ACLS COMPLETE 2021

12 September 2022
4.7 (114 reviews)
288 test answers

Unlock all answers in this set

Unlock answers (284)
question
BEST PLAYLIST I'VE FOUND FOR ALL HEART.ORG ACLS CODES!
answer
https://www.youtube.com/watch?v=qQTpqjvvduI=PLy60DSDPg9urf_l5ss1FLakrRQDKOkTZj This is a good starting point for Jose (big Megacode at end): https://www.youtube.com/watch?v=8OB7OreUjy0 . Use the feedback after failing to get closer and closer to passing!
question
In which situation does bradycardia require treatment?
answer
Hypotension
question
Which intervention is most appropriate for the treatment of a patient in asystole?
answer
Epinephrine
question
You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previousy advised "no shock indicated." A rhythm check now finds asystole. After resuming high-quality compressions, which action do you take next?
answer
Establish IV or IO access
question
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 38mm Hg, and the pulse oximetry reading is 98%. There is vascular access in the left arm, and the patient has not been given any vasoactive drugs. A 12-lead ECG confirm a supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal maneuvers. what is your next action?
answer
Administer adenosine 6mg IV push
question
A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a toal does of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 88/56 mm Hg. Which therapy is now indicated?
answer
Epinephrine 2 to 10 mcg/min
question
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug should be administered first?
answer
Epinephrine 1 mg IV/IO
question
A 62-year-old man suddenly experienced difficulty speaking and left-sided weakness. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain si ordered. Which best describes the guidelines for antiplatelet and fibrinolytic therapy?
answer
Hold aspirin for at least 24 hours if rtPA is administered
question
A patient is in refractory ventricular fibrillation and has received multiple appropriate defribillation shocks, epinephrine 1 mg IV twice, and an initial dose of amiodarone 300mg IV. The patient is intubated. Which best describe the recommended second does of amiodarone for this patient?
answer
150 mg IV push
question
A patient with sinus bradycardia and a heart rate of 42/min has diaphoresis and a blood pressure of 80/60mm Hg. What is the initial does of atropine?
answer
0.5mg
question
A 35-year-old woman has palpitations, light-headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminating the rhythm. An IV has been established. Which drug should be administered?
answer
Adenosine 6mg
question
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. If no pathway for medication administration is in place, which method is preferred?
answer
IV or IO
question
What is the indication for the use of magnesium in cardiac arrest?
answer
Pulseless ventricular tachycardia-associated torsades de pointes
question
A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70 mm Hg. He has a history of angina. What action is recommended next?
answer
Seeking expert consultation
question
A patient is in cardiac arrest. High-quality chest compressions are being given. The patient is intubated, and an IV has been started. The rhythm is asystole. What is the first drug/dose to administer?
answer
Epinephrine 1mg IV/IO
question
A patient is in refractory ventricular fibrillation. High-quality CPR is in progress. One does of epinephrine was given after the second shock. An antiarrhythmic drug was given immediately after the third shock. You are the team leader. Which medication do you order next.
answer
Epinephrine 1 mg
question
A patient with possible STEMI has ongoing chest discomfort. What is a contraindication to nitrate administration?
answer
Use of a phosphodiestrase inhibitor within the previous 24 hours
question
A 57-year-old woman has palpitation, chest discomfort, and tachycardia. The monitor shows a regular wide-QRS at a rate of 180/min. She becomes diaphoretic, and her blood pressure is 80/60 mm HG/ Which action do you take next?
answer
Perform electrical cordioversion
question
A patient with STEMI has ongoing chest discomfort. Heparin 4000 units IV bolus and a heparin infusion of 1000 units per hour are being administered. The patient did not take aspirin because he has a history of gastritis, with was treated 5 years ago. What is your next action?
answer
Give aspirin 160-325 mg to chew
question
You are caring for a 66-year-old man with a history of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. The CT scan is negative for hemorrhage. The patient is receiving oxygen via nasal cannula at 2L/min, and an IV has been established. His blood pressure is 180/100mm Hg. Which drug do you anticipate giving to this patient?
answer
Aspirin
question
A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next?
answer
Amiodarone 300mg
question
What is the maximum interval for pausing chest compressions?
answer
10 seconds
question
Your patient is a 56-year-old woman with a history of type 2 diabetes who reports feeling dizzy. She is pale and diaphoretic. Her blood pressure is 80/66mm Hg. The cardiac monitor documents the rhythm shown here. She is receiving oxygen at 4L/min by nasal cannula, and an Iv has been established. What do you administer next?
answer
Atropine 0.5mg IV
question
A 35-year-old woman presents with a chief complaint of palpitations. She has no chest discomfort, shortness of breath, or light-headedness. Her blood pressure is 120/78mm Hg. Which intervention is indicated first?
answer
Vagal maneuvers
question
Which action should you take immediately after providing an AED shock?
answer
Resume chest compressions
question
What action minimizes the risk of air entering the victim's stomach during-bag mask ventilation?
answer
Ventilating until you see the chest rise
question
You are providing bag-mask ventilations to a patient in respiratory arrest. How often should you provide ventilation?
answer
About every 5-6 seconds
question
After initiation of CPR and 1 shock for ventricular fibrillation, this rhythm is present on the next rhythm check. A second shock is given, and chest compressions are resumed immediately. An IV is in place, and no drugs have been given. Bag-mask ventilations are producing visible chest rise. What is your next intervention?
