What element of a system of care is represented by properly functioning resuscitation equipment?
System
Structure
Process
Patient outcome
answer
Structure
question
What is the first link in the out-of-hospital cardiac arrest (OHCA) chain of survival?
Activation of emergency response
Defibrillation
Advanced resuscitation
High-quality CPR
answer
Activation of emergency reponse
question
What are signs of clinical deterioration that would prompt the activation of rapid response system?
Symptomatic hypertension
Seizure
Unexplained agitation
Diastolic blood pressure greater than 60 mm Hg or less than 100 mm Hg
What is the primary purpose of a rapid response team (RRT) or medical emergency team (MET)?
To provide diagnostic consultation to emergency department patients
To improve care for patients admitted to critical care units
To improve patient outcomes by identifying and treating early clinical deterioration
To provide online consultation to emergency medical services personnel in the field
answer
To improve patient outcomes by identifying and treating early clinical deterioration
question
What happens when teams rapidly assess and intervene when patients have abnormal vital signs?
Morbidity and mortality rates are maintained
The number of out of hospital cardiac arrest increases
The number of in hospital cardiac arrest decreases
Morbidity and mortality rates increase
answer
The number of in hospital cardiac arrest decreases
question
Which is the main advantage of effective teamwork?
Early defibrillation
Division of tasks
Mastery or resuscitation skills
Immediate CPR
answer
Division of tasks
question
Which is the best example of a role of the team leader?
Proficient at endotracheal intubation
Does not over ventilate the patient
Performs within scope of practice
Models excellent team behavior
answer
Models excellent team behavior
question
Which is the best example of a role of a team member?
Monitors individual team members
Helps train future team leaders
Focuses on comprehensive patient care
Prepared to fulfill their role responsibilities
answer
Prepared to fulfill their role responsibilities
question
What is the primary purpose of the CPR coach on a resuscitation team?
Recording CPR data
Resolving team conflicts
Increasing CPR quality
Giving encouragement
answer
Increasing CPR quality
question
What are the 6 positions for high performance teams in resuscitation?
answer
Team leader
Airway
Timer/recorder
Compressor (rotate every 2 minutes)
Monitor/defibrillator/cpr coach
IV/IO/Medications
question
Which member of the high performance team has the responsibility for assigning roles (positions)?
Compressor
Time/recorder
Airway
Team leader
answer
Team leader
question
Which high performance team member is part of the resuscitation triangle?
Timer/recorder
Monitor/defibrillator/Cpr coach
IV/IO/medications
Team leader
answer
Monitor/defibrillator/cpr coach
question
Which is an example of knowledge sharing by a team leader?
Changing a treatment strategy when supported by new information
Maintaining an ongoing record of treatments
Asking for suggestions about interventions
Asking the compressor to decrease or increase rate
answer
Asking for suggestions about interventions
question
Which is an example of summarizing and reevaluating?
"1mg of epinephrine given"
Questioning a colleague who is about to make a mistake
"Compressions are at a good rate"
Increasing monitoring if the patients condition deteriorates
answer
Increasing monitoring of the pati
question
Which is a step of closed-loop communication?
Confirming task completion before assigning another task
Encouraging all team members to speak clearly
Abandoning ego
Using distinctive speech and a controlled voice
answer
Confirming task completion before assigning another task
question
Which are examples of mutual respect? Select all that apply:
Acknowledging correctly completed task in a positive way
Requesting a clear response and eye contact from the team member
Giving drugs only after verbally confirming the order
Ensuring that only 1 person talks at a time
answer
Acknowledging correctly completed tasks in a positive way
Ensuring that only one person talks at a time
question
What are the components of high quality CPR? Select all that apply:
Synchronous ventilation with chest compressions
Avoiding excessive ventilation
Compression rate around 10/min
Complete chest recoil after each compression
Interruptions limited to less than or equal to 10 seconds
Low coronary perfusion pressure
Switching compressors every 2 minutes
Compression depth of at least 2 inches (5cm)
answer
Compression depth of at least 2 inches (5cm)
Switching compressors every 2 minutes
Avoiding excessive ventilation
Complete chest recoil after each compression
Interruption limited to under 10 seconds
question
How do you calculate the chest compression fraction (CCF)? What is ideal percentage?
answer
Divide chest compression time by total code time. You want this at least 60% but ideally greater than 80%
question
Which component of effective high-performance teams is represented by the use of real-time feedback devices?
Quality
Administration
Timing
Coordination
answer
Quality
question
How do you calculate Coronary Perfusion Pressure (CPP)?
answer
Aortic diastolic pressure "minus" Right Atrial Diastolic Pressure
question
How do interruptions in chest compressions negatively impact survival after cardiac arrest?
