ACLS quiz
What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindications after hospital arrival?
45 minutes
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 initial impulse setting for transcutaneous pacemaker use in the management of unstable bradycardia?
60 to 80 /min
During CPR, chest compression fraction (CCF) should be at least --- and ideally greater than 80%.
60%
You are preparing to provide electrical cardioversion. You are monitoring the patient's EKG and have applied the defibrillation pads to the patient's bare chest. You have delivered sufficient sedation and have turned the defibrillator on. What is the next step you should perform?
Activate the sync control button
What is the first link in the out-of-hospital cardiac arrest (OHCA) chain of survival?
Activation of emergency response
The 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 O2 as needed
The width of the QRS in a patient presenting with tachycardia is 0.16 seconds. Each QRS complex has a visible P wave. How would you classify this tachycardia?
Wide QRS complex tachycardia
What is recommended time window after symptom onset for early fibrinolytic therapy or direct catheter- based reperfusion for patients with St-segment elevation myocardial infraction and no contraindications?
Within 12 hours
What validated abbreviated out-of-hospital neurologic evaluation tool contains 3 components: the facial droop, arm drift, and abnormal speech tests?
(CPSS) Cincinnati Prehospital Stroke Scale
Which is an example of knowledge sharing by a team leader?
Asking for suggestions about interventions
What is the recommended norepinephrine dose for hypotensive patients during the post-cardiac arrest phase?
0.1 to 0.5mcg/kg per minute
How long should the second rescuer squeeze the bag mask device when providing 2-rescuer ventilation?
1 second
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 1.5mg/kg
What is the recommended fluid bolus dose for patients who are hypotensive during the post-cardiac arrest phase?
1 to 2 L
What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department?
10 minutes
What is the maximum amount of time you should simultaneously perform the pulse and breathing checks?
10 seconds
What is the lower heart rate limit for a patient with sinus tachycardia?
100/min
What is the diastolic blood pressure times hold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke?
110mmHg
Obtaining a --- is the most important assessment tool for a patient displaying signs and symptoms of acute coronary syndromes.
12 lead EKG
What is the average RR for an adult at rest?
12 to 20/min
What is the follow up dose of adenosine for the management of supraventricular tachycardia unresponsive to the first adenosine dose?
12mg IV
What is the upper heart rate limit for a patient with sinus tachycardia?
130/min
What is the recommended first dose of amiodarone for the management of stable wide-complex tachycardia?
150 mg IV
Generally speaking, electrical cardioversion is not recommended as the initial therapy for patients unless the heart rate is above
150/min
Symptoms of instability are not usually caused by heart rates less than --- unless ventricular function is impaired.
150/min
What is the recommended first dose of amiodarone for the management of stable wide-complex tachycardia?
150mg IV
What blood glucose level should trigger the administration of IV or subcutaneous insulin for a patient with acute ischemic stroke?
180mg/dl
Identify the systolic BP threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke.
185mmHg
What is the recommended first dose of IV atropine for the management of bradycardia?
1mg IV
What is the recommended dose for epinephrine during a resuscitation effort?
1mg IV every 3 to 5 minutes
What is the recommended starting IV infusion dose of epinephrine for patients in cardiac arrest achieve ROSC and need vasopressor support?
2 to 10 mcg per minute
What is the recommended infusion rate for epinephrine in the management of symptomatic bradycardia unresponsive to atropine?
2 to 10 mg per minute
What is the goal for neurologic assessment by the stroke team or design and noncontrast computed tomography or magnetic resonance imaging 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 (energy above the dose at which consistent capture is observed) should you allow when the transcutaneous pacemaker?
2mA
EKG: during the EKG you note the presence of more P waves than QRS complexes. You also note all PR intervals have a uniform length but random QRS complexes are dropped. What type of atrioventricular block is most likely present?
2nd degree AV block- Type II
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
What is the longest acceptable emergency department-door-to-needle time when fibrinolysis is the intended reperfusion strategy?
