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ACLS Advanced Cardiovascular Life
Support WRITTEN EXAM 136
QUESTIONS AND ANSWERS
You find an unresponsive pt. who is not breathing. After activating the emergency response system, you determine there is no pulse. What is your next action? - answer Start chest compressions of at least 100 per min. You are evaluating a 58-year-old man with chest pain. The blood pressure is 92/50 mm Hg, the heart rate is 92/min, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry reading is 97%. What assessment step is most important now? - answer Obtaining a 12 lead ECG. What is the preferred method of access for epi administration during cardiac arrest in most pts?
- answer Peripheral IV An AED does not promptly analyze a rythm. What is your next step? - answer Begin chest compressions. You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm below, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. What management step is your next priority? - answer Administer 1mg of epinephrine During a pause in CPR, you see this lead II ECG rhythm on the monitor. The patient has no pulse. What is the next action? - answer Resume compressions What is a common but sometimes fatal mistake in cardiac arrest management? - answer Prolonged interruptions in chest compressions.
Which action is a componant of high-quality chest comressions? - answer Allowing complete chest recoil Which action increases the chance of successful conversion of ventricular fibrillation? - answer Providing quality compressions immediately before a defibrillation attempt. Which situation BEST describes pulseless electrical activity? - answer Sinus rythm without a pulse What is the BEST strategy for performing high-quality CPR on a patient with an advanced airway in place? - answer Provide continuous chest compressions without pauses and 10 ventilations per minute. Three minutes after witnessing a cardiac arrest, one member of your team inserts an endotracheal tube while another performs continuous chest compressions. During subsequent ventilation, you notice the presence of a waveform on the capnography screen and a PETCO level of 8 mm Hg. What is the significance of this finding? - answer Chest compressions may not be effective. The use of quantitative capnography in intubated patients - answer allows for monitoring of CPR quality. For the past 25 minutes, an EMS crew has attempted resuscitation of a patient who originally presented in ventricular fibrillation. After the first shock, the ECG screen displayed asystole, which has persisted despite 2 doses of epinephrine, a fluid bolus, and high-quality CPR. What is your next treatment? - answer Consider terminating resuscitive efforts after consulting medical control. Which is a safe and effective practice within the defibrillation sequence? - answer Be sure oxygen is not blowing over the patient's chest during the shock.
A patient presents to the emergency department with new onset of dizziness and fatigue. On examination, the patient's heart rate is 35/min, the blood pressure is 70/50 mm Hg, the respiratory rate is 22 breaths/min, and the oxygen saturation is 95%. What is the appropriate first medication? - answer Atropine 0.5mg A patient with dizziness and shortness of breath with a sinus bradycardia of 40/min. The initial atropine dose was ineffective, and your monitor/defibrillator is not equipped with a transcutaneous pacemaker. What is the appropriate dose of dopamine for this patient? - answer 2 to 10 mcg/kg per minute A patient has sudden onset of dizziness. The patient's heart rate is 180/min, blood pressure is 110/70 mm Hg, respiratory rate is 18 breaths/min, and pulse oximetry reading is 98% on room air. The lead II ECG is shown below: - answer Vagal manuever. A monitored patient in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 220/min. The patient's blood pressure is 128/58 mm Hg, the PETCO2 is 38 mm Hg, and the pulse oximetry reading is 98%. There is vascular access at the left internal jugular vein, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirms a supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal maneuvers. What is the next recommended intervention? - answer Adenosine 6mg IV push You are receiving a radio report from an EMS team en route with a patient who may be having an acute stroke. The hospital CT scanner is not working at this time. What should you do in this situation? - answer Divert the patient to a hospital 15 minutes away with CT capabilities. Choose an appropriate indication to stop or withhold resuscitative efforts. - answer Evidence of rigor mortis. A 49-year-old woman arrives in the emergency department with persistent epigastric pain. She had been taking oral antacids for the past 6 hours because she thought she had heartburn. The initial blood pressure is 118/72 mm Hg, the heart rate is 92/min and regular, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry reading is 96%. Which is the most appropriate intervention to perform next? - answer Obtain a 12 lead ECG.
