ACLS Exam A

11/16/2014
AHA ACLS Written Test flashcards | Quizlet
AHA ACLS Written Test
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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?
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?
Obtaining a 12 lead ECG.
What is the preferred method of access for

epi administration during cardiac arrest in
most pts?
Peripheral IV
An AED does not promptly analyze a

rythm. What is your next step?
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?
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?
Resume compressions
What is acommon but sometimes fatal

mistake in cardiac arrest management?
Prolonged interruptions in chest

compressions.
Which action is a componant of highquality chest comressions?
Allowing complete chest recoil
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Which action increases the chance of

successful conversion of ventricular
fibrillation?
Providing quality compressions

immediately before a defibrillation
attempt.
Which situation BEST describes PEA?
Sinus rythm without a pulse
What is the best strategy for perfoming

high-quality CPR on a pt.with an advanced
airway in place?
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?
Chest compressions may not be effective.
The use of quantitative capnography in

intubated pt's does what?
Allowsfor monitoring CPR quality
For the past 25 min, EMS crews have

attemptedresuscitation 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 next treatment?
Consider terminating resuscitive efforts

after consulting medical control.
Which is a safe and effective practice

within the defibrillation sequence?
Be sure O2 is NOT blowing over the pt's

chest during shock.
During your assessment, your pt suddenly

loses consciousness. After calling for help
and determining that the pt. is not
breathing, you are unsure whether the pt.
has a pulse. What is your next action?
Begin chest compressions.
What is an advantage of using hands-free

d-fib pads instead of d-fib paddles?
Hands-free allows for more rapid d-fib.
What action is recommended to help

minimize interruptions in chest
compressions during CPR?
Continue CPR while charging the

defibrillator.
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Which action is included in the BLS

survey?
Early defibrillation
Which drug and dose are recommended

for the management of a pt. in refractory
V-FIB?
Amioderone 300mg
What is the appropriate intervalfor an

interruption in chest compressions?
10 seconds or less
Which of the following is a sign of

effective CPR?
PETCO2 = or > 10mm Hg
What is the primary purpose of a medical

emergency