answer
Give epinephrine 1mg IV/IO
question
A patient's 12-lead ECG is transmitted by the paramedics and shows a STEMI. When the patient arrives in the emergency department, the rhythm shown here is seen on the cardiac monitor. The patient has resolution of moderate (5/10) chest pain after 3 doses of sublingual nitroglycerin. Blood pressure is 104/70mm Hg. Which intervention is most important in reducing this patient's in-hospital and 30-day mortality rate?
answer
Repersfusion therapy
question
A patient was in refractory ventricular fibrillation. A thrid shock has just been administered. Your team looks to you for instructions. What is your next action?
answer
Resume high quality chest compressions
question
Which action is likely to cause air to enter the victim's stomach (gastric inflation) during bag-mask ventilation?
answer
Ventilating too quickly
question
A 45-year-old woman with a history of palpitations develops light-headedness and palpitations. She has received adensoine 6mg IV for the rhythm shown here (SVT), without conversion of the rhythm. She is now extremely apprehensive. Her blood pressure si 128/70mm Hg. What is the next appropriate intervention?
answer
Administer adenosine 12 mg IV
question
Your patient is not responsive and is not breathing, You can palpate a carotid pulse. Which action do you take next?
answer
Start rescue breathing
question
You arrive on the scene to find CPR in progress. Nursing staff report the patient was recovering from a pulmonary embolism and suddenly collapsed. Two shocks have been delivered, and an IV has been initiated. What do you administer now?
answer
Epinephrine 1 mg IV
question
You are the code team leader and arrive to find a patient with CPR in progress. On the next rhythm check, you see the rhythm shown here. Team members tell you that the patient was well but reported chest discomfort and then collapsed. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise, and IV access has been established, Which intervention would be your next action?
answer
Epinephrine 1mg
question
What is recommended depth of chest compressions for an adult victim?
answer
At least 2 inches
question
How does complete chest recoil contribute to effective CPR?
answer
Allows maximum blood return to the heart
question
What is the recommended compression rate for high-quality CPR?
answer
100-120 compressions per minute
question
A patient becomes unresponsive. You are uncertain if a faint pulse is present. They rhythm shown here is seen on the cardiac monitor. An IV is in pace. Which action do you take next?
answer
Start high-quality CPR
question
A patient has been resuscitated from cardiac arrest. During post-ROSC treatment, the patient becomes unresponsive, with the rhythm shown here. Which action is indicated next?
answer
Give an immediate unsynchronized high-energy shock (defibrillation dose)
question
How often should you switch chest compressors to avoid fatigue?
answer
About every 2 minutes
question
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.
question
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.
question
What is the preferred method of access for epi administration during cardiac arrest in most pts?
answer
Peripheral IV
question
An AED does not promptly analyze a rythm. What is your next step?
answer
Begin chest compressions.
question
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
question
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?
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
question
What is a common but sometimes fatal mistake in cardiac arrest management?
answer
Prolonged interruptions in chest compressions.
question
Which action is a componant of high-quality chest comressions?
answer
Allowing complete chest recoil
question
Which action increases the chance of successful conversion of ventricular fibrillation?
answer
Providing quality compressions immediately before a defibrillation attempt.
question
Which situation BEST describes pulseless electrical activity?
answer
Sinus rythm without a pulse
question
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.
question
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 PETCO2 level of 8 mm Hg. What is the significance of this finding?
answer
Chest compressions may not be effective.
question
The use of quantitative capnography in intubated patients
answer
allows for monitoring of CPR quality.
question
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.
question
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.
question
During your assessment, your patient suddenly loses consciousness. After calling for help and determining that the patient is not breathing, you are unsure whether the patient has a pulse. What is your next action?
answer
Begin chest compressions.
question
What is an advantage of using hands-free defibrillation pads instead of defibrillation paddles?
answer
Hands-free pads allow for a more rapid defibrillation.
question
What action is recommended to help minimize interruptions in chest compressions during CPR?
answer
Continue CPR while charging the defibrillator.
question
Which action is included in the BLS survey?
answer
Early defibrillation
question
Which drug and dose are recommended for the management of a patient in refractory ventricular fibrillation?
answer
Amioderone 300mg
question
What is the appropriate interval for an interruption in chest compressions?
answer
10 seconds or less
question
Which of the following is a sign of effective CPR?
answer
PETCO2 ?10 mm Hg
question
What is the primary purpose of a medical emergency team (MET) or rapid response team (RRT)?
answer
Identifying and treating early clinical deterioration.
question
Which action improves the quality of chest compressions delivered during a resuscitation attempt?
answer
Switch providers about every 2 minutes or every 5 compression cycles.
question
What is the appropriate ventilation strategy for an adult in respiratory arrest with a pulse rate of 80/min?
answer
1 breath every 5-6 seconds
question
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
question
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
question
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.
question
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
question
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.
question
Choose an appropriate indication to stop or withhold resuscitative efforts.
answer
Evidence of rigor mortis.
question
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.
question
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.
question
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.
question
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 ?