A patient in respiratory failure becomes apneic but continues to have a strong pulse. The heart rate is dropping rapidly and now shows a sinus bradycardia at a rate of 30/min. What intervention has the highest priority? - answer Simple airway manuevers and assisted ventilations. What is the appropriate procedure for endotracheal tube suctioning after the appropriate catheter is selected? - answer Suction during withdrawal but for no longer than 10 seconds. While treating a patient with dizziness, a blood pressure of 68/30 mm Hg, and cool, clammy skin, you see this lead II ECG rhythm:What is the first intervention? - answer Atropine 0.5mg A 68-year-old woman experienced a sudden onset of right arm weakness. EMS personnel measure a blood pressure of 140/90 mm Hg, a heart rate of 78/min, a nonlabored respiratory rate of 14 breaths/min, and a pulse oximetry reading of 97%. The lead II ECG displays sinus rhythm. What is the most appropriate action for the EMS team to perform next? - answer Cincinnati Prehospital Stroke Scale assessment EMS is transporting a patient with a positive prehospital stroke assessment. Upon arrival in the emergency department, the initial blood pressure is 138/78 mm Hg, the pulse rate is 80/min, the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95% on room air. The lead II ECG displays sinus rhythm. The blood glucose level is within normal limits. What intervention should you perform next? - answer Head CT scan What is the proper ventilation rate for a patient in cardiac arrest who has an advanced airway in place? - answer 8-10 breaths per minute A 62-year-old man in the emergency department says that his heart is beating fast. He says he has no chest pain or shortness of breath. The blood pressure is 142/98 mm Hg, the pulse is 200/min, the respiratory rate is 14 breaths/min, and pulse oximetry is 95% on room air. What intervention should you perform next? - answer Obtain a 12 lead ECG.
What is the minimum systolic blood pressure one should attempt to achieve with fluid, inotropic, or vasopressor administration in a hypotensive post-cardiac arrest patient who achieves ROSC? - answer 90mm Hg What is the first treatment priority for a patient who achieves ROSC? - answer Optimizing ventilation and oxygenation. What should be done to minimize interruptions in chest compressions during CPR? - answer Continue CPR while the defibrillator is charging. Which condition is an indication to stop or withhold resuscitative efforts? - answer Safety threat to providers After verifying the absence of a pulse, you initiate CPR with adequate bag-mask ventilation. The patient's lead II ECG appears below. What is your next action? - answer IV or IO access After verifying unresponsiveness and abnormal breathing, you activate the emergency response team. What is your next action? - answer Check for a pulse. What is the recommendation on the use of cricoid pressure to prevent aspiration during cardiac arrest? - answer Not recommended for routine use What survival advantages does CPR provide to a patient in ventricular fibrillation? - answer Produces a small amount of blood flow to the heart What is the recommended compression rate for performing CPR? - answer At least 100 per minute EMS personnel arrive to find a patient in cardiac arrest. Bystanders are performing CPR. After attaching a cardiac monitor, the responder observes the following rhythm strip. What is the most important early intervention? - answer defibrillation
A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. The next intervention is to - answer administer a second shock. What is the recommended next step after a defibrillation attempt? - answer Begin CPR, starting with chest compressions. Which of the following is the recommended first choice for establishing intravenous access during the attempted resuscitation of a patient in cardiac arrest? - answer Antecubital vein Which finding is a sign of ineffective CPR? - answer PETCO2 <10 mm Hg How often should the team leader switch chest compressors during a resuscitation attempt? - answer. Every 2 minutes IV/IO drug administration during CPR should be - answer given rapidly during compressions What is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation? - answer 300 mg A team leader orders 1 mg of epinephrine, and a team member verbally acknowledges when the medication is administered. What element of effective resuscitation team dynamics does this represent? - answer Closed-loop communication How long should it take to perform a pulse check during the BLS Survey? - answer 5 to 10 seconds Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive and notice that he is taking agonal breaths. What is the next step in your assessment and management of this patient? - answer Check the patient's pulse.
