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AHA ACLS EXAM ACTUAL EXAM
2024 | ALL QUESTIONS AND
CORRECT ANSWERS (ALREADY
GRADED A+) | LATEST UPDATE
Which action improves the quality of chest compressions delivered during resuscitave attemepts? ------CORRECT ANSWER----------------Shitch providers about every 2 min or every 5 compression cycles. What is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse of 80 beats/min? ------CORRECT ANSWER----------------1 breath every 5-6 seconds A pt. presents to the ER with a new onset of dizziness and fatugue. Onexamination, the pt's heart rate is 35 beats/min, BP is 70/50, resp. rate is 22 per min, O2 sat is 95%. What is the appropriate 1st medication? ------CORRECT ANSWER----------------Atropine 0.5mg A pt. presents to the ER with dizziness and SOB with a sinus brady of 40/min. The initial atropine dose was ineffective and your monitor does not provide TCP. What is the appropriate dose of Dopamine for this pt? ------CORRECT ANSWER---------------- 2 - 10mcg/kg/min A pt. has an onset of dizziness. The pt.s heart rate is 180, BP is 110/70, resp. rate is 18, O2 sat is 98%. This is a reg narrow complex tach rythm. What is the next intervention? - -----CORRECT ANSWER----------------Vagal manuever. A monitored pt. in the ICU developed a suddent onset of narrow complex tach at a rate of 220/min. The pt's BP is 128/58, the PETCO2 is 38mm Hg, and the O2 sat is 98%. There is an EJ established for vascular access. The pt. denies taking any vasodialators.
A 12 lead shows no ischemia or infarction. Vagal manuevers are ineffective. What is the next intervention? ------CORRECT ANSWER----------------Adenosine 12mg IV You receiving a radio report from an EMS team enroute with a pt. who may be having a stroke. The hospital CT scanner is broken. What should you do? ------CORRECT ANSWER----------------Divert the pt. to a hospital 15 min away with CT capabilities. Foundational Facts: Stroke Centers and Stroke Units Choose an appropriate inidication to stop or withhold resuscitive efforts. ------CORRECT ANSWER----------------Evidence of rigor mortis. A 49 y/ofmaile arrives in the ER with persistant epigastric pain. She has been taking antacids PO for the past 6 hours because she she had heartburn. BP is 118/72, heart rate is 92/min, resp. rate is 14 non-labored and O2 sat is 96%. What is the most appropriate next action? ------CORRECT ANSWER----------------Obtain a 12 lead ECG. A pt. in respiratory failure becomes apneic but contineues to have a strong pulse. The heart rate is dropping paridly and now shows a sinus brady rate at 30/min. What intervention has the highest priority? ------CORRECT ANSWER----------------Simple airway manuevers and assisted ventilations. What is the appropriate procedure for ET suctioning after the catheter is selected? ------ CORRECT ANSWER----------------Suction during withdrawl, but not for longer than 10 seconds. While treating a stable pt for dizziness, a BP of 68/30, cool and clammy, you see a brady rythm on the ECG. How do you treat this? ------CORRECT ANSWER---------------- Atropine 0.5mg A 68 y/o female pt. experienced a sudden onset of right arm weakness. BP is 140/90, pulse is 78/min, resp rate is non-labored 14/min, 02 sat is 97%. Lead 2 in the ECG
What is the usual post-cardiac arrest target range for PETCO2 who achieves return of spontaneous circulation (ROSC)? ------CORRECT ANSWER---------------- 35 - 40mm Hg Which conditionis a contraindication to theraputic hypothermia during the post-cardiac arrest period for pt's who achieve return of spontaneous circulation (ROSC)? ------ CORRECT ANSWER----------------Responding to verbal commands 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? ------ CORRECT ANSWER----------------Start chest compressions of at least 100 per min. You are evaluating a 58 year old man with chest pain. The BP is 92/50 and a heart rate of 92/min, non-labored respiratory rate is 14 breaths/min and the pulse O2 is 97%. What assessment step is most important now? ------CORRECT ANSWER---------------- Obtaining a 12 lead ECG. Identification of Chest Discomfort Suggestive of Ischemia What is the preferred method of access for epi administration during cardiac arrest in most pts? ------CORRECT ANSWER----------------Peripheral IV An AED does not promptly analyze a rythm. What is your next step? ------CORRECT ANSWER----------------Begin chest compressions. You have completed 2 min of CPR. The ECG monitor displays the lead below (PEA) and the pt. has no pulse. You partner resumes chest compressions and an IV is in place. What management step is your next priority? ------CORRECT ANSWER------------ ----Administer 1mg of epinepherine During a pause in CPR, you see a narrow complex rythm on the monitor. The pt. has no pulse. What is the next action? ------CORRECT ANSWER----------------Resume compressions