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
question
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
question
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
question
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
question
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.
question
You are evaluating a 48-year-old man with crushing substernal chest pain. The patient is pale, diaphoretic, cool to the touch, and slow to respond to your questions. The blood pressure is 58/32 mm Hg, the heart rate is 190/min, the respiratory rate is 18 breaths/min, and the pulse oximeter is unable to obtain a reading because there is no radial pulse. The lead II ECG displays a regular wide-complex tachycardia. What intervention should you perform next?
answer
Synchronized cardioversion
question
What is the initial priority for an unconscious patient with any tachycardia on the monitor?
answer
Determine whether pulses are present.
question
Which rhythm requires synchronized cardioversion?
answer
Unstable supraventricular tachycardia
question
What is the recommended second dose of adenosine for patients in refractory but stable narrow-complex tachycardia?
answer
12mg
question
What is the usual post-cardiac arrest target range for PETCO2 when ventilating a patient who achieves return of spontaneous circulation (ROSC)?
answer
35-40mm Hg
question
Which condition is a contraindication to therapeutic hypothermia during the post-cardiac arrest period for patients who achieve return of spontaneous circulation ROSC?
answer
Responding to verbal commands
question
What is the potential danger of using ties that pass circumferentially around the patient's neck when securing an advanced airway?
answer
Obstruction of venous return from the brain
question
What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube?
answer
Continuous waveform capnography
question
hat is the recommended IV fluid (normal saline or Ringer's lactate) bolus dose for a patient who achieves ROSC but is hypotensive during the post-cardiac arrest period?
answer
1 to 2 Liters
question
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
question
What is the first treatment priority for a patient who achieves ROSC?
answer
Optimizing ventilation and oxygenation.
question
What should be done to minimize interruptions in chest compressions during CPR?
answer
Continue CPR while the defibrillator is charging.
question
Which condition is an indication to stop or withhold resuscitative efforts?
answer
Safety threat to providers
question
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?
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
question
After verifying unresponsiveness and abnormal breathing, you activate the emergency response team. What is your next action?
answer
Check for a pulse.
question
What is the recommendation on the use of cricoid pressure to prevent aspiration during cardiac arrest?
answer
Not recommended for routine use
question
What survival advantages does CPR provide to a patient in ventricular fibrillation?
answer
Produces a small amount of blood flow to the heart
question
What is the recommended compression rate for performing CPR?
answer
At least 100 per minute
question
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
question
A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. The next intervention is to
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.
question
What is the recommended next step after a defibrillation attempt?
answer
Begin CPR, starting with chest compressions.
question
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
question
Which finding is a sign of ineffective CPR?
answer
PETCO2 <10 mm Hg
question
How often should the team leader switch chest compressors during a resuscitation attempt?
answer
. Every 2 minutes
question
IV/IO drug administration during CPR should be
answer
given rapidly during compressions
question
What is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation?
answer
300 mg
question
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
question
How long should it take to perform a pulse check during the BLS Survey?
answer
5 to 10 seconds
question
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.
question
An AED advises a shock for a pulseless patient lying in snow. What is the next action?
answer
Administer the shock immediately and continue as directed by the AED.
question
Which treatment or medication is appropriate for the treatment of a patient in asystole?
answer
Epinephrine
question
What is the minimum depth of chest compressions for an adult in cardiac arrest?
answer
2 inches
question
A patient with pulseless ventricular tachycardia is defibrillated. What is the next action?
answer
Start chest compressions at a rate of at least 100/min.
question
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?
answer
Have a team member attempt to palpate a carotid pulse.
question
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?
answer
Intraosseous (IO)
question
What is the appropriate rate of chest compressions for an adult in cardiac arrest?
answer
At least 100/min
question
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.
question
A 53-year-old man has shortness of breath, chest discomfort, and weakness. The patient's blood pressure is 102/59 mm Hg, the heart rate is 230/min, the respiratory rate is 16 breaths/min, and the pulse oximetry reading is 96%. The lead II ECG is displayed below. A patent peripheral IV is in place. What is the next action?
answer
Vagal maneuvers
question
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.
question
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
question
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.
question
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.
question
What is the recommended oral dose of aspirin for patients suspected of having one of the acute coronary syndromes?
answer
160 to 325 mg
question
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
question
What is the most appropriate intervention for a rapidly deteriorating patient who has this lead II ECG?
What is the most appropriate intervention for a rapidly deteriorating patient who has this lead II ECG?
answer
Synchronized cardioversion
question
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
question
What is the recommended assisted ventilation rate for patients in respiratory arrest with a perfusing rhythm?
answer
10 to 12 breaths per minute
question
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
question
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?
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
question
A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm:
 What is the appropriate next intervention?
A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm: What is the appropriate next intervention?
answer
Defibrillation
question
What is the recommended energy dose for biphasic synchronized cardioversion of atrial fibrillation?
answer
120to200J
question
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.
question
Which is a contraindication to nitroglycerin administration in the management of acute coronary syndromes?
answer
Right ventricular infarction and dysfunction
question
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
question
Which is an appropriate and important intervention to perform for a patient who achieves ROSC during an out-of-hospital resuscitation?
answer
Transport the patient to a facility capable of performing PCI.
question
What is the immediate danger of excessive ventilation during the post-cardiac arrest period for patients who achieve ROSC?
answer
Decreased cerebral blood flow
question
What is the recommended target temperature range for achieving therapeutic hypothermia after cardiac arrest?
answer
32°C to 34°C
question
What is the recommended duration of therapeutic hypothermia after reaching the target temperature?
answer
12 to 24 hours
question
What is the danger of routinely administering high concentrations of oxygen during the post- cardiac arrest period for patients who achieve ROSC?
answer
Potential oxygen toxicity
question
What is the recommended dose of epinephrine for the treatment of hypotension in a post- cardiac arrest patient who achieves ROSC?
answer
0.1 to 0.5 mcg/kg per minute IV infusion
question
You have completed 2 min of CPR. The ECG monitor displays the lead below (PEA) and the patient has no pulse. You partner resumes chest compressions and an IV is in place. What management step is your next priority?