A 49-year-old man has retrosternal chest pain radiating into the left arm. The patient is diaphoretic, with associated shortness of breath. The blood pressure is 130/88 mm Hg, the heart rate is 110/min, the respiratory rate is 22 breaths/min, and the pulse oximetry value is 95%. The patient's 12-lead ECG shows ST-segment elevation in the anterior leads. First responders administered 160 mg of aspirin, and there is a patent peripheral IV. The pain is described as an 8 on a scale of 1 to 10 and is unrelieved after 3 doses of nitroglycerin. What is the next action? - answer Administer 2 to 4 mg of morphine by slow IV bolus. A 56-year-old man reports that he has palpitations but not chest pain or difficulty breathing. The blood pressure is 132/68 mm Hg, the pulse is 130/min and regular, the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95%. The lead II ECG displays a wide-complex tachycardia. What is the next action after establishing an IV and obtaining a 12-lead ECG? - answer Seeking expert consultation A postoperative patient in the ICU reports new chest pain. What actions have the highest priority? - answer Obtain a 12-lead ECG and administer aspirin if not contraindicated. An 80-year-old woman presents to the emergency department with dizziness. She now states she is asymptomatic after walking around. Her blood pressure is 102/72 mm Hg. She is alert and oriented. Her lead II ECG is below. After you start an IV, what is the next action? - answer Conduct a problem-focused history and physical examination. What is the recommended oral dose of aspirin for patients suspected of having one of the acute coronary syndromes? - answer 160 to 325 mg A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient's lead II ECG is displayed below. - answer stable supraventricular tachycardia What is the most appropriate intervention for a rapidly deteriorating patient who has this lead II ECG? - answer Synchronized cardioversion
What is the purpose of a medical emergency team (MET) or rapid response team (RRT)? - answer Improving patient outcomes by identifying and treating early clinical deterioration What is the recommended assisted ventilation rate for patients in respiratory arrest with a perfusing rhythm? - answer 10 to 12 breaths per minute Family members found a 45-year-old woman unresponsive in bed. The patient is unconscious and in respiratory arrest. What is the recommended initial airway management technique? - answer Performing a head tilt-chin lift maneuver A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the following lead II ECG rhythm: What is the appropriate next intervention? - answer Synchronized cardioversion A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm: What is the appropriate next intervention? - answer Defibrillation What is the recommended energy dose for biphasic synchronized cardioversion of atrial fibrillation? - answer 120to200J Which of the following is an acceptable method of selecting an appropriately sized oropharyngeal airway (OPA)? - answer Measure from the corner of the mouth to the angle of the mandible. Which is a contraindication to nitroglycerin administration in the management of acute coronary syndromes? - answer Right ventricular infarction and dysfunction What is the recommended initial intervention for managing hypotension in the immediate period after return of spontaneous circulation (ROSC)? - answer Administration of IV or IO fluid bolus
given immediately after the the third shock. What drug should the team leader request to be prepared for administration next? - answer second dose of epinephrine 1 mg A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine has been given. Which is the next drug to anticipate to administer? - answer amiodarone 300 mg You are monitoring a patient with chest discomfort who suddenly becomes unresponsive. You observe the following rhythm on the cardiac monitor. A defibrillator is present. What is your first action? - answer Give a single shock what do you do after return of spontaneous circulation - answer maintain O2 sat at 94% treat hypotension (fluids vasopressor) 12 lead EKG if in coma consider hypothermia if not in coma and ekg shows STEMI or AMI consider re-perfusion what are the 5 h's and 5 t's - answer hypovolemia hypoxia hydrogen ion (acidosis) hypo/hyperkalemia hypothermia tension pneumothorax tamponade, cardiac toxins thrombosis, pulmonary thrombosis, coronary
Bradycardia require treatment when? - answer chest pain or shortness of breath is present how do you treat non-symptomatic bradycardia - answer monitor and observe what constitutes symptomatic bradycardia - answer hypotension altered mental status signs of shock chest pain acute heart failure A patient with sinus bradycardia and a heart rate of 42 has diaphoresis and blood pressure of 80/60. What is the initial dose of atropine? - answer 0.5 mg how do you treat symptomatic bradycardia - answer give 0.5mg atropine every 3-5 mins to max of 3mg if that doesn't work try one of the following: transcutaneous pacing 2-10mcg/kg / minute dopamine infusion 2-10mcg per minute epinephrine infusion what is considered a tachycardia requiring treatment - answer over 150 per minute when do you consider cardioversion - answer if persistent tachycardia is causing: hypotension altered mental status signs of shock chest pain
second degree AV block type 1 wenckenbach - answer second degree AV block mobitz type 2 - answer third degree AV block - answer asystole - answer normal sinus rhythm - answer pulseless electrical activity - answer agonal rhythm/asystole - answer The five links in the adult Chain of Survival - answer 1- Immediate activation of EMS 2- Early CPR 3- Rapid defibrillation (not in peds) 4- Effective advanced life support 5- Integrated post-cardiac arrest care Type of breaths (not normal) that may be present in the first minutes after sudden cardiac arrest - answer Agonal gasps To place the pads on the victims bare chest, Place one pad on the upper-right chest (below the collarbone) and place the other pad - answer to the side of the left nipple, with the top edge of the pad a few inches below the armpit
If the heart muscle resets and initiates an organized rhythm this is called - answer ROSC return of spontaneous circulation