Increase intracranial pressure
Decrease coronary perfusion pressure
Reduce right ventricular period
Increase intrathoracic pressure
answer
Decrease coronary perfusion pressure
question
What is the only intervention that can restore an organized rhythm in patients with ventricular fibrillation (VF)?
High-quality CPR
Epinephrine administration
Early and effective defibrillation
Advanced airway insertion
answer
Early and effective defibrillation
question
How quickly does the chance of survival decline for every minute of defibrillation delay in patients with ventricular fibrillation who do receive bystander CPR?
3-4%
5-6%
11-13%
7-10%
answer
7-10%
question
What is the advantage of a systematic approach to patient assessment?
Reduces the need for secondary assessment
Reduces the chance of missing important signs and symptoms
Permits assessment modification based on patient symptoms
Standardizes treatment across systems of care
answer
Reduces the chances of missing important signs and symptoms
question
What is the first step in the systematic approach to patient assessment?
BLS assessment
Initial impression
Primary assessment
Secondary assessment
answer
Initial impression
question
What is the maximum amount of time you should simultaneously perform pulse and breathing checks?
10 seconds
5 seconds
20 seconds
15 seconds
answer
10 seconds
question
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?
Determine if the patients airway is patent
Asses the patients oxygen status
Perform fluid resuscitation
Attach a quantitative waveform capnography device
answer
Determine is the patients airway is patent
question
The initial assessment reveals a conscious patient. The patients airway is patent and an advanced airway is not indicated.
Which action in the primary assessment should you perform next?
Remove clothing to perform a physical examination
Check for neuro function
Administer oxygen as needed
Check for the presence of a pulse
answer
Administer oxygen as needed
question
Which action is part of secondary assessment of a conscious patient?
Give IV/IO fluids if needed
Formulate a differential diagnosis
Determine the patients level of consciousness
Attach a monitor defibrillator
answer
Formulate a differential diagnosis
question
Which of the following are the "H's" causes of reversible cardiac arrest? Select all that apply:
Hyperkalemia/hypokalemia
Hypertensive crisis
Acidosis
HELLP syndrome
Hyperventilation
Hypoxia
Hypothermia
Heydes syndrome
Hypocalcemia
Hypovolemia
Which of the following are the "T" causes of reversible cardiac arrest?
Cardiac tamponade
Deep vein thrombosis
Thyrotoxicosis
Coronary thrombosis
Tension pneumothorax
Pulmonary thrombosis
Toxins
Simple pneumothorax
Thoracic outlet syndrome
Tachycardiomyopathy
What is the only intervention that can restore an organized rhythm in patients with ventricular fibrillation (VF)?
answer
Early and effective defibrillation
question
What is the most common symptom of myocardial ischemia and infarction?
answer
Retrosternal chest pain
question
Which demographic group experiencing acute coronary syndromes is more likely to present without chest pain?
Smokers
Patients taking B-blockers
Females
Adolescents
answer
Females
question
Oxygen should be delivered to a patient who has obvious signs of heart failure if the oxygen saturation is less than?
answer
90%
question
Obtaining a what is the most important assessment tool for a patient displaying signs and symptoms of acute coronary syndrome?
answer
12 lead ekg
question
What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department?
answer
10 minutes
question
When should oxygen be administered?
answer
If the patient is dyspneic or hypoxemic, has obvious signs of heart failure, or has an arterial o2 saturation that is less than 90% or unknown.
question
Which is a contraindication to the administration of aspirin for the management of a patient with acute coronary syndromes?
Shortness of breath
Recent GI bleeding
Nausea
Vomitting
answer
Recent GI bleeding
question
What are the contraindications of nitroglycerin?
answer
-If patient has a confirmed inferior wall stemi or right ventricular infarction
-avoid nitro if patient has hypotension, bradycardia, or tachycardia
-if patient recently has taken sildenafil, vardenafil, or tadalafil in the past 24-48 hrs
question
What is a physiological effect of nitroglycerin?
Bronchodilation
Reduces preload
Binds to opioid receptors
Platelet aggregation inhibition
answer
Reduces preload
question
Which clinical findings represents a contraindication to the administration of nitroglycerin?
Anterior wall infarction
Posterior wall infarction
Lateral wall infarction
Confirmed right ventricular infarction
answer
Confirmed right ventricular infarction
question
When is morphine indicated?
answer
In STEMI patients with severe chest discomfort that does not respond to nitrates
question
What should you always monitor after giving morphine?
answer
Monitor BP and respiratory rate
question
When should you use caution when giving morphine?
answer
Use caution when patient is in NSTE-ACS because of the association of mortality
question
If someone starts developing hypotension after giving morphine or nitroglycerin?
answer
Administer fluids
question
Which class of medications commonly given to patients with acute coronary syndrome may be adversely affected by morphine administration?