30 minutes
What is the recommended first IV/ IO dose of amiodarone for patients in cardiac arrest with VF/PVT that is unresponsive to defibrillation?
300mg
If the patient is not following commands, start targeted temperature management as soon as possible with what targeted temperature range?
32o to 36o C
What is the normal PETCO2 range?
35 to 45 mmHg
EKG: you note presence of more P waves than QRS complexes. You also note the absence of a relationship between P waves and QRS complexes. What type of atrioventricular block is most likely present?
3rd degree Av block
When adjusting ventilation rales, with PETCO2 value lies within the recommended range for a patient who achieves return of spontaneous circulation?
40mmHg
How quickly should resuscitation Team leaders consider perimortem cesarean delivery after beginning resuscitative efforts it returns of spontaneous circulation 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 20mcg/kg per minute
Symptomatic bradycardia is defined by a heart rate less than
50/min
When you use a bag-mask device, you should deliver approximately ---tidal volume.
500 to 600 mL
What is the maximum time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment?
6 hours
Patients with perfusing rhythms should receive ventilations once every
6 seconds
How much tidal volume must provide with a bag-mask device to produce visible chest rise for an adult patient in respiratory arrest?
6 to 7 mL/kg
What is tidal volume typically maintaining normal oxygenation and elimination of carbon dioxide?
6 to 8 mL/kg
What is the mean arterial pressure target when administering epinephrine to patients in cardiac arrest who return of spontaneous circulation and have vasopressor support?
65mmHg
What is the recommended initial dose of adenosine for the management of supraventricular tachycardia unresponsive to vagal maneuvers?
6mg IV
How quickly does the chance of survival describe for every minute of defibrillation delay in patients with ventricular fibrillation (VF) who do not receive bystander CPR?
7-10%
How long should you wait to determine the neurologic prognosis of a patient treated with targeted temperature management after the patient returns to normothermia?
72 hours
What is the estimated probability of the Cincinnati Prehospital Stroke Scale with 1 abnormal finding when scored by prehospital provides?
72%
Oxygen should be delivered to a patient who has obvious signs of heart failure if the oxygen saturation is less than ---- or unknown.
90 %
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-balloon inflation time for a patient receiving percutaneous coronary intervention?
90 minutes
A patient without dyspnea has signs of acute coronary syndrome. There are no obvious signs of heart failure. You assess a noninvasively monitored oxyhemoglobin saturation. What is the oxygen saturation threshold below which supplemental oxygen would be required?
90%
Oxygen should be delivered to a patient who has obvious signs of heart failure if the oxygen saturation is less than --- or unknown
90%
When titrating inspired oxygen, which arterial oxyhemoglobin saturation value lies within the recommended range for a patient who achieves return of spontaneous circulation?
95%
The initial assessment reveals a conscious patent. The patient's airway is patent, and an advanced airway is not indicated. Which action is the Primary Assessment should perform next?
Administer oxygen as needed
Which sxs indicate a symptomatic bradycardia?
Altered mental status, SOB, pulmonary edema
Which is indicate a symptomatic bradycardia?
Altered mental status, chest pain
Which therapy is not supported by evidence for use in patients with cardiac arrest secondary to hypothermia?
Antiarrhythmics
When is the recommended point to administer epinephrine to a patient with a systole?
As soon as IV/IO access is available
When should resuscitation team leaders activate the protocol for perimortem cesarean delivery?
As soon as cardiac arrest is determined in a pregnant patient
Which is an example of knowledge showing by a team leader?
Asking for suggestions about interventions
What is the first-line treatment for unstable bradycardia?
Atropine
When is the recommended point to administer the first dose of epinephrine for a patient in a shockable rhythm?
Between the second and third shocks
What is the main determinant of end-tidal carbon dioxide (ETCO2) measurement during CPR?
Blood delivery to the lungs
PEA can present as which of the following organized rhythms?
Bundle brunch blocks, Atrial fibrillation or flutter, Sinus rhythm
Which of the following defines chest compression fraction (CCF)?