answer
Administer 1mg of epinephrine
question
A patient is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of 300 mg amiodarone IV. The patient is intubated. A second dose of amiodarone is now called for. The recommend second dose of amiodarone is ?
answer
150 mg IV push
question
A patient is in refractory ventricular fibrillation. High CPR is in progress and shocks have been given. One dose of epinephrine was given after the second shock. An anti arrhythmic drug was 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
question
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
question
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
question
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
question
what are the 5 h's and 5 t's
answer
The Hs and Ts is a mnemonic used to aid in remembering the possible reversible causes of cardiac arrest.[1] A variety of disease processes can lead to a cardiac arrest; however, they usually boil down to one or more of the "Hs and Ts". hypovolemia hypoxia hydrogen ion (acidosis) hypo/hyperkalemia hypothermia tension pneumothorax tamponade, cardiac toxins thrombosis, pulmonary (PE) thrombosis, coronary
question
Bradycardia require treatment when?
answer
chest pain or shortness of breath is present
question
how do you treat non-symptomatic bradycardia
answer
monitor and observe
question
what constitutes symptomatic bradycardia
answer
hypotension altered mental status signs of shock chest pain acute heart failure
question
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
question
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
question
what is considered a tachycardia requiring treatment
answer
over 150 per minute
question
when do you consider cardioversion
answer
if persistent tachycardia is causing: hypotension altered mental status signs of shock chest pain acute heart failure
question
if persistent tachycardia does not present with symptoms what do you need to consider
answer
wide QRS? greater than 0.12 seconds
question
Your patient has been intubated. IV/IVO access is not available. Which combination of drugs can be administered by endotracheal route?
answer
Lidocaine, epinephrine, vasopressin
question
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
question
Type of breaths (not normal) that may be present in the first minutes after sudden cardiac arrest
answer
Agonal gasps
question
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
question
If the heart muscle resets and initiates an organized rhythm this is called
answer
ROSC return of spontaneous circulation
question
a patient is in cardiac arrest. ventricular fibrillation has been refractory to an initial shock. if no pathway for medication is in place, preferred method?
answer
IV or IO
question
A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 100/60 mm HG. What is now indicated?
answer
EPI 2-10 mcg/min
question
A patient with ST-segment elevation MI has ongoing chest discomfort. Fibrinolytic therapy has been ordered. Heparin 4000 units IV bolus was administered, and a heparin infusion of 1000 units per hour is being administered. ASA was not taken by the patient because he had a history of gastritis treated 5 years ago. What is the next action?
answer
ASA 160-325 mg chew
question
A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70 mm Hg. He has a history of angina. What should you do?
answer
seek expert consultation
question
A 35 year old woman has palpitations, light headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminating the rhythm. An IV has been established. What drug should be administered?
answer
adenosine 6 mg
question
A 57 year old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180 bpm. She becomes diaphoretic and her blood pressure is 80/60 mm Hg. What is the next action?
answer
cardioversion
question
when does bradycardia require treatment?
answer
hypotension
question
You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated". A rhythm check now finds asystole. After resuming high-quality compressions, your next action is to what?
answer
establish IV or IO access
question
you are caring for a 66 year old man with a history of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. the ct scan is negative for hemorrhage. The patient is receiving oxygen via nasal cannula at 2 L/min, and an IV has been established. His blood pressure is 180/100 mm Hg. Which drug do you anticipate giving?
answer
aspirin
question
A 62 year old man suddenly experienced difficulty speaking and left-sided weakness. He was brought into the emergency department. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. What are the guidelines for antiplatelet and fibrinolytic therapy?
answer
hold aspirin for at least 24 hours if rtPA is administered
question
a 45 year old woman has a history of palpitations develops lightheadedness and palpitations. She has received adenosine 6 mg IV for SVT without conversion. BP 128/70. next step?
answer
adenosine 12 mg
question
STEMI intervention is most important in reducing patients in hospital and 30 day mortality?
answer
reperfusion therapy
question
a patient has been resuscitated from cardiac arrest. During post-ROSC treatment, the patient becomes unresponsive, with the rhythm VT. What tx is indicated
a patient has been resuscitated from cardiac arrest. During post-ROSC treatment, the patient becomes unresponsive, with the rhythm VT. What tx is indicated
answer
unsynchronized high energy shock
question
which action should you take immediately after providing an AED shock
answer
resume chest compressions
question
which action causes air to enter victim's stomach (gastric inflation) during bag-mask ventilation
answer
ventilation too quickly,
question
A patient becomes unresponsive. You are uncertain if a faint pulse is present with the rhythm 
below. What is your next action?
A patient becomes unresponsive. You are uncertain if a faint pulse is present with the rhythm below. What is your next action?
answer
CPR
question
you are the code team leader and arrive to find a patient with CPR in progress. On next rhythm check NSR. Pt reported chest discomfort and then collapsed. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise and IO access has been established. Intervention?
answer
EPI 1 mg
question
refractory ventricular fibrillation. 3rd shock just administered. what is next action
answer
resume high-quality chest compression
question
A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your 
team looks to you for instructions. Your immediate next order is?