B-blockers
Calcium channel blockers
Phosphodiasterase inhibitors
Oral anti platelet meds
answer
Oral anti platelet meds
question
What is the benefit of morphine when given for management of acute coronary syndrome?
Increases left ventricular preload
Vasoconstriction
Central nervous system preload
Increases systemic vascular resistance
answer
Central nervous system analgesic
question
You obtain a 12-lead ECG in a patient with retrosternal chest pain.
Which ECG finding is suggestive of high risk non-ST-segment elevation acute coronary syndrome?
ST-depression less than 0.5mm
New left Bundle branch block
ST-segment elevation
Dynamic T-wave inversion
answer
Dynamic t wave inversion????
question
Upon reviewing a patients 12 lead ECG, you note ST segment elevation of 2mm in leads 2, 3, and aVF.
How would you classify the ECG finding?
answer
ST-segment elevation myocardial infarction
question
What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department?
30 min
10 min
20 min
15 min
answer
10 min
question
Which action is part of the secondary assessment of a conscious patient?
Determine the patients LOC
Formulate a differential diagnosis
Give IV/IO fluids if needed
Attach a monitor/defibrillator
answer
Formulate a differential diagnosis
question
What do fibrinolytic meds end in?
answer
"ase"
question
Upon reviewing a patients 12-lead ECG, you note ST-segment elevation of 2mm in leads II, III and aVF.
How would you classify these ECG findings?
answer
ST-segment elevation myocardial infarction
question
What is the goal for first medical contact-to-balloon inflation time for a patient receiving percutaneous coronary intervention?
120 min
45 min
30 min
90 min
answer
90 min
question
What is the longest acceptable emergency door to needle time when fibrinolysis is the indented reperfusion strategy?
15 min
30 min
45 min
60 min
answer
30 min
question
What is the recommended window after symptoms onset for early fibrinolytic therapy or direct catheter based reperfusion for patients ST segment elevation myocardial infarction and no contraindications?
Within 18 hours
Within 12 hours
Within 24 hours
Within 48 hours
answer
Within 12 hours
question
Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of myocardial ischemia, what will your first actions include? Select all that apply
Administer epinephrine 1 mg IV
Administer a blood thinner
Administer aspirin
Assess airway, breathing, and circulation (ABCs)
If considering prehospital fibrinolysis, use fibrinolytic checklist
Provide prehospital notification to the receiving hospital
Consider oxygen, nitroglycerin, and morphine if needed
Obtain a 12 lead ECG
answer
Administer aspirin
Assess ABCs
If considering prehospital fibrinolysis, perform fibrinolytic checklist
Provide prehospital notification to the reveiving hospital
Consider 02, nitro and morphine
Obtain a 12 lead ECG
question
Upon reviewing a patients 12 lead ECG, you note ST elevation of 2mm in leads II, III, and aVF. How would you classify these ECG findings?
Non-st segment elevation MI
ST-segment elevation myocardial infarction
Normal findings
answer
ST segment elevation MI
question
Which action is part of the secondary assessment of a conscious patient?
Attach a monitor/defibrillator
Formulate a different diagnosis
Determines patients LOC
Give IV/IO fluids if needed
answer
Formulate a different diagnosis
question
What is the most common type of stroke?
answer
Ischemic stroke
question
What type of stroke occurs when a blood vessel in the brain suddenly ruptures into the surrounding tissue?
Hemorrhagic stroke
Transient ischemic attack
Cryptogenic stroke
Ischemic stroke
answer
Hemorrhagic stroke
question
Which is a sign of a stroke?
Abdominal pain
Shortness of breath
Trouble speaking
Retrosternal chest pain
answer
Trouble speaking
question
Which is a symptom of stroke?
Diaphoresis
Fever
Sudden trouble seeing
Diarrhea
answer
Sudden trouble seeing
question
What are the 3 components of the Cincinnati Prehospital stroke scale?
answer
Facial droop
Arm drift
Abnormal speech
question
What is the estimated probability of the prehospital stroke scale with 1 abnormal finding when scored by prehospital providers?
72%
88%
80%
50%
answer
72%
question
What is a stroke severity tool that helps EMS differentiate a large vessel occlusion stroke from a non-large vessel occlusion stroke?
Miami emergency neurologic deficit score
Cincinnati prehospital stroke scale
Melbourne ambulance stroke screen
Los Angeles Motor Scale
answer
Los Angela's motor scale
question
What is the primary advantage of using a stroke severity tool?