CCF= actual chest compression time/ Total code time
What is the first line treatment of unstable tachycardia?
Cardioversion
What is a benefit of morphine when given for the management of acute coronary syndromes?
Central nervous system analgesia
What is the benefit of morphine when given for the management of ACS?
Central nervous system analgesia
During the post-cardiac arrest care period, the 12-lead EKG reveals ST-segment elevation myocardial infraction. Which step has the highest priority?
Coronary angiography
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
Select the first step in the use of an oropharyngeal airway
Clear the mouth and pharynx
What is the highest level of stroke center certification?
Comprehensive stroke center
Which of the following are immediately available as feedback from CPR performance monitors?
Compression depth, recoil, chest compression rate
Which clinical finding represents a contraindication to the administration of nitroglycerin?
Confirmed right ventricular infarction
Which is a step of closed-loop communication?
Confirming task completion before assigning another task
What is a contraindication to the use of an oropharyngeal airway?
Conscious patient
In addition to decreased IHCA, what are some other benefits of implementing a rapid response system?
Decrease ICU length of stay, decreased in total hospital length of stay
How do interruptions in chest compressions negatively impact survival after cardiac arrest?
Decrease coronary perfusion pressure
In addition to decreased IHCA, what are some other benefits of implementing a rapid response system?
Decreased ICU length to stay, decrease in total hospital length to stay
In addition to CPR with minimal interruptions in chest compressions what is the most critical intervention during the first minutes of arrest for a patient in ventricular fibrillation?
Defibrillation
While you 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 patient's airway is patent
What is the main advantage of effective teamwork?
Division of tasks
You obtain a 12-lead EKG in a patient with retrosternal chest pain. Which EKG finding is suggestive of high-risk non-ST-Segment Elevation acute coronary syndromes?
Dynamic T-wave inversion
The BLS Assessment is a systematic approach to BLS for trained healthcare providers. This approach stresses:
Early CPR and defibrillation
What is the only intervention that can restore on organize rhythm in patients with ventricular fibrillation (VF)?
Early and effective defibrillation
What is the only CPR performance monitor typically available for measuring a physiologic end point outside of a hospital setting?
End tidal carbon dioxide (ETCO2)
What is the potential complication of using a nasopharyngeal airway that is too long?
Entering the esophagus
During the management of a patient in cardiac arrest, you have initiated CPR, attached the manual defibrillator, delivered the first shock, and immediately resumed high quality CPR, beginning with chest compressions. What is your next intervention?
Establish IV or IO access
What is the advantage of placing a post-cardiac arrest patient in a critical care bed after coronary reperfusion interventions?
Experts can perform timely neurologic evaluation
Which action is part of the Secondary Assessment of conscious patient?
Formulate a differential diagnosis
What is a complication of IV atropine when administered in doses of less than 0.5mg?
Further showing of heart rate
What type of stroke occurs when a blood vessel is the brain suddenly ruptures into the surrounding tissue?
Hemorrhagic stroke
What is the term of the rise in arterial CO2 levels typically associated with respiratory failure?
Hypercapnia
What is the symptom of unstable tachycardia?
Hypotension
You are treating a patient with a heart rate of 186/min. which symptom (if present) suggests an unstable tachycardia?
Hypotension
Which sxs indicate a symptomatic bradycardia?
Hypotension, SOB, altered mental status
In addition to hypoxia, what is the most common underlying, potentially reversible cause of pulseless electrical activity?
Hypovolemia
Which of the following are the "H" causes of reversible cardiac arrest?
Hypovolemia, hypoxia, acidosis, hyperkalemia/ hypokalemia, hypothermia
In addition to hypovolemia what is the most common underlying, potentially reversible cause of pulseless electrical activity?
Hypoxia
What is the recommended destination for a post-cardiac arrest patient after coronary reperfusion and initiation of targeted temperature management?
ICU
Among others, which factor has been associated with improved survival in patients with cardiac arrest?
