Heartcode ACLS
in addition to decreased IHCA, what are some other benefits of implementing a rapid response system? 1. decrease in total hospital length of stay 2. decreased ICU length of stay 3. increase ICU admissions 4. decreased emergency department admissions 5. increased hospital length of stay
1 and 2
SCENARIO the patient is unresponsive and not breathing but has a strong pulse what should your initial actions include? 1. initiate ventilation with a bag-mask device attached to supplemental oxygen 2. administer high flow oxygen via a nonrebreathing mask 3. open the patients airway via a head tilt-chin lift of jaw thrust 4. begin CPR
1 and 3
in which of the following patients can nasopharangeal airways be used? 1. unconscious 2. conscious 3. patients with nasal trauma 4. semiconscious
1, 2 and 4
which of the following are the "T" causes of reversible cardiac arrest? 1. coronary thrombosis 2. pulmonary thrombosis 3. toxins 4. thoracic outlet syndrome 5. simple pneumothorax 6. thyrotoxicosis 7. tachycardiomyopathy 8. tension pneumothorax 9. cardiac tamponade 10. deep vein thrombosis
1, 2, 3, 8, 9
SCENARIO 2 a 74 year old man experienced left-arm weakness and left-sided facial paralysis when he woke up this morning. he has a past medical history of poorly controlled hypertension the HR is -92 RR 14 BP 130/86 SPO 97 and atrial fibrillation is on the monitor what additional assessment and stabilization activities should be completed? 1. initiate stroke protocol 2. check glucose 3. perform complete history and physical 4. perform validated prehospital stroke screen and stroke severity tool 5. establish time of symptom onset (last known normal) 6. provide prehospital notification to receiving hospital 7. administer O2
1, 2, 4, 5, 6
SCENARIO 1 what additional questions help you determine next steps? 1. do you have any allergies 2. do you take any medication? 3. when was the last time you went to the doctor? 4. have you had recent falls? 5. when did the symptoms start?
1, 2, and 5
SCENARIO 2 what are some of the general questions you need to ask? 1. when did the symptoms start? 2. did you eat anything today? 3. what other symptoms do you have? 4. do you have any allergies? 5. do you take any medications? 6. has your wife been sick as well?
1, 3, 4, 5
SCENARIO 1 a 49 year old man says that he has had chest discomfort and excessive sweating for the past 25 minutes. the pain is not relieved with rest within the first 10 minutes, on the basis of the patient showing symptoms suggestive of myocardial ischemia, what will your first actions include? 1. administer epinephrine 1 mg IV 2. assess airway, breathing, and circulation ABCs) 3. obtain a 12-lead electrocardiogram 4. administer aspirin 5. administer a blood thinner 6. consider oxygen, nitroglycerin and morphine if needed 7. provide prehospital notification to the receiving hospital 8. if considering prehospital fibrinolysis, use the fibrinolytic checklist
2, 3, 4, 6, 7, 8
SCENARIO a 54 year old man became unconscious after suffering from severe shortness of breath and difficulty breathing. you arrive on scene and confirm that the scene is safe what initial actions should be taken? 1. consider an advanced airway 2. call for additional help 3. assess airway, breathing and circulation ABCs) 4. attach a 12 lead ECG 5. check for responsiveness
2, 3, and 5
which of the following are the "H" causes of reversible cardiac arrest? 1. hypocalcemia 2. hypothermia 3. hypertensive crisis 4. hypovolemia 5. hyperkalemia/hypokalemia 6. hypercalcemia 7. Heyde's syndrome 8. HELLP syndrome 9. acidosis 10. hypoxia
2, 4, 5, 9, 10
SCENARIO2 because this patient is no longer a candidate for fibrinolytic therapy, what are your next steps for him? 1. order an emergent CT scan 2. begin the stroke pathway 3. consider giving adenosine 4. support airway, breathing and circulation ABCs) 5. order an emergent x-ray 6. admit the patient to an intensive care unit 7. administer O2
2, 4, 6
which signs and symptoms indicate a symptomatic bradycardia? 1. fever 2. chest pain 3. nausea 4. altered mental status 5. respiratory arrest 6. pulmonary edema
2, 4, and 6
during CPR, chest compression fraction (CCF) should be at least ___% and idealls greater than ___%
60, 80
SCENARIO 1 with the diagnosis of STEMI, what is the most probable treatment? a) admission for PCI or fibrinolysis b) release to home c) admission to an intensive care unit d) admission for observation
A
what is the most common type of stroke? a) ischemic stroke b) hemorrhagic stroke c) intracerebral stroke d) transient ischemic attack
A