A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks to you for instructions. Your immediate next order is?
answer
resume high quality chest compressions
question
A patient with sinus bradycardia and a heart rate of 42 bpm has diaphoresis and a BP of 80/60 mm Hg. What is the initial dose of atropine?
answer
0.5 mg
question
When can you use magnesium in cardiac arrest?
answer
VF/pulseless VT associated with torsades de pointes
question
A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138/min. He is asymptomatic, with a blood pressure of 110/70 mm Hg. He has a history of angina. What should you do?
answer
Seek expert consultation
question
A patient with possible ST-segment elevation MI has ongoing chest discomfort. What is a containdication to the administration of nitrates?
answer
Phosphodiesterase inhibitor within 12 hours
question
Bradycardia requires treatment when?
answer
Chest pain or shortness of breath
question
You patient has been intubated. IV/IO access is not available. Which combination of drugs can be administered by the endotracheal route?
answer
Lidocaine, epinephrine, vasopressin
question
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug and dose should be administered first by the IV/IO route?
answer
Epinephrine 1 mg
question
A patient is in refractory ventricular fibrillation. High quality CPR is in progress, and shocks have been given. One dose of epinephrine was given after the second shock. An antiarrhythmic drug was given immediately after the third shock. What drug should the team leader request to be prepared for administration next?
answer
Second dose of epinephrine 1 mg
question
A 62 year old man suddenly experienced difficulty speaking and left-sided weakness. He was brought into the emergency department. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. What are the guidelines for antiplatelet and fibrinolytic therapy?
answer
Do not give ASA for at least 24 hours if rtPA is administered
question
A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which is the next drug/dose to anticipate to administer?
answer
Amiodarone 300 mg
question
A patient is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of 300 mg amiodarone IV. The patient is intubated A second dose of amiodarone is now called for. The recommended second dose of amiodarone is what?
answer
150 mg IV push
question
A 57 year old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180 bpm. She becomes diaphoretic and her blood pressure is 80/60 mm Hg. What is the next action?
answer
Perform immediate electrical cardioversion
question
A 35 year old woman has palpitations, light headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal maneuvers have not been effective in terminating the rhythm. An IV has been established. What drug should be administered IV?
answer
Adenosine 6 mg
question
A patient is in cardiac arrest. High quality chest compressions are being given. The patient is intubated and an IV has been started. The rhythm is asystole. Which is the first drug/dose to administer?
answer
Epinephrine 1 mg or vasopressin 40 units IV or IO
question
A patient with ST-segment elevation MI has ongoing chest discomfort. Fibrinolytic therapy has been ordered. Heparin 4000 units IV bolus was administered, and a heparin infusion of 1000 units per hour is being administered. ASA was not taken by the patient because he had a history of gastritis treated 5 years ago. What is the next action?
answer
Give ASA 160-325 chewed immediately
question
What is the dose of vasopressin and how is it administered (in cardiac arrest)?
answer
40 units administered IV or IO
question
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. What is the recommended route for drug administration during CPR?
answer
IV or IO
question
A patient has sinus bradycardia with a heart rate of 36/min. Atropine has been administered to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is confused, and her blood pressure is 100/60 mm HG. What is now indicated?
answer
Epinephrine 2 to 10 mcg/min
question
You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated". A rhythm check now finds asystole. After resuming high-quality compressions, your next action is to what?
answer
Gain IV or IO access
question
A patient with a possible acute coronary syndrome has ongoing chest discomfort unresponsive to 3 SL NTG tablets. There are no contraindications, and 4 mg of morphine sulfate was administered. Shortly afterward, blood pressure falls to 88/60 mm Hg, and the patient has increased chest discomfort. What should you do?
answer
Give normal saline 250 mL to 500 mL fluid bolus
question
Second deg AV block: Mobitz 2
Second deg AV block: Mobitz 2
answer
Intermittent non-conducted P waves without progressive prolongation of the PR interval (compare this to Mobitz I).
question
Pulseless electrical activity
Pulseless electrical activity
answer
Push Epi Always
question
If patient is in cardiac arrest and the rhythm is asystole and CPR is beign given. What is the first drug you should give? (a) Atropine 0.5 mg IV/IO (b) Atropine 1 mg IV/IO (c) Dopamine 2 to 20 mcg/kg per min IV/IO (d) Epinephrine 1 mg IV/IO
answer
(d) Epinephrine 1 mg IV/IO
question
A patient has a rapid irregular wide-complex tachycardia. The ventricular rate is 138 bpm. He is asymptomatic, with a blood pressure of 110/70. He has a history of angina. What action is recommended next? (a) Giving adenosine 6 mg IV bolus (b) Giving lidocaine 1 to 1.5 mg IV bolus (c) Performing synchroniczed cardioversion (d) Seeking expert consultation
answer
(d) Seeking expert consultation
question
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to a second shock. Which drug should be administered first? (a) Atropine 1 mg IV/IO (b) Epinephrine 1 mg IV/IO (c) Lidocaine 1 mg/kg IV/IO (d) Sodium bicarbonate 50 mEq IV/IO
answer
(b) Epinephrine 1 mg IV/IO
question
You arrive on the scene with the code team. High-quality CPR is in progress. An AED has previously advised "no shock indicated." A rhythm check now finds asystole. After resuming high-quality compressions, which action do you take next? (a) Call for a pulse check (b) Establish IV or IO access (c) Insert a laryngeal airway (d) Perform endotracheal intubation
answer
(b) Establish IV or IO access
question