Immediate high- quality CPR
What is primary purpose of the CPR coach on a resuscitation team?
Increasing CPR quality
Which is an example of summarizing and reevaluating?
Increasing monitoring of the patient's condition deteriorates
What is the first step in the systematic approach to patient assessment?
Initial impression
Depending on training and individual circumstances how can rescuers administer naloxone?
Intranasally, intravenously, intramuscularly
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
What is the advantage of primary percutaneous coronary intervention in a cath lab for patients with cardiac arrest secondary to coronary artery occlusion once they achieve return of spontaneous circulation?
It restores blood flow in an infarction-related artery
When performing the jaw-thrust maneuver on patients with suspected cervical spine injury, where should you place your fingers?
Just under the angel of the lower jaw
You are assessing an unresponsive patient known to have an implanted left ventricular assist device (LVAD). The patient is not breathing, the patient's skin is pale and cool, and capillary refill is inadequate. How do you assess whether the LVAD is functioning?
Listen for device hum
Which is a stroke severity tool that helps EMS differentiate occlusion from non-large-vessel occlusion stroke?
Los Angeles Motor Scale
Which alternation to be standard ACLS algorithm is appropriate for patients whose cardiac arrest is caused by hypothermia?
Medications spared at longer intervals
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?
Models excellent team behavior
Which high-performance team member is part of the resuscitation triangle?
Monitor/ defibrillator/ CPR coach
The width of the QRS in a patient presenting with tachycardia is 0.10 seconds. There are no clearly discernable P waves. How would you classify this tachycardia?
Narrow-complex tachycardia
What alternations one recommended for resuscitation drug administration to 3rd trimester gravid patients in cardiac arrest?
No dosing alternations are recommended
What is the recommended ventilation for an adult in cardiac arrest with an advanced airway device in place?
Once every 6 seconds
Which class of medications commonly given to patients with acute coronary syndromes may be adversely affected by morphine administration?
Oral antiplatelet medications
What term best describes an organized rhythm without a pulse?
PEA
A patient with ventricular assist device (VAD) is not breathing, has signs of inadequate perfusion, and is unconscious. You determine the VAD is functioning. After endotracheal intubation, the patient has a PETCO2 of 12 mmHg. What is your next action?
Perform external chest compressions
What blood component is acted upon by aspirin administration during the management of a patient with acute coronary syndromes?
Platelets
Which is the best example of a role of a team member?
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 value
Which is contraindicated to the use of procainamide infusion in the management of stable wide-complex tachycardia?
Prolonged QT interval
A patient with suspected opioid poisoning is not breathing normally but has a pulse. What is your next step?
Provide rescue breathing and give naloxone
What is a 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-team feedback devices?
Quality
Which component of effective high-performance teams is represented by the use of real-time feedback devices?
Quality
What is the 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 a cute coronary syndrome?
Recent GI bleeding
What is a physiologic effect of nitroglycerin?
Reduces preload
What is the advantage of a systematic approach to patient assessment?
Reduces the chances of missing important signs and symptoms
A 59 yo patient is reporting difficulty breathing. Physical exam reveals nasal flaring, intercostal interaction and use of accessory muscles. RR is 28 breaths per minute. O2 sat is 92% PTCO2 is 36 mmHg. How would you categorize this patent's condition?
Respiratory distress
An 18 yo patient is reporting difficulty breathing and is displaying increased respiratory effort. Auscultation reveals bilateral wheezing; the respiratory rate is 28 breaths per minute. Oxygen saturations is 91%. PETCO2 is 44 mmHg. How would you categorize this patient's condition?
Respiratory distress
A 75 yo patient is having difficulty breathing, with increased respiratory effort. The patient has history of emphysema. The patient is drowsy, auscultation reveals bilateral wheezing, although the lung sounds are difficult to appreciate. RR is 38/min. O2 sat = 85%, PETCO2= 49mmHg. How would you categorize this patient's condition?
Respiratory failure
which is an advantage of EMS transport to a stroke hospital for a patient with suspected acute ischemic stroke?