which is a stroke severity tool that helps EMS differentiate large-vessel occlusion stroke from non-large vessel occlusion stroke? a) los angeles motor scale b) melbourne ambulance stroke screen c) miami emergency neurologic deficit score d) cincinnati prehospital stroke scale
A
which is a symptom of stroke? a) sudden trouble seeing b) diaphoresis c) fever d) diarrhea
A
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? a) determine if the patient's airway is patent b) assess the patient's oxygenation status c) perform fluid resuscitation d) attach a quantitative waveform capnography device
A
what is a contraindication to the administration of aspirin for the management of a patient with acute coronary syndromes? a) vomiting b) recent gastrointestinal bleeding c) nausea d) shortness of breath
B
what is the main advantage of effective teamwork? a) immediate CPR b) division of tasks c) early defibrillation d) mastery of resuscitation skills
B
SCENARIO 1 his inital vitals are HR - 120 BP - 135/88, RR 23 SPO 87% temp 37.3 C when considering oxygen saturation, what is your course of action? a) administer albuterol nebulizer b) intubate the patient immediately c) start oxygen at 4L/Min via nasal cannula d) do not start oxygen
C
SCENARIO 1 after you give your report to the hospital, staff advise you to proceed to the cath lab for PCI. what is the goal for PCI when treating this patient? a) door-to-balloon inflation time of 30 minutes b) door-to-need time of 90 minutes c) first medical contact-to-balloon inflation time of 90 minutes d) first medical contact-to-needle time of 30 minutes
C
SCENARIO 1 your patient continues to say that he has chest discomfort what treatment can you repeat as long as it is not contraindicated by vital signs? a) morphine IV every 1 to 3 minutes b) morphine sublingual every 1 to 3 minutes c) nitroglycerin sublingual or translingual every 3 to 5 minutes d) nitroglycerin IV every 1 to 3 minutes
C
What validated, abbreviated out of hospital neurologic evaluation tool contains 3 components: facial droop, arm drift, and abnormal speech test? a) glasgow coma scale b) primary arterial occlusion evaluation scale c) cincinnati prehospital stroke scale d) los angeles prehospital stroke screen
C
a patient without dyspnea has signs of acute coronary syndromes 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? a) 93% b) 92% c) 90% d) 91%
C
among others, which of the following factors has been associated with improved survival in patients with cardiac arrest? a) compression-only CPR b) presence of 2 or more rescuers c) immediate high -quality CPR d) manual defibrillation
C
obtaining a ______ is the most important assessment tool for a patient displaying signs and symptoms of acute coronary syndromes a) blood glucose level b) portable ultrasound c) 12-lead ECG d) computed tomography scan
C
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? a) check for the presence of a pulse b) remove clothing to perform a physical examination c) administer oxygen as needed d) check for neurologic function
C
what blood component is acted upon by aspirin administration during the management of a patient with acute coronary syndromes? a) plasma b) red blood cells c) platelets d) white blood cells
C
what is an advantage of a systemic approach to patient assessment? a) reduces the need for secondary assessment b) standardizes treatment across systems of care c) reduces the chances of missing important signs and symptoms d) permits assessment modification based on patient symptoms
C
what is the highest level of stroke center certification? a) acute stroke ready hospital b) thrombectomy-capable stroke center c) comprehensive stroke center d) primary stroke center
C
what is the maximum amount of time you should simultaneously perform the pulse and breathing checks? a) 15 seconds b) 20 seconds c) 10 seconds d) 5 seconds
C
what is the most appropriate destination for patients with suspected acute ischemic stroke? a) hospital catheterization laboratory b) trauma center c) certified stroke center d) closest emergency department
C
what is the primary advantage of using a stroke severity tool? a) it helps determine the last known normal time b) it helps identify level of weakness c) it helps identify large-vessel occlusion stroke d) it helps EMS providers identify signs of a stroke
C
what is the recommended time window after symptom onset for early fibrinolytic therapy or direct catheter-based reperfusion for patients with ST segment elevation myocardial infarction and no contraindications? a) within 18 hours b) within 48 hours c) within 12 hours d) within 24 hours
C