What is acommon but sometimes fatal mistake in cardiac arrest management? ------ CORRECT ANSWER----------------Prolonged interruptions in chest compressions. Which action is a componant of high-quality chest comressions? ------CORRECT ANSWER----------------Allowing complete chest recoil Which action increases the chance of successful conversion of ventricular fibrillation? --- ---CORRECT ANSWER----------------Providing quality compressions immediately before a defibrillation attempt. Which situation BEST describes PEA? ------CORRECT ANSWER----------------Sinus rythm without a pulse What is the best strategy for perfoming high-quality CPR on a pt.with an advanced airway in place? ------CORRECT ANSWER----------------Provide continuous chest compressionswithout pauses and 10 ventilations per minute. 3 min after witnessing a cardiac arrest, one memeber of your team inserts an ET tube while another performs continuous chest comressions. During subsequent bentilation, you notice the presence of a wavefom on the capnogrophy screen and a PETCO2 of 8 mm Hg. What is the significance of this finding? ------CORRECT ANSWER---------------- Chest compressions may not be effective. The use of quantitative capnography in intubated pt's does what? ------CORRECT ANSWER----------------Allowsfor monitoring CPR quality For the past 25 min, EMS crews have attempted resuscitation of a pt who originally presented with V-FIB. After the 1st shock, the ECG screen displayed asystole which has persisted despite 2 doses of epi, a fluid bolus, and high quality CPR. What is your
Which of the following is a sign of effective CPR? ------CORRECT ANSWER---------------- PETCO2 = or > 10mm Hg What is the purpose of a medical emergency team (MET) or rapid response team? ------ CORRECT ANSWER----------------Improving patient outcomes by identifying and treating early clinical deterioration. Foundational Facts: Medical Emergency Teams (METs) and Rapid Response Teams (RRTs) What is the potential danger to using ties that pass circumfrentially around the pt's neck when securing an advanced airway? ------CORRECT ANSWER----------------Obstruction of veneous return from the brain What is the most reliable method of confirming and montioring correct placement of an ET tube? ------CORRECT ANSWER----------------Continuous waveform capnography What is the recommended IV fluid (NS or LR) bolus dose for a pt. who achieves ROSC but is hypotensive during the post-cardiac arrest period? ------CORRECT ANSWER------ ----------1 to 2 Liters What is the minimum systolic BP one should attempt to achieve with fluid, Inotropic, or vasopressor administration in a hypotensive post-cardiac arrest who achieves ROSC? - -----CORRECT ANSWER----------------90mm Hg What is the 1st treatment priority for a pt. who achieves ROSC? ------CORRECT ANSWER----------------Optimizing ventilation and oxygenation. Which is an appropriate and important intervention to perform for a patient who achieves ROSC during an out-of-hospital resuscitation? ------CORRECT ANSWER------- ---------Transport the patient to a facility capable of performing PCI.
What is the recommended oral dose of aspirin for patients suspected of having one of the acute coronary syndromes? ------CORRECT ANSWER----------------160 to 325 mg Administer Oxygen and Drugs: Aspirin (Acetylsalicyclic Acid) 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 above. After you start an IV, what is the next action? (3rd degree heart block) ------CORRECT ANSWER----------------Conduct a problem- focused history and physical examination. BLS and ACLS surveys IV/IO drug administration during CPR should be ------CORRECT ANSWER---------------- Given rapidly during compressions Routes of Access for Drugs Which treatment or medication is appropriate for the treatment of a patient in asystole? - -----CORRECT ANSWER----------------Epinephrine Administer Vasopressors Which of the following is the recommended first choice for establishing intravenous access during the attempted resuscitation of a patient in cardiac arrest? ------CORRECT ANSWER----------------Antecubital vein 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? ------CORRECT ANSWER----------------Closed-loop communication
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? ------CORRECT ANSWER----------------Seeking expert consultation. Application of the Tachycardia Algorithm to the Stable Patient: Wide (Broad)-Complex Tachycardias EMS personnel arrive to find a patient in cardiac arrest. Bystanders are performing CPR. After attaching a cardiac monitor, the responder observes the rhythm strip shown above. What is the most important early intervention? (V-fib) ------CORRECT ANSWER----------------Defibrillation Principle of Early Defibrillation A patient with pulseless ventricular tachycardia is defibrillated. What is the next action? - -----CORRECT ANSWER----------------Start chest compressions at a rate of at least 100/min. Resume CPR Emergency medical responders are unable to obtain a peripheral IV for a patient in cardiac arrest. What is the next most preferred route for drug administration? ------ CORRECT ANSWER----------------Intraosseous (IO) Routes of Access for Drugs What is the recommended compression rate for performing CPR? ------CORRECT ANSWER----------------At least 100 per minute (100-120) The BLS Survey You have completed your first 2-minute period of CPR. You see an organized, nonshockable rhythm on the ECG monitor. What is the next action? ------CORRECT ANSWER----------------Have a team member attempt to palpate a carotid pulse.
