Going to the pharmacy for medications

1,2,4

3 To estimate the atrial rate, count the number of P waves over a 6-second period and multiply by ________.

10

Dont not check fo breathing and pulse for loner than

10 seconds

13 What part of the heart's electrical conduction system helps to protect the ventricles from atrial tachyarrhythmias? Select the correct answer to this question. Left bundle branch Atrioventricular (AV) node Sinoatrial (SA) node Right bundle branch

2

Switch compressions every ___ mins

2

Secondary assessment

A broader assessment to narrow the list of differential diagnoses and discover underlying causes; includes a focused history and physical examination and diagnostic testing

Closed-loop communication

A communication technique used to prevent misunderstandings; the receiver confirms that the message has been received and understood.

Primary assessment

A focused assessment of airway, breathing, circulation, disability and exposure (ABCDE) to identify potentially life-threatening conditions and address them immediately

Rapid assessment

A quick survey to ensure safety; form an initial impression about the patient's condition; and, if the patient appears to be unresponsive, check for responsiveness, breathing and a pulse

Hover hands over chest but do not touch during

AED shock

13 A team member confirms that a message is received and understood. What communication technique is the team member using? Select the correct answer to this question. Direct communication One-to-one communication Closed-loop communication Open-loop communication

Closed-loop communication

expiratory plateau

During this phase, the last of the carbon dioxide-laden air from the most distal alveoli is exhaled from the body. The ETCO2 value is measured at the end of exhalation (point D), which represents the peak level.

14 A 12-lead ECG shows wide-complex ventricular tachycardia in a stable patient with a pulse. Which of the following may be indicated in the management of this patient?

Expert consultation and/or an antiarrhythmic infusion

Compressor

One team member is responsible for chest compressions.

Which statement about electrocardiography is true?

The 5-lead ECG uses 4 limb leads and 1 precordial lead to provide 7 views of the electrical activity of the heart.

Inspiratory downslope

The phase of the capnography waveform representing inhalation. uring this phase, inhalation occurs and the carbon dioxide is rapidly purged from the airways and alveoli.

2 What parts of the heart's electrical conduction system play a role in ventricular contraction? Select all correct options that apply. Purkinje fibers Interventricular septum Bundle of His Bundle branches

1,3,4

5 In third-degree AV block, there is no electrical communication between the atria and ventricles, so there is no relationship between the P waves and the _________. Select the correct answer to this question. QRS complexes ST segments T waves J point

1

6 In third-degree AV block, there is no electrical communication between the atria and ventricles, so there is no relationship between the P waves and the _________. Select the correct answer to this question. QRS complexes ST segments T waves J point

1

What drugs may be used as second-line therapy for an unstable patient with symptomatic bradycardia? Epinephrine or dopamine Atropine or dopamine Lidocaine or epinephrine Dopamine or lidocaine

1

What is the capnography waveform a graphical representation of? Select the correct answer to this question. The movement of carbon dioxide through the respiratory system The peak end-tidal carbon dioxide level The movement of oxygen through the respiratory system The movement of oxygen and carbon dioxide through the respiratory system

1

You should expect to see an ETCO2 value less than ___ in the presence of hyperventilation. Select the correct answer to this question. 35 mmHg 40 mmHg 45 mmHg 50 mmHg

1

When an advanced airway has been placed in a patient who is in cardiac arrest, compressions and ventilations are delivered continuously with no interruptions. One provider delivers __________ every 6 seconds while the second provider performs compressions at a rate of 100 to 120 compressions per minute.

1 ventilation

24 Which types of arrhythmias are narrow-complex tachyarrhythmias? Select all correct options that apply. Sinus tachycardia Atrial flutter Atrial fibrillation Ventricular tachycardia

1,2,3

Which tasks are responsibilities of the team leader? Select all correct options that apply. Sets clear expectations Leads a debriefing session Assigns roles Administers medications

1,2,3

3 Which of the following complications can occur when providing ventilations with a bag-valve-mask (BVM) resuscitator? Select all correct options that apply. All correct answers will be revealed after two attempts. Regurgitation and aspiration Tension pneumothorax Decreased cardiac output Laryngeal injury

1,2,3 Improper technique can lead to complications when using a BVM resuscitator, including regurgitation and aspiration (as a result of gastric insufflation), tension pneumothorax (as a result of barotrauma) and decreased venous return, which can lead to decreased cardiac output.

8 Which blood tests are often indicated in the evaluation of patients experiencing a cardiovascular, cerebrovascular or respiratory emergency? Select all correct options that apply. 1Electrolyte panel 2Toxicology screens 3Complete blood count (CBC) 4Serum cardiac markers 5Arterial blood gases (ABGs) 6Thyroid function test 7Blood glucose 8Human chorionic gonadotropin (HCG) testing

1,2,3,4,5,7

15 Which statements apply to providing high-quality chest compressions? Select all correct options that apply. Minimize interruptions. Provide at the proper depth. Minimize chest recoil. Provide at the proper rate.