A patient is in pulseless ventricular tachycardia. Two shocks and 1 dose of epinephrine have been given. Which drug should be given next? (a) Adenosine 6 mg (b) Amiodarone 300 mg (c) Epinephrine 3 mg (d) Lidocaine 0.5 mg/kg
answer
(b) Amiodarone 300 mg
question
A 35 yr old female has palpitation, light-headedness, and a stable tachycardia. The monitor shows a regular narrow-complex QRS at a rate of 180/min. Vagal manuevers have not been effective in terminating the rhythm. An IV has been established. Which drug should be administered? (a) Adenosine 6 mg (b) Atropine 0.5 mg (c) Epinephrine 2 to 10 mcg/kg per minute (d) Lidocaine
answer
(a) Adenosine 6 mg
question
Pt is in refractory ventricular fibrilation. CPR is in progress. 1 dose of epinephrine given after second shock. An antiarrhythmic drug was given immediately after third shock. Which med is next? (a) Epinephrine 1 mg (b) Epinephrine 3 mg (c) Sodium bicarb 50 mEq (d) Second dose of antiarrhythmic drug
answer
(a) Epinephrine 1 mg
question
What is the indication for use of magnesium in cardiac arrest? (a) Ventricular tachycardia associated with a normal QT interval (b) Shock-refractory monomorphic ventricular tachycardia (c) Pulseless ventricular tachycardia-associated torsades de pointes (d) Shock-refractory ventricular fibrillation
answer
(c) Pulseless ventricular tachycardia-associated torsades de pointes
question
A pt is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock. If no pathway for medication administration is in place, which method is preferred? (a) Central line (b) Endotracheal tube (c) External jugular vein (d) IV or IO
answer
(d) IV or IO
question
Which intervention is most appropriate for the treatment of a patient in asystole? (a) Atropine (b) Defibrillation (c) Epinephrine (d) Transcutaneous pacing
answer
(c) Epinephrine
question
You are caring for a 66 yr old man with a hx of a large intracerebral hemorrhage 2 months ago. He is being evaluated for another acute stroke. The CT scane is negative for hemorrhage. The pt is receiving oxygen via nasal cannula at 2 L/min, and an IV has been established. His BP is 180/100. Which drug do you anticipate giving to this pt? (a) Aspirin (b) Glucose (D50) (c) Nicardipine (d) rTPA
answer
(a) Aspirin
question
Pt is in refractory ventricular fibrillation and has received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of amiodarone 300 mg IV. Pt is intubated. Which best describes the recommended second dose of amiodarone for this pt? (a) 1 mg/kg IV push (b) 1 to 2 mg/min infusion (c) 150 mg IV push (d) 300 mg IV push
answer
(c) 150 mg IV push
question
A monitored pt in the ICU developed a sudden onset of narrow-complex tachycardia at a rate of 200. Pt's BP is 128/58, PETCO2 is 38, and pulse oximetry reading is 98%. There is vascular access in the left arm, and pt has not been given any vasoactive drugs. 12 lead EKG confirms a supraventricular tachycardia w/ no evidence of ischemia or infarction. Heart rate has not responded to vagal manuevers. What is your next action? (a) Administer adenosine 6 mg IV push (b) Administer amiodarone 300 mg IV push (c) Perform synchronized cardioversion at 50 J (d) Perform synchronized cardioversion at 200 J
answer
(a) Administer adenosine 6 mg IV push
question
In which situation does bradycardia require treatment? (a) 12-lead ECG showing a normal sinus rhythm (b) Hypotension (c) Diastolic blood pressure > 90 (d) Systolic blood pressure > 100
answer
(b) Hypotension
question
A 67 yr old woman has palpitations, chest discomfort, and tachycardia. The monitor shows a regular wide-complex QRS at a rate of 180/min. She becomes diaphoretic, and her blood pressure is 80/60. Which action do you take next? (a) Establish IV access (b) Obtain a 12 lead EKG (c) Perform electrical cardioversion (d) Seek expert consultation
answer
(c) Perform electrical cardioversion
question
Pt w/ sinus bradycardia and a heart rate of 42 has diaphoresis and a blood pressure of 80/60. What is the initial dose of atropine? (a) 0.1 mg (b) 0.5 mg (c) 1 mg (d) 3 mg
answer
(b) 0.5 mg
question
A pt w/ STEMI has ongoing chest discomfort. Heparin 4000 units IV bolus and a heparin infusion of 1000 units per hr are being administered. The pt did not take aspirin because he has a hx of gastritis, which was treated 5 yrs ago. What is your next action? (a) Give aspirin 160 to 325 mg to chew (b) Give clopidogrel 300 mg orally (c) Give enteric-coated aspirin 75 mg orally (d) Give enteric-coated aspirin 325 mg rectally
answer
(a) Give aspirin 160 to 325 mg to chew
question
62 yr old man suddenly expereinced difficulty speaking and left-sided weakness. He meets initial criteria for fibrinolytic therapy, and a CT scan of the brain is ordered. Which best describes the guidelines for antiplatelet and fibrinolytic therapy? (a) Give aspirin 160 to 325 mg to be chewed immediately (b) Give aspirin 160 mg and clopidogrel 75 mg orally (c) Give heparin if the CT scan is negative for hemorrhage (d) Hold aspirin for at least 24 hrs if rtPA is administered
answer
(d) Hold aspirin for at least 24 hrs if rtPA is administered
question
A patient has sinus bradycardia w/ a heart rate of 36. Atropine has been administered to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The pt is confused, and her BP is 88/56. Which therapy is now indicated? (a) Atropine 1 mg (b) Epinephrine 2 to 10 mcg/min (c) Adenosine 6 mg (d) Normal saline 250 mL to 500 mL bolus
answer
(b) Epinephrine 2 to 10 mcg/min
question
A 45 yr old woman with a hx of palpitations develops light-headedness and palpitations. She has received adenosine 6 mg IV for the rhythm shown here, without conversion of the rhythm. She is now extremely apprehensive. Her BP is 128/70 mm Hg. What is the next appropriate intervention? (a) Administer adenosine 12 mg IV (b) Perform unsynchronized cardioversion (c) Perform vagal maneuvers (d) Perform synchronized cardioversion
answer
(a) Administer adenosine 12 mg IV
question
Which action is likely to cause air to enter the victim's stomach (gastric inflation) during bag-mask ventilation? (a) Giving breaths over 1 second (b) Ventilating too quickly (c) Providing a good seal btwn the face and mask (d) Providing just enough volume for chest to rise
answer
(b) Ventilating too quickly
question
What is the recommended depth of chest compressions for an adult victim?