It helps identify large vessel occlusion stroke
It helps determine the last known normal time
It helps identify level of weakness
It helps EMS providers identify signs of a stroke
answer
It helps identify large vessel occlusion stroke
question
What is the most appropriate destination for patients with suspected acute ischemic stroke?
Certified stroke center
Trauma center
Hospital catheterization lab
Closest emergency department
answer
Certified stroke center
question
What is the highest level of stroke center certification?
Comprehensive stroke center
Thrombectomy-capable stroke center
Primary stroke center
Acute stroke ready hospital
answer
Comprehensive stroke center
question
Which is an advantage of EMS transport to a stroke hospital for a patient with a suspected acute ischemic stroke?
Family members can ride to the hospital with the patient
Responding providers can stabilize critical issues
Patients transported by ambulance are seen first
EMS transport is faster than being driven by a friend
answer
Responding providers can stabilize critical issues
question
What is an advantage of EMS alerting the receiving facility of the impending arrival of a patient with suspected acute ischemic stroke?
The hospital can determine the most appropriate patient destination
The hospital can have fibrinolytic drugs already prepared
The emergency department can quickly determine glucose levels
The hospital can perform more efficient evaluation and management
answer
The hospital can perform more efficient evaluation and management
question
What is the time for neurological assessment by the stroke team or designee and noncontrast computed tomography or magnetic resonance imaging performed after the hospital arrival?
20 min
25 min
15 min
10 min
answer
20 min
question
What is the time goal for initiation of fibrinolytic therapy for patients w/o contraindications after hospital arrival
answer
45 min
question
What is the door-to device time for direct-arriving patients with acute ischemic stroke treated with endovascular therapy?
answer
90 min
question
Evidence suggest 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?
12 hours
3 hours
24 hours
6 hours
answer
3hrs
question
What is the maximum time for last known normal when endovascular therapy can be performed?
3hrs
12hrs
6hrs
24hrs
answer
24hrs
question
What is the maximum time from last known normal when intra arterial thrombolysis for select patients can be used for treatment?
12hrs
3hrs
6hrs
4hrs
answer
6hrs
question
What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindications after hospital arrival?
30 min
45 min
35 min
40 min
answer
45 min
question
Identify the systolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke.
answer
185
180
177
190
question
Identify the diastolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke.
110
105
115
100
answer
110
question
What blood glucose level should trigger administration of IV or subq insulin for a patient with acute ischemic stroke?
170
160
150
180
answer
180
question
What tidal volume typically maintains normal oxygenation and elimination of carbon dioxide?
12-14 ml/kg
6-8 ml/kg
9-11 ml/kg
3-5 ml/kg
answer
6-8
question
How long should the second rescuer squeeze the bag mask device when providing 2-rescuer ventilation?
1 sec
3 sec
4 sec
2 sec
answer
1sec
question
When performing the jaw-thrust maneuver on patients with suspected cervical spine injury, where should you place your fingers?
Just under the angle of the lower jaw
Behind the patients ears
Under the patients chin
On top of the patients jaw
answer
Just under the angle of the lower jaw
question
What is a contraindication of the use of an oropharyngeal airway?
Bag mask ventilation
Conscious patient
Pediatric patient
Absent gag reflex
answer
Conscious patient
question
Which of the following patients can NPAs be used in?
Unconscious
Patient with nasal trauma
Conscious
Semiconscious
answer
Everything but nasal trauma
question
What is the first line treatment for bradycardia?
answer
Give atropine 1mg IV may repeat for a total does of 3mg IV
If this is ineffective provide transcutaneous pacing and/or dopamine 5 to 20 mcg/kg per minute or epinephrine 2 to 10 mcg/min
question
You are treating a patient with a heart rate of 186/min. Which symptom (if present) suggest unstable tachycardia?
SOB
Weakness
Hypotension
Fatigue
answer
Hypotension
question
What is the first line treatment for unstable tachycardia?
Lidocaine
Cardioversion
Amiodarone
Adenosine
answer
Cardioversion
question
What is the upper heart rate limit for a patient with sinus tachycardia?
200/min
130
180
150
answer
130
question
What is the lower heart rate limit for a patient with sinus tachycardia?
answer
100
question
What is the recommended initial therapy for a patient with stable narrow-complex tachycardia, after establishing an IV and acquiring a 12-lead ecg?
Adenosine
B-blockers
Cardioversion
Vagal maneuvers
answer
Vagal maneuvers
question
If a patient with stable ventricular tachycardia does not response to vagal maneuvers, what drug and dose regimen is to be given?
answer
Give Adenosine 6mg over 1 second followed by a flush in a large vein and elevate arm quickly after
If they don't response in 1-2 minutes, Administer 12 mg IV followed by a flush and elevate arm quickly
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