Rhythm Check What is the most appropriate intervention for a rapidly deteriorating patient who has the lead II ECG shown above? ------CORRECT ANSWER----------------Synchronized cardioversion Indications for Cardioversion What is the appropriate rate of chest compressions for an adult in cardiac arrest? ------ CORRECT ANSWER----------------At least 100/min. Not approximately 120/min. The BLS Survey A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the lead II ECG rhythm above. What is the appropriate next intervention? (Wide, regular Tachycardia with a Pulse) ------CORRECT ANSWER---------------- Synchronized cardioversion Indications for Cardioversion A responder is caring for a patient with a history of CHF. The patient is experiencing SOB, BP of 68/50 mm Hg, and a HR of 190/min. The patient's lead II ECG is displayed above. Which of the following terms best describes this patient? ------CORRECT ANSWER----------------Unstable supraventricular tachycardia The Approach to Unstable Tachycardia Symptoms and Signs What is the recommended assisted ventilation rate for patients in respiratory arrest with a perfusing rhythm? ------CORRECT ANSWER----------------10 to 12 breaths per minute Ventilation Rates
What is the recommended duration of therapeutic hypothermia after reaching the target temperature? ------CORRECT ANSWER----------------12 to 24 hours What is the recommended initial intervention for managing hypotension in the immediate period after return of spontaneous circulation (ROSC)? ------CORRECT ANSWER----------------Administration of IV or IO fluid bolus Treat Hypotension (SBP <90 mm Hg) What is the recommendation of the use of cricoid pressure to prevent aspiration during cardiac arrest? ------CORRECT ANSWER----------------Not recommended for routine use What is the danger of routinely administering high concentrations of oxygen during the post-cardiac arrest period for patients who achieve ROSC? ------CORRECT ANSWER-- --------------Potential oxygen toxicity Optimize Ventilation and Oxygenation What is the recommended target temperature range for achieving therapeutic hypothermia after cardiac arrest? ------CORRECT ANSWER----------------32 to 34 degrees Celsius 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? ------CORRECT ANSWER----------------Check the patient's pulse What is the recommended next step after a defibrillation attempt? ------CORRECT ANSWER----------------Begin CPR, starting with chest compressions.
An AED advises a shock for a pulseless patient lying in snow. What is the next action? - -----CORRECT ANSWER----------------Administer the shock immediately and continue as directed by the AED. AED Use in Special Situations What survival advantages does CPR provide to a patient in V-Fib? ------CORRECT ANSWER----------------Produces a small amount of blood flow to the heart. Principle of Early Defibrillation A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. The next intervention is to ------CORRECT ANSWER----------------Administer a second shock The Cardiac Arrest Algorithm What is the recommended dose of epinephrine for the treatment of hypotension in a post-cardiac arrest patient who achieves ROSC? ------CORRECT ANSWER---------------- 0.1 to 0.5 mcg/kg per minute IV infusion Treat hypotension (SBP <90 mm Hg) 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? ------CORRECT ANSWER----------------Performing a head tilt- chin lift maneuver Which of the following is an acceptable method of selecting an appropriately sized oropharyngeal airway (OPA)? ------CORRECT ANSWER----------------Measure from the corner of the mouth to the angle of the mandible Which condition is an indication to stop or withhold resuscitative efforts? ------ CORRECT ANSWER----------------Safety threats to providers
What is the first step when using an AED? --------CORRECT ANSWER---------------turn it on What is the 2nd step when using an AED --------CORRECT ANSWER---------------listen to it and follow the instructions What is a team leaders first responsibility --------CORRECT ANSWER--------------- managing the team - clear roles and responsibilities What is ventilation rate and frequency for the adult patient with a pulse? What happens to the heart rate in a patient with severe hypoxia? (respiratory arrest) --------CORRECT ANSWER---------------w/ pulse = rescue breathing, 1 breath every 6 seconds, 10 breaths per minute hypoxia - bradycardia initially What type of patient requires oral pharyngeal airway? When is it appropriate to place? -- ------CORRECT ANSWER---------------unconscious/unresponsive no gag reflex After ROSC, what is the target PETCO2 reading? --------CORRECT ANSWER------------- -- 35 - 45 mmHg What is the ventilation rate on the pulseless patient after advanced airway placement? Do you pause compressions during ventilation with ETT? --------CORRECT ANSWER--- ------------(no advanced airway 30:2) advanced airway - 1 breath every 6 seconds, 10 times per minute