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? a) attach a quantitative waveform capnography device b) perform fluid resuscitation c) determine if the patient's airway is patent d) assess the patient's oxygenation status
C
What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department? a) 20 minutes b) 15 minutes c) 30 minutes d) 10 minutes
D
coronary perfusion pressure (CPP) equals aortic_______ pressure minus ____ atrial diastolic pressure a) systolic, left b) systolic, right c) diastolic, left d) diastolic, right
D
what is a physiologic effect of nitroglycerin? a) bronchodilation b) platelet aggregation inhibition c) binds to opioid receptors d) reduces preload
D
what is the goal for first medical contact-to-balloon inflation time for a patient receiving percutaneous coronary intervention? a) 30 minutes b) 120 minutes c) 45 minutes d) 90 minutes
D
what is the longest acceptable emergency department door-to-need time when fibrinolysis is the intended reperfusion strategy? a) 60 minutes b) 15 minutes c) 45 minutes d) 30 minutes
D
you obtain a 12-lead ECG in a patient with retrosternal chest pain which electrocardiographic finding is suggestive of high-risk-non-ST segment elevation acute coronary syndromes? a) ST segment elevation b) new left bundle branch block c) ST depression less than 0.5mm d) Dynamic T-wave inversion
D
SCENARIO while ventilating the patient, you hear loud gurgling sounds coming from the airway what is your next action? a) suction the airway b) intubate the patient c) increase ventilation volume d) increase the ventilation rate
a
an 18 year old patient is reporting difficulty breathing and is diplaying increased respiratory effort auscultation reveals bilateral wheezing the respiratory rate is 28 breaths per minute oxygen saturation 91% PETCO2 is 44 mm Hg how would you categorize this patient's condition? a) respiratory distress b) respiratory arrest c) respiratory failure d) normal respiratory status
a
how quickly does the chance of survival decline for every minute of defibrillation delay in patients with ventricular fibrillation ((VF) who do not receive bystander CPR? a) 7% to 10% b) 5% to 6% c) 11% to 13% d) 3% to 4%
a
the length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patients nose to the____ a) earlobe b) mandible c) corner of the mouth d) epiglottis
a
upon reviewing a patient's 12-lead ECG, you note ST segment elevation of 2 mm in leads II, III, aVF how would you classify the electrocardiographic findings? a) ST segment elevation myocardial infarction b) Non -ST segment elevation c) normal d) nondiagnostic
a
what device on a resuscitation bag-mask device may prevent sufficient tidal volume in patient with poor lung compliance? a) pressure-relief valve b) HEPA or viral filter c) manometer d) PETCO2 cuvette
a
what is the most common symptom of myocardial ischemia and infarction? a) retrosternal chest pain b) sweating c) nausea d) difficulty breathing
a
what is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindications after hospital arrival? a) 45 minutes b) 35 minutes c) 40 minutes d) 30 minutes
a
when should you occlude the side opening of a suction catheter when performing oropharyngeal suctioning? a) while withdrawing the catheter b) during insertion of the catheter c) only when secretions are visualized d) during both withdrawal and insertion
a
when you use a bag-mask device, you should deliver approximately 500 to _____ mL tidal volume a) 600 b) 700 c) 800
a
which action is part of the secondary assessment of a conscious patient? a) formulate a differential diagnosis b) attach a monitor/defibrillator c) give IV/IO fluids if needed d) determine the patient's level of consciousness
a
which demographic group experiencing acute coronary syndromes is more likely to present without chest pain? a) females b) adolescents c) patients taking beta-blockers d) smokers
a
SCENARIO the patient is not responding well to ventilation and suctioning. you decide to intubate the patient in addition to clinical assessment, what is the single most reliable method of confirming and monitoring correct placement of the ET tube? a) chest x ray b) quantitative waveform capnography c) auscultation d) direct visualization
b
SCENARIO the patient's signs are HR - 84 BP 124/73 SPO 66% and the skin is cyanotic around the mouth and extremities what is the recommended rate for rescue breaths? a) 2 breaths every 5 to 6 seconds b) 1 breath every 6 seconds c) 1 breath every 3 seconds d) 2 breaths every 10 seconds
b
SCENARIO 2 what actions should the hospital staff take to determine whether the patient is a candidate for fibrinolytic therapy? a) obtain an MRI of the brain for confirmation of hemorrhage b) repeat the neurologic exam c) order a 12-lead ECG d) determine family stroke history