answer
At least 2 inches
question
You are the code team leader and arrive to find a patient with CPR in progress. On the next rhythm check, you see electrical activity on the monitor. She has no pulse or respirations. Bag-mask ventilations are producing visible chest rise, and IO access has been established. Which intervention would be your next action? (a) Atropine 1 mg (b) Dopamine at 10 to 20 mcg/kg per min (c) Epinephrine 1 mg (d) Intubation and administration of 100% oxygen
answer
(c) Epinephrine 1 mg
question
How often should you switch chest compressors to avoid fatigue?
answer
Every 2 minutes
question
You are providing bag-mask ventilation to a pt in respiratory arrest. How often should you provide ventilations?
answer
About every 5-6 secs
question
Which intervention is most important in reducing this patient's in-hospital and 30 day mortality rate? (a) Application of transcutaenous pacemaker (b) Atropine administration (c) Nitroglycerin administration (d) Reperfusion therapy
answer
(d) Reperfusion therapy
question
How does complete chest recoil contribute to effective CPR? (a) Allows maximum blood return to the heart (b) Reduces rescuer fatigue (c) Reduces the risk of rib fractures (d) Increases the rate of chest compressions
answer
(a) Allows maximum blood return to the heart
question
A patient was in refractory ventricular fibrillation. A third shock has just been administered. Your team looks to you for instructions. What is your next action? (a) Check the carotid pulse (b) Give amiodarone 300 mg IV (c) Give atropine 1 mg IV (d) Resume high-quality chest compressions
answer
(d) Resume high-quality chest compressions
question
A patient has been rususcitated from cardiac arrest. During post-ROSC treatment, pt becomes unresponsive, with ventricular fibrillation. Which action is indicated next? (a) Give an immediate unsynchronized high-energy shock (defibrillation dose) (b) Give lidocaine 1 to 1.6 mg/kg IV (c) Perform synchronized cardioversion (d) Repeat amiodarone 300 mg IV
answer
(a) Give an immediate unsynchronized high-energy shock (defibrillation dose)
question
What is the recommended compression rate for high-quality CPR?
answer
100-120 compressions per min
question
What action minimizes the risk of air entering the victim's stomach during bag-mask ventilation? (a) Ventilating until you see the chest rise (b) Ventilating as quickly as you can (c) Squeezing the bag with both hands (d) Delivering the largest breath you can
answer
(a) Ventilating until you see the chest rise
question
Which action should you take immediately after providing an AED shock? (a) Check pulse rate (b) prepare to deliver a second shock (c) Resume chest compressions (d) Start rescue breathing
answer
(c) Resume chest compressions
question
After initiation of CPR and 1 shock for ventricular fibrillation, pt is still in ventricular fibrillation at next rhythm check. A second shock is given, and chest compressions are resumed immediately. An IV is in place, and no drugs have been given. BBag-mask ventilations are producing visible chest rise. What is your next intervention? (a) Administer 3 sequential (stacked) shocks at 360 J (monophasic defibrillator) (b) Give amiodarone 300 mg IV/IO (c) Give epinephrine 1 mg IV/IO (d) Intubate and administer 100% oxygen
answer
(c) Give epinephrine 1 mg IV/IO
question
What is the maximum interval for pausing chest compressions?
answer
10 seconds
question
A 35 yr old woman presents w/ a chief complaint of palpitations. She has no chest discomfort, shortness of breath, or light-headedness. Her BP is 120/78. On EKG, it shows she is in SVT. Which intervention is indicated first? (a) Adenosine 3 mg IV bolus (b) Adenosine 12 mg IV slow push (over 1 to 2 min) (c) Metoprolol 5 mg IV and repeat if necessary (d) Vagal manuevers
answer
(d) Vagal manuevers
question
Your patient is not responsive and is not breathing. You can palpate a carotid pulse. Which action do you take next? (a) Apply an AED (b) Obtain a 12 lead EKG (c) Start an IV (d) Start rescue breathing
answer
(d) Start rescue breathing
question
What is more important to start for a nonresponsive patient with no pulse, putting on an AED or starting rescue breathing?
answer
Starting rescue breathing
question
You arrive on scene to find CPR in progress. Nursing staff report the pt was recovering from a pulmonary embolism and suddenly collapsed. Two shocks have been delivered, and an IV has been initiated. What do you administer now? (a) Atropine 0.5 mg IV (b) Epinephrine 1 mg IV (c) Endotracheal intubation (d) Transcutaneous pacing
answer
(b) Epinephrine 1 mg IV
question
A patient becomes unresponsive. You are uncertain if a faint pulse is present. An IV is in place. Which action do you take next? (a) Begin transcutaneous pacing (b) Start high-quality CPR (c) Administer atropine 1 mg (d) Administer epinephrine 1 mg IV
answer
(b) Start high-quality CPR
question
If cases where ______ is the likely cause of cardiac arrest, VENTILATION becomes much more important
answer
hypoxia
question
___________ correlates w/ ROSC
answer
High quality CPR
question
What are the consequences of interrupting CPR?