1,2,4

A healthcare provider is conducting a secondary assessment of a patient with an arrhythmia. Which questions should the healthcare provider seek answers to while obtaining the patient's history? Select all correct options that apply. What medications are you currently taking? Can you describe what you were doing when your symptoms began? Do you have a history of appendicitis? Do you have a history of pulmonary or thyroid disease?

1,2,4

Changes in which of the following can affect the rate and depth of breathing? Select all correct options that apply. Arterial pH Arterial oxygen levels Arterial carbon monoxide levels Arterial carbon dioxide levels Venous oxygen levels

1,2,4

27 Synchronized cardioversion is indicated for the treatment of which arrhythmias? Select all correct options that apply. Atrial fibrillation Asystole Monomorphic ventricular tachycardia with a regular rhythm Pulseless electrical activity (PEA) Atrial flutter

1,3,5

7 A team leader instructs a team member to perform an intervention. To practice good communication, the team member should do which of the following? Select all correct options that apply. Acknowledge completion of the intervention. Use nonverbal communication methods to indicate follow-through with the intervention. Repeat the task back to the team leader. Record completion of the intervention. Acknowledge initiation of the intervention.

1,3,5

8 Which non-respiratory differential diagnoses would you consider when assessing a patient with respiratory compromise? Select all correct options that apply. Acute valvular insufficiency Gastrointestinal bleeding Cardiac tamponade Cholelithiasis Cardiogenic pulmonary edema

1,3,5

3 Which assessments would be included in a primary assessment? Select all correct options that apply. 1Checking for life-threatening injuries 2Obtaining a medication history 3Obtaining a health history 4Checking airway patency

1,4

What are goals of the secondary assessment in a patient with a suspected arrhythmia? Determining potentially reversible causes for the arrhythmia Assessing the patient's level of consciousness Assessing the pulse rate, quality and rhythm Determining the severity of signs and symptoms

1,4

14 What end-tidal carbon dioxide (ETCO2) value confirms adequate ventilation in an intubated patient in respiratory arrest? 25-35 mmHg 35-45 mmHg 40-50 mmHg 45-55 mmHg

2

2 Which underlying mechanism can lead to hypoxia in a patient with a right shift of the oxygen-hemoglobin dissociation curve? Select the correct answer to this question. Increased affinity for oxygen binding Decreased affinity for oxygen binding Decreased affinity for oxygen offloading Increased affinity for oxygen binding and decreased affinity for oxygen offloading

2

During a primary assessment, what tool would you use to determine a patient's level of consciousness? Select the correct answer to this question. Mini-Mental State Exam AVPU model NIHSS Braden scale

2

In _________, atrial contraction occurs at such a rapid rate that discrete P waves separated by a flat baseline cannot be seen. Select the correct answer to this question. Ventricular tachycardia Atrial flutter Torsades des pointes Atrial fibrillation

2

What is the body's primary muscle of inspiration? Select the correct answer to this question. Upper trapezius Diaphragm Pectoralis External oblique Scalene

2

When providing high-quality CPR to an adult, what is the proper rate for chest compressions? Select the correct answer to this question. 80 to 100 per minute 100 to 120 per minute 120 to 130 per minute 130 to 140 per minute

2

9 When obtaining a 12-lead ECG, where should the electrodes for the limb leads be placed? Select the correct answer to this question. On the wrists and ankles On the upper arms and on the thighs or calves Under the clavicles and on the lower abdomen On the shoulders and ankles

2 For a 12-lead ECG, the limb electrodes should be placed on the limbs, not the torso. Place the arm electrodes on the upper arms and the leg electrodes on the thighs or calves, avoiding bony areas like the ankles.

7 The resuscitation team decides to place an advanced airway in a patient who is in cardiac arrest. How should ventilations be provided following placement of the advanced airway? Two ventilations after each set of 30 compressions One ventilation every 6 seconds Two ventilations every 15 seconds One ventilation every 10 seconds

2 When a patient is receiving CPR and an advanced airway is in place, provide 1 ventilation every 6 seconds without pausing compressions.

Based on your visual survey, the patient appears to be unresponsive. What should your immediate next action be? Establish cardiac monitoring. Check for responsiveness using the shout-tap-shout sequence. Assess airway patency. Begin CPR.

2 When a patient appears to be unresponsive, check for responsiveness using the shout-tap-shout sequence. If they are unresponsive, call for additional resources and simultaneously check breathing and a pulse for at least 5 seconds but less than 10.