b
SCENARIO 2 what needs to be completed for this patient within 20 minutes after hospital arrival? a) admission to a monitored bed b) neurologic assessment c) administration of fibrinolytic therapy d) interpretation of the emergent CT scan or MRI of the brain
b
The BLS Assessment is a systematic approach to BLS for trained healthcare providers. This approach stresses: a) basic airway management b) early cpr and defibrillation c) defibrillation
b
how long should the second rescuer squeeze the bag-mask device when providing 2 rescuer ventilation? a) 2 seconds b) 1 second c) 4 seconds d) 3 seconds
b
oxygen should be delivered to a patient who has obvious signs of heart failure if the oxygen saturation is less than _____ or unknown a) 94% b) 90% c) 92% d) 88%
b
select the first step in the use of an oropharyngeal airway a) measure and select the proper size oropharyngeal airway b) clear the mouth and pharynx c) rotate the oropharyngeal airway into the proper position d) ventilate the patient with a bag-mask device
b
what is a benefit of morphine when given for the management of acute coronary syndromes? a) vasoconstriction b) central nervous system analgesia c) increases systemic vascular resistance d) increases left ventricular preload
b
what is an advantage of EMS alerting the receiving facility of the impending arrival of a patient with suspected acute ischemic stroke? a) the hospital can determine the most appropriate patient destination b) the hospital can perform more efficient evaluation and management c) the hospital can have fibrinolytic drugs already prepared d) the emergency department can quickly determine glucose levels
b
what is the diastolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke? a) 100mm Hg b) 110mm Hg c) 115mm Hg d) 105mm Hg
b
what is the door-to-needle time goal for 85% or more of acute ischemic stroke patients treated with IV thrombolytics? a) 30 minutes b) 60 minutes c) 40 minutes d) 50 minutes
b
what is the estimated probability of the Cincinnati prehospital stroke scale with 1 abnormal finding when scored by prehospital providers? a) 88% b) 72% c) 50% d) 80%
b
what is the most effective way to deliver bag-mask ventilation? a) using a head tilt- chin lift maneuver b) using a 2 person technique c) using a jaw thrust maneuver d) using a 1 person technique
b
what is the most reliable method of confirming and monitoring correct placement of an endotracheal tube? a) watching for chest rise b) quantitative waveform capnography c) direct visualization of endotracheal tube placement d) absence of gurgling sounds from the stomach
b
what is the most serious potential complication of nasopharyngeal airway insertion into a patient with facial trauma? a) trismus b) misplacement into the cranial cavity c) laryngospasm d) hypopharyngeal placement
b
what is the recommended ventilation rate for an adult in cardiac arrest with an advanced airway device in place? a) twice every 30 compressions b) once every 6 seconds c) once every 4 seconds d) once every 15 compressions
b
what type of stroke occurs when a blood vessel in the brain suddenly ruptures into the surround tissue? a) cryptogenic stroke b) hemorrhagic stroke c) transient ischemic attack d) ischemic stroke
b
when performing the jaw thrust maneuver on patients with suspected cervical spine injury, where should you place your fingers? a) behind the patients ears b) just under the angle of the lower jaw c) on top of the patient's jaw d) under the patients chin
b
which is an advantage of EMS transport to a stroke hospital for a patient with suspected acute ischemic stroke? a) patients transported by ambulance are seen first b) responding providers can stabilize critical issues c) family members can ride to the hospital with the patient d) EMS transport is faster than being driven by a friend
b
SCENARIO 2 within 45 minutes, the neuroimaging interpretation of the CT scan of the brain suggests an acute ischemic infarction. there are no signs of hemorrhage or mass leisons is this patient a potential candidate for fibrinolytic therapy? a) no b) not enough information c) yes
c
SCENARIO2 you find that the patient's neurologic function is rapidly improving. is the patient still a candidate for fibrinolytic therapy? a) yes b) not enough information c) no
c
a 5 9year old patient is reporting difficulty breathing physical examination reveals nasal flaring, intercostal retractions, and use of accessory muscles. the respiratory rate is 28 breaths per minute oxygen saturation is 92% PETCO2 is 36 mm Hg how would you categorize this patient's condition? a) respiratory arrest b) normal respiratory status c) respiratory distress d) respiratory failure