Agonal breathing may indicate what? --------CORRECT ANSWER---------------cardiac arrest (brainstem breathing) (ex: almost dead fish breathing on the dock) (ON TEST) What is the easiest way to open the airway of a patient who isnt breathing? -------- CORRECT ANSWER---------------least intrusive - head tilt chin lift intrusive - (c spine injury or unsure) jaw thrust Correct treatments for unstable bradycardia --------CORRECT ANSWER---------------APP A - atropine, 1 mg q3-5 mins up to 3 mg, anticholinergic med working on parasympathetic side therefore competitive antagonist - normalizes HR (unresolved vagal tone) P - pacing, transcutaneous (pads placed on chest, same as defibrillation placement) P - pressers, epi 2-10 mcg/min, DA 5-20 mcg/kg/min, they are equal and accomplish same goal (faster and safer = DA per instructor, premixed) (epi grows bacteria if pre mixed, has to be mixed during code) What is true about PR interval in second degree type 2 block? --------CORRECT ANSWER---------------consistent PR, every P wave is there but they dont always have QRS What is true about PR interval in second degree type 1 block? --------CORRECT ANSWER---------------continuing prolongation, longer longer longer drop now you have a Weinkibach Relationship between the p wave and QRS in 3rd degree or complete heart block -------- CORRECT ANSWER---------------there is no relationship, they are working independently from each other What is the most common cause of bradycardias? --------CORRECT ANSWER------------ ---hypoxia
bolus in 100 mL of D5 over 10 mins, can repeat over 10 mins, maintenance 1 mg per min for 6 hours) unstable VT - synchronized cardioversion at 100 J What is the first treatment option for all unstable bradycardias and blocks? -------- CORRECT ANSWER---------------atropine 1 mg every 3-5 mins, max 3 mg How is closed loop communication used in med admin during a code? What to do if told to give wrong dose/med? --------CORRECT ANSWER---------------person running the code state the drug they want, repeated out loud by the person giving it SAY SOMETHING List the 5 Hs and 5 Ts --------CORRECT ANSWER---------------H's: hypoxia, hypovolemia (#1 cause), hypothermia, hydrogen ion excess (acidotic - anaerobic cellular respiration - krebbs), hypoglycemia, hypo/hyper kalemia T's: tension pneumothorax, toxin (MC non cardiac related issue), tamponade, thrombosis (PE, coronary - heart attack) What is the most frequent cause of PEA/Asytole --------CORRECT ANSWER--------------- hypovolemia What is PEA --------CORRECT ANSWER---------------pulseless electrical activity, any non ventricular organized electrical rhythm without a pulse (ex - second degree type 2 heart block w/o pulse, SVT w/o pulse, etc!) How do you confirm a patient is really in asytole --------CORRECT ANSWER--------------- check the pulse of the patient change the lead on the monitor - check in a second lead
If your patient has persistent asystole after continuous CPR for 10 mins and several doses of epi, what discussion might be appropriate? --------CORRECT ANSWER---------- -----d/c efforts During a code of PeTCO2 reading of 8 could indicate what? --------CORRECT ANSWER---------------crappy CPR (needs to be at least 10) What does a PeTCO2 reading that jumps to 35 during compressions indicate? -------- CORRECT ANSWER---------------continue to compress until 2 min cycle is over - STOP if patient wakes up patient now has pulse - CHECK THE PULSE What does ROSC stand for? --------CORRECT ANSWER---------------Return of spontaneous circulation What is the first treatment priority after ROSC --------CORRECT ANSWER--------------- 1 - airway: is it patent - likely not so intubate (ETT) 2 - breathing: bagging appropriately, use PeTCO2 to monitor (too fast CO2 will fall, too slow CO2 will rise) List the assessments done immediately after ROSC ABCD and the 3 E's --------CORRECT ANSWER---------------airway breathing circulation: fresh set of vitals, any change of status get new vitals (ex - bad BP hang some fluid, after 2 boluses then go onto pressors) are you awake? (if unresponsive TTM - 32 - 36 C for at least 24 hrs) EKG expert consult
