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ACLS Post Test
You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The CT was normal with no sign of hemorrhage. The patient does not have any contraindications to fibrinolytic therapy. Which treatment is best? a. start fibrinolytic therapy ASAP b. hold fibrinolytic therapy for 24 hours c. order an echo before fibrinolytic administration d. wait for MRI result - ✔a. start fibrinolytic therapy ASAP For STEMI pt, maximum goal time for ED door-to-balloon-inflation time for PCI? a. 150 mins b. 180 mins c. 120 mins d. 90 mins - ✔d. 90 mins Which is the recommended oral dose of aspirin for a patient with suspected acute coronary syndrome? a. 81 mg b. 325-650 mg c. 160-325 mg d. 40 mg - ✔c. 160-325 mg chest compressions during for adult rate a. 40-60/min b. 60-80/min c. 80-100/min d. 100-120/min - ✔d. 100-120/min What is the effect of excessive ventilation? a. decresed cardiac output b. decreased intrathoracic pressure c. increased perfusion pressure d. increased venous return - ✔a. decreased cardiac output temperature to achieve targeted temperature management after cardiac arrest a. 30-34C b. 32-36C
c. 36-40C d. 38-42C - ✔b. 32-36C 3 mins into cardiac arrest resuscitation attempt, one member of your team inserts an endotracheal tube while another performs chest compressions. Capnography shows a persistent waveform & a PETCO2 of 8mmHg. What is the significance of the finding? a. chest compression may not be effective b. The endotrachael tube is in the esophagus c. the team is ventilating the patient too often d. the patient meets the criteria for termination of efforts - ✔a. chest compression may not be effective Your patient is in cardiac arrest and has been intubated. To assess CPR quality, you should? a. obtain a chest x-ray b. check the patient's pulse c. monitor the patient's PETCO d. obtain a 12-lead ECG - ✔c. monitor the patient's PETCO In addition to clinical assessment, which is the most reliable method to confirm & monitor correct placement of an endotracheal tube? a. arterial blood gas b. hemoglobin levels c. chest radiography d. continuous waveform capnography - ✔d. continuous waveform capnography A 45M had coronary artery stents placed 2 days ago. Today he is in severe distress and reporting "crushing" chest discomfort. He is pale, diphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40, respiratory is 28 bpm/min and O2 set is 89% on room air. - ✔answer has to do with acute coronary syndrome A 45M had coronary artery stents placed 2 days ago. Today he is in severe distress and reporting "crushing" chest discomfort. He is pale, diphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40, respiratory is 28 bpm/min and O2 set is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. WhIn addition to defibrillation, which intervention should be performed immediately? a. chest compression b. vasoactive meds c. vascular access d. advanced airway - ✔a. chest compression
radial pulse is very weak, blood pressure is 64/40, respiratory is 28 bpm/min and O2 set is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. Which would you have done first if the patient had not gone into ventricular fibrillation? a. given atropine 1mg b. established IV access c. obtained a 12 lead d. performed synchronized cardioversion - ✔d. performed synchronized cardioversion During post-cardiac arrest, which is recommended duration of targeted temp. management after reaching the correct temperature range? a. at least 24 hours b. 0-8 hour c. at least 36 hours d. at least 48 hours - ✔a. at least 24 hours which is the primary purpose of medical emergency team or rapid response team? a. provide diagnostic consultation to emergency department patients b. provide online consultation to EMS personnel c. improving patient outcomes by identifying & treating early clinical deterioration d. improving care for patients admitted to critical care units - ✔c. improving patient outcomes by identifying & treating early clinical deterioration Which of these tests should be performed for a patient with suspected stroke within 25 mins of hospital arrival? a. coagulation studies b. cardiac enzymes c. noncontrast CT scan of the head d. 12 lead ECG - ✔c. non-contrast CT scan of the head Which of the following signs are likely indicator of cardiac arrest in an unresponsive patient? a. slow, weak pulse rate b. cyanosis c. irregular, weak pulse d. agonal gasps - ✔d. agnoal gasps a patient is being resuscitated in a very noisy environment. A team member thinks he heard an order of 500mg of amiodarone IV. Which is the best response from the team member? - ✔I have an order to give 500mg of amiodarone IV. Is this correct?
Which is the recommended next step after a defibrillation attempt? a. check the ECG for evidence of a rhythm b. determine if a carotid pulse is present c. resume CPR, starting with chest compressions d. open the patient's airway - ✔c. resume CPR, starting with chest compressions A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, 68/50 mmHg, heart rate 190/min. The patient's lead 2 ECG is shown. Which best characterizes this patient's rhythm? - ✔unstable supraventicular tachycardia which is one way to minimize interruptions in chest compressions during CPR? - ✔continue CPR while the defibrillator charges A 68F lightheadedness, nausea, chest discomfort. Your assessment finds her awake & responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready & fast. Your are unable to get a BP. She has no obvious dependent edema, & her neck veins are flat. Her lung sounds are equal w/ moderate rales present bilaterally. The cardiac monitor shows rhythm seen here. Based on the patient's initial assessment, what adult ACLS algorithm should you follow? - ✔tachycardia wide complex (monophasic) tachycardia A 68F lightheadedness, nausea, chest discomfort. Your assessment finds her awake & responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready & fast. Your are unable to get a BP. She has no obvious dependent edema, & her neck veins are flat. Her lung sounds are equal w/ moderate rales present bilaterally. The cardiac monitor shows rhythm seen here. After your initial assessment, which intervention should be preformed? - ✔synchronized cardioversiion A 68F lightheadedness, nausea, chest discomfort. Your assessment finds her awake & responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready & fast. Your are unable to get a BP. She has no obvious dependent edema, & her neck veins are flat. Her lung sounds are equal w/ moderate rales present bilaterally. The cardiac monitor shows rhythm seen here. If the patient became apnic & pulseless but the rhythm remained the same, which would take the highest priority? - ✔perform defibrillation Which best describes the rhythm? - ✔monomorphic ventricular tachycardia A patient in stable narrow-complex tachycardia with a peripheral IV in place is refractory to the 1st dose of adenosine. Which dose would you administer next? - ✔12mg
d. reassign the team members - ✔a. address the team member immediately Which facility is the most appropriate EMS destination for a patient w/ a sudden cardiac arrest who achieved return of spontaneous circulation in the field? - ✔coronary reperfusion-capable medical center which is an acceptable method of selecting an appropriately sized oropharyngeal airway? - ✔measure from the corner of the mouth to the angle of the mandible A team member is unable to perform an assigned task because it is beyond the team member's scope of practice. Which action should the team member take? - ✔ask for a new task or role What is the minimum systolic blood pressure one should attempt to achieve w/ fluid administration or vasoactive agents in a hypotensive post-cardiac arrest patient who achieves return of spontaneous circulation? - ✔90 mmHg You are evaluating a 58M w/ chest discomfort, BP 92/50, heart rate 92/min, his non- labored respiratory rate is 14 bpm, and his pulse oximetry reading is 97%. Which assessment step is most important now? - ✔obtaining a 12 lead As a team leader, when do you tell the chest compressors to switch? a. about every 2 minutes b. about every 5 minutes c. only when they tell you that they are fatigued d. about every 7 minutes - ✔a. about every 2 minutes The patient's pulse ox shows a reading of 84% on room air. Which initial action do you take? - ✔apply oxygen (I think I put Bag valve mask for this and I got it wrong)