c
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? a) 12 hours b) 24 hours c) 3 hours d) 6 hours
c
identify the systolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke a) 177mm Hg b) 190mm Hg c) 185mm Hg d) 180mm Hg
c
patients with perfusing rhythms should receive ventilations once every ____ seconds a) 3 b) 4 c) 6 d) 5 e) 2
c
what is the average respiratory rate for an adult at rest? a) 28 to 32/min b) 6 to 10/min c) 12 to 20/min d) 22 to 26/min
c
what is the door-to-device time goal for direct-arriving patients with acute ischemic stroke treated with endovascular therapy? a) 80 minutes b) 70 minutes c) 90 minutes d) 100 minutes
c
what is the first step in the systematic approach to patient assessment? a) primary assessment b) secondary assessment c) initial impression d) BLS assessment
c
what is the maximum time from last known normal when endovascular therapy can be performed? a) 6 hours b) 3 hours c) 24 hours d) 12 hours
c
what tidal volume typically maintains normal oxygenation and elimination of carbon dioxide? a) 12 to 14mL/kg b) 3 to 5mL/kg c) 6 to 8mL/kg d) 9 to 11mL/kg
c
which is a contraindication to the use of an oropharyngeal airway? a) pediatric patient b) bag-mask ventilation c) conscious patient d) absent gag reflex
c
Symptoms of ACS
chest pain (tightness or pressure) pressure fullness squeezing or pain in center o chest lasting several minutes chest discomfort spreading to shoulder, neck one or both arms, or jaw. spread to back or between shoulder blades light-headed, dizzy, fainting, syncope, sweating, nausea, vomiting unexplained SOB with or without chest discomfort less common - epigastrium discomfort
a 75 year old patient is having difficulty breathing, with increased respiratory effort the patient has a history of emphysema the patient is drowsy auscultation reveals bilateral wheezing, although the lung sounds are difficult to appreciate the respiratory rate is 38 breaths per minute oxygen saturation is 85% PETCO2 is 49 mm Hg a) respiratory arrest b) normal respiratory status c) respiratory distress d) respiratory failure
d
how much tidal volume must you provide with a bag-mask device to produce visible chest rise for an adult patient in respiratory arrest? a) 2 to 3 mL/kg b) 4 to 5 mL/kg c) 8 to 9 mL/kg d) 6 to 7 mL/kg
d
what blood glucose level should trigger the administration of IVV or subcutaneous insulin for a patient with acute ischemic stroke? a) 150 mg/dL b) 170 mg/dL c) 160 mg/dL d) 180 mg/dL
d
what is a potential complication of using a nasopharyngeal airway that is too long? a) blocking carotid blood flow b) exiting through the oral cavity c) nasopharyngeal obstruction d) entering the esophagus
d
what is the maximum length of suction catheter that should be inserted into the patient's oropharynx beyond the tongue? a) the corner of the mouth to the laryngeal cartilage b) the corner of the mouth to the epigastric region c) the tip of the nose to the corner of the mouth d) the tip of the nose to the earlobe
d
what is the maximum time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment? a) 4 hours b) 12 hours c) 3 hours d) 6 hours
d
what is the potential complication of inserting an oropharyngeal airway that is too small? a) trauma to laryngeal structures b) laryngeal obstruction c) soft tissue trauma to the lips d) pushing the base of the tongue back
d
what is the term for the rise in arterial carbon dioxide levels typically associated with respiratory failure a) bradypnea b) hyperventilation c) hypoxemia d) hypercapnia
d
what is the time goal for neurologic assessment by the stroke team or designee and noncontrast computed tomography or magnetic resonance imaging performed after hospital arrival? a) 10 minutes b) 25 minutes c) 15 minutes d) 20 minutes
d
which action is not part of the acute stroke pathway? a) monitoring blood pressure b) performing dysphagia screening c) monitoring temperature d) seizure prophylaxis
d
which class of medications commonly given to patients with acute coronary syndromes may be adversely affected by morphine administration? a) beta blockers b) phosphodiesterase inhibitors c) calcium channel blockers d) oral antiplatelet medications
d
which clinical finding represents a contraindication to the administration of nitroglycerin? a) anterior wall infarction b) lateral wall infarction c) posterior wall infarction d) confirmed right ventricular infarction
d
which is a sign of stroke? a) shortness of breath b) abdominal pain c) retrosternal chest pain d) trouble speaking
d