6 You have just placed an advanced airway. How should you verify correct placement? Select all correct options that apply. All correct answers will be revealed after two attempts. Observe for fogging in the tube Observe for bilateral chest rise Auscultate both lungs and over the epigastrium Use capnography or an airway placement confirmation device Look for improved oxygen saturation values on pulse oximetry

2,3,4 When an advanced airway is in use, it is essential to confirm its placement initially, whenever the patient is moved and on an ongoing basis. Correct placement of an advanced airway is verified using both physical assessment (observing for bilateral chest rise and auscultating over the lungs and epigastrium) and a confirmation tool (such as capnography). Fogging in the tube and improved oxygen saturation values on pulse oximetry are not reliable methods of confirming advanced airway placement.

In a 12-lead ECG, the four limb leads produce views in the frontal plane. What are those views? Select all correct options that apply. V2 aVL I aVR V3 II III aVF

2,3,4,6,7,8

15 The oxygen-hemoglobin dissociation curve depicts the relationship between the partial pressure of oxygen (PaO2) and the: Select the correct answer to this question. Arterial oxygen content (CaO2) Peripheral capillary oxygen saturation (SpO2) Arterial oxygen saturation (SaO2) Central venous oxygen saturation (ScvO2)

3

A concept that helps to promote effective and efficient teamwork and reduce the likelihood of errors is called _____. Select the correct answer to this question. Debriefing Crew resource management Problem solving Critical thinking

3

10 Which anatomic landmark should be used to ensure proper placement of the precordial electrodes for a 12-lead ECG? The center of the sternum The nipples The angle of Louis (sternal angle) The xiphoid process

3 For proper landmarking when placing the precordial electrodes for a 12-lead ECG, first identify the angle of Louis (sternal angle), which is adjacent to the second rib. Then palpate down along the sternal border to identify the fourth intercostal space.

8 Which assessment could be made during the rapid assessment? The patient's heart rate is irregular. The patient's heart rate is elevated. The patient is diaphoretic. The patient's capillary refill time is decreased.

3 The rapid assessment is a quick survey conducted as you approach the patient to check for safety, gain an initial impression about the patient's condition, and, if the patient appears to be unresponsive, check for responsiveness, breathing and a pulse. Assessing heart rate and rhythm and capillary refill time are assessments that would be carried out as part of the primary assessment.

4 On rapid assessment, you note that your patient has increased work of breathing, as evidenced by tripod positioning, an inability to speak more than one or two words at a time and diaphoresis. What assessments should you obtain as part of your primary assessment? Airway patency 12-Lead ECG Pulse oximetry Vital signs

3,4

10 In a patient who is showing signs and symptoms of respiratory compromise, you should provide the minimum level of supplemental oxygen needed to maintain an oxygen saturation of at least: Select the correct answer to this question. 80%. 85%. 90%. 94%.

4

10 What is the rapid assessment? Select the correct answer to this question. 1A broad assessment to differentiate possible diagnoses and underlying causes 2A quick head-to-toe assessment of the patient 3A focused assessment of airway, breathing and circulation 4A quick assessment to ensure safety, form an initial impression of the patient and, if the patient appears to be unresponsive, check for responsiveness, breathing and a pulse

4

12 When providing high-quality CPR to an adult, what is the proper depth for chest compressions? Select the correct answer to this question. About 1.5 inches (4 cm) At least 1.5 inches (4 cm) but less than 2 inches (5 cm) About 2 inches (5 cm) At least 2 inches (5 cm) but less than 2.4 inches (6 cm)

4

16 What part of the ECG rhythm strip represents repolarization of the ventricular myocardial cells? QRS complex QT interval P wave T wave

4

28 In ventricular tachycardia, the QRS complexes are wide, lasting longer than: 90 milliseconds 100 milliseconds 110 milliseconds 120 milliseconds

4

In the event of primary pacemaker dysfunction or failure, what part of the heart's conduction system can function as a backup pacemaker? Select the correct answer to this question. Purkinje fibers Left bundle branch Bundle of His Atrioventricular (AV) node

4

What is the first-line therapy for an unstable patient with symptomatic bradycardia? Select the correct answer to this question. Lidocaine Magnesium sulfate Amiodarone Atropine

4

When performing high-quality CPR on an adult without an advanced airway in place, what is the correct ratio of compressions to ventilations? Select the correct answer to this question. 15 compressions to 1 ventilation 15 compressions to 2 ventilations 30 compressions to 1 ventilation 30 compressions to 2 ventilations

4

5 Which airway device is most appropriate as an initial intervention for a semiconscious patient who requires ventilation with a bag-valve-mask (BVM) resuscitator? An oropharyngeal airway (OPA) A laryngeal mask airway An endotracheal tube A nasopharyngeal airway (NPA)

4 An NPA may be used on a conscious, semiconscious or unconscious patient.

Recognize

After you gather assessment data, use critical thinking, your past clinical experience and your general knowledge to correctly interpret the meaning of the data and gain an understanding of the patient's clinical situation and care needs. This understanding enables you to determine your next steps.

Care

Implement appropriate care based on your understanding of the patient's condition. Proper care cannot be provided without effective assessment and accurate recognition of the patient's condition.

You use critical thinking when you

Obtain an initial impression. Determine a course of action. Anticipate roles and functions as part of a team based on the patient's presentation and condition. Consistently re-evaluate the situation for changes, interpret these changes and apply them to the patient's care and treatment. Modify your actions based on the changes you observe.

Data Manager

One team member is responsible for communicating and recording key data during the resuscitation effort (for example, data related to medication administration and interruptions to chest compressions).

Medication Administrator

One team member is responsible for establishing vascular access and administering medications.

AED/Defibrillator Operator

One team member is responsible for managing the AED or defibrillator and for establishing any other monitoring. This team member also relieves the team member who is performing compressions.

Airway manager and ventilator

One team member is responsible for managing the airway and providing ventilations. A trained respiratory therapist, if available, would fill this role.

Team Leader

One team member is responsible for prioritizing and directing the other team members' actions.

15 A 12-lead ECG reveals a tachyarrhythmia with narrow QRS complexes (< 0.12 second). You would classify this arrhythmia as ________.

SVT (use the three letters not the word)(

Team Member Responsibilities

Team members: Have the necessary knowledge and skills to perform their assigned role. Stay in their assigned role but assist others as needed, as long as they are able to maintain their own assigned responsibilities. Communicate effectively with the team leader if they: -Feel they are lacking any knowledge or skills to perform assigned roles. -Identify something that the team leader may have overlooked. -Recognize a dangerous situation or need for urgent action. Share information with other team members. Focus on achieving the goals. Ask pertinent questions and share pertinent observations. Participate in debriefing sessions. Crew

You need to obtain intraosseous (IO) access. Identify the preferred site.

The anterior proximal tibia is often used for IO access because it provides a flat surface with a relatively thin outer layer of bone, a large marrow cavity and easily identifiable landmarks to facilitate placement. The proximal humerus is also commonly used.

Respiratory baseline

The phase on the capnography waveform representing the beginning of exhalation. During this phase, "dead space" air (i.e., air in the airways from the bronchioles to the nasal cavity that does not contain carbon dioxide) is exhaled from the body.

Respiratory upstroke

The phase on the capnography waveform representing the exhalation of air containing carbon dioxide from the alveoli. epresenting air from the alveoli that contains carbon dioxide being exhaled from the body. For most patients, the respiratory upstroke should be nearly vertical.

7 When assessing a patient with respiratory compromise, it is important to determine where the patient is on the continuum of respiratory compromise. True False

True

Assess, Recognize and Care

a concept that describes the ongoing process of gathering data about the patient's condition, using that data to identify a problem and then intervening to address the problem. Because an acutely ill patient's condition can change rapidly (for better or for worse), you must continuously assess the patient, recognize what is happening with the patient and provide care accordingly.

If capnography is less than 10 there may be probelm with _________

compressions

8 Which findings may suggest that a patient is experiencing hemodynamic compromise as a result of a bradyarrhythmia? Select all correct options that apply. Hypotension Ischemic chest discomfort Signs of shock Changes in mental status Hypertension Acute heart failure

everything but hypetension

1 When providing transcutaneous pacing, the appearance of wide QRS complexes and tall, broad T waves after each pacing spike confirms that mechanical capture has been achieved.

false

Crew Resource Management

is a concept that helps to promote effective and efficient teamwork and reduce the likelihood of errors. Crew resource management emphasizes using all available resources (including people, equipment and procedures) to reduce the likelihood of human error and promote effective and efficient teamwork. Crew resource management also guides team members to communicate directly and effectively with the team leader about dangerous or time-critical decisions. When a problem arises, team members must get the attention of the team leader, state their concern, describe the problem as they see it and suggest a solution. The team leader then provides direction, enabling the team to work together to resolve the issue.

Assess

is the process of gathering the data that help you to determine what is happening with the patient. To ensure that the most pressing problems are addressed first, take a phased, systematic approach to assessment: perform a rapid assessment, a primary assessment and (when the patient's condition allows) a secondary assessment. In an emergency situation, assessment is ongoing.

Hyperventilation leads to alkalosis and a _______ shift of the oxygen-hemoglobin dissociation curve.

left

When hemoglobin's affinity for oxygen is increased, oxygen binds to the hemoglobin easily, but offloading is difficult. This is reflected on the oxygen-hemoglobin dissociation curve as a shift to the _________.

left

Brown lead going right side of chest in __________

middle (approx 3-4th inter-coastal space)

Do not place AED pads over___________

pacemaker

9 You need to set up cardiac monitoring with a five-electrode system. Where should you place the white electrode?

top right chest anatomically oreinted