Responding providers can stabilize critical issues
What is the most common symptom of myocardial ischemia and infraction?
Retrosternal chest pain
Which signs and symptoms indicate a symptomatic bradycardia?
SOB, chest pain, pulmonary edema
Which sxs indicate a symptomatic bradycardia?
SOB, hypotension
Upon reviewing a patient's 12-lead EKG, you note ST-segment elevation of 2mm in leads II, III, and AVF. How would you classify the EKG findings?
ST segment elevation myocardial infraction
Upon reviewing a patient's 12-lead EKG, you note ST-Segment elevation of 2mm in leads II, III and AVF. How would you classify the EKG findings?
ST-segment elevation myocardial infraction
Which action is NOT part of the acute stroke pathway?
Seizure prophylaxis
What roles does ECPR fill in the management of cardiac arrest?
Severe as a bridge for left ventricular assist device implantation, provides vital organ support while treating reversible causes
What element of a system of care is represented by properly functioning resuscitation equipment?
Structure
Which are the elements of a system of care?
Structure, processes, system, patient outcome
Which is a symptom of stroke?
Sudden trouble seeing
What is the recommended CPR position for a third-trimester gravid patient?
Supine with normal left uterine displacement
What are signs of clinical deterioration that would prompt the activation of a rapid response system?
Systemic hypertension, unexplained agitation, seizure
Which factor can confound neuroprognostication during the post-cardiac arrest phase?
Targeted temperature management
Which member of the high-performance team has the responsibility for assigning roles (positions)?
Team leader
Which of the following are the "T" causes of reversible cardiac arrest?
Tension pneumothorax, cardiac tamponade, toxins, pulmonary thrombosis, coronary thrombosis
How will the current generation of continuous-flow left ventricular assist devices complicate the BLS assessment?
The devices will not produce a pulse
What is the 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 happens when teams rapidly assess and intervene when patients have abnormal vital signs?
The number of in-hospital cardiac- arrest decreases
What is the maximum length of suction catheter that should be inverted into the patient's oropharynx beyond the tongue?
The tip of the nose to the earlobe
What is the purpose of obtaining a 12-lead EKG early during the post-cardiac arrest care phase?
To detect ST-segment elevation or left bundle branch block
During the post-cardiac arrest care phase, your team has optimized the patient's oxygenation, ventilation, and hemodynamic status. The patient's 12-lead EKG identifies St-segment elevation MI, and the patient is being prepped for transport to the cath lab to undergo coronary reperfusion therapy. 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 improve patient outcomes by identifying and treating early clinical deterioration
What therapy is a recommended alternative to vasopressor infusion in the management of unstable bradycardia unresponsive to atropine?
Transcutaneous pacing
Which is a sign of stroke?
Trouble speaking
In which of the following patients can nasopharyngeal airways be used?
Unconscious, semiconscious, conscious
What are signs of clinical deterioration that would prompt the activation of a rapid system?
Unexplained agitation, symptomatic hypertension, seizure
What is the most effective way to deliver bag-mask ventilation?
Using a 2 person technique
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 procedure used in the management of stable narrow-complex tachycardia forces a patient to strain a closed glottis?
Valsalva maneuver
When should you include the side opening of a suction catheter when performing oropharyngeal suctioning?
While withdrawing the catheter
Coronary perfusion pressure (CPP) equals aortic ---- pressure minus right atrial diastolic pressure.
diastolic
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
Which demographic group experiencing acute coronary syndrome in more likely to present without chest pain?
females
If the patient is conscious, establish IV access prior to synchronized cardioversion and administer
sedation
Which are examples of mutual respect?
· Acknowledging correctly completed tasks in a positive way · Ensuring that only 1 person talks at a time
What are the components of high-quality CPR?
· Compression depth of at least 2 inches (5cm) · Complete chest recoil after each compression · Interruptions limited £ 10 seconds · Switching compressions every 2 minutes · Avoiding excessive ventilation