answer
coronary perfusion falls
question
__________ can help indicate coronary perfusion pressure
answer
Capnography
question
Adequate CPR compression are at least
answer
2 inches
question
Why should chest compressions recoil?
answer
To ensure adequate coronary perfusion pressure
question
Chest compression fraction should be around
answer
60-80%
question
Don't spend more than ____ seconds without compressions
answer
10 seconds
question
What should the tidal volume be for adequate ventilations?
answer
500-600 mL or half of a bag squeeze
question
What should be the first thing you do when you arrive on scene?
answer
See if patient is conscious or unconscious
question
What do you do next If the patient is unconscious when you first arrive on scene?
answer
Initiate BLS
question
If a patient is not responsive when you first arrive on scene, what should you do next?
answer
Call code Get AED
question
During BLS, should you check breathing and pulse (a) Separately (b) Simultaenously
answer
(b) Simultaenously
question
If pt is not breathing normally but has pulse, what should you do?
answer
Bypass chest compressions and ventilate every 5-6 seconds
question
After intubating someone, what should you do next?
answer
Provide 1 ventilation every 6 seconds
question
What should you assess for in the Disability function of ABCDE?
answer
Neurologic function - Alert - Pain - Voice - Unresponsive
question
What are the H's of PEA?
answer
Hypovolemia Hypoxia H+ (acidosis) HyperK+ HypoK+ Hypothermia
question
What are the T's of PEA?
answer
Trauma Tension PTX Tamponade Toxins Thrombosis (Pulmonary or Coronary)
question
Why should you not excessively ventilate?
answer
Causes gastric insufflation Incr intrathoracic pressure Decr venous return and CO Decr survival
question
When do you use oropharyngeal airways?
answer
Unconscious pts No gag reflex pts
question
When do you use a nasopharyngeal airway?
answer
Conscious, semiconscious, or unconscious pts with or without gag flex
question
When should you proceed with an advanced airway?
answer
Difficult to bag mask vent Airway compromise Need to isolate airway
question
What should you use to monitor ET tube?
answer
Waveform capnography
question
If waveform capnography jumps up, it may indicate...
answer
ROSC
question
If a patient is in cardiac arrest what are the first two steps?
answer
(1) CPR (2) Attach AED
question
What rhythms are shockable?
answer
VFib or pulseless VTach
question
What rhythms are NOT shockable
answer
Asystole or PEA
question
How often should you give epinephrine?
answer
Every 3-5 minutes
question
When should you consider giving amiodarone?
answer
After you have given 3 shocks and 3 CPR sessions and they are still in VF or pVT
question
When should you determine if the rhythm is shockable for asystole or PEA in the cardiac arrest algorithm?
answer
After the first CPR session (2 minutes)
question
When should you start treating reversible causes of asystole or PEA?
answer
After the second CPR session
question
Bradycardia is categorized as a HR less than...
answer
50
question
When should you give atropine?
answer
When there is bradycardia and perfusion is low
question
If atropine fails in treating bradycardia, what should you do?
answer
(1) Transcutaneous pacing (2) Dopamine (3) Epinephrine
question
If atropine, tcp, dopamine, epinephrine all fail to tx bradycardia, what should you do?
answer
(1) Seek expert consultation (2) Transcutaneous pacing
question
When should you use synchronized cardioversion in tachycardia?
answer
If the pt is hemodynamically unstable
question
What should you do if you encounter a pt who has a pulseless tachycardia?
answer
Manage it like a cardiac arrest algorithm
question
Most symptomatic tachycardias will present with a HR of greater than
answer
150
question
If a tachycardia patient is hemodynamically stable, what is the next thing you should assess?
answer
If QRS is wide (>= 0.120 sec)
question
If QRS is not wide for a tachycardia patient, what should you do next?
answer
(1) Vagal manuevers (2) Adenosine (3) Bblock or CCB (4) Expert consultation
question
What things do you need to do after ROSC?
answer
(1) Optimize ventilation and oxygenation (2) Treat Hypotension (3) EKG (4) See if pt follows commands
question
During post ROSC, what things do you need to do to optimize ventilation and oxygenation?
answer
- O2 > 94% - Advanced airway + capnography - Don't hyperventilate
question
During post ROSC, if a pt cannot follow commands, what do you need to do?
answer
Initiate targeted temperature management
question
If a patient is responsive and talking, what is the next step of the ACS algorithm?
answer
Obtain a 12 lead ECG
question
What is the dosing of nitroglycerin according to the ACS algorithm?
answer
Every 3-5 minutes for a maximum of 3 doses
question
What are the contraindications of nitroglycerin according to the ACS algorithm?
answer
- Severe bradycardia - Tachycardia - Hypotension - Phosphodiesterase inhibitors
question
Initiation of fibrinolytic therapy, if appropriate, within _____ of hospital arrival and ______ from onset of symptoms
answer
Initiation of fibrinolytic therapy, if appropriate, within 1 hour of hospital arrival and 3 hours from onset of symptoms
question
In ACS algorithm, what determines whether or not a STEMI gets reperfusion or not?
answer
Whether or not the sxs of onset are less than 12 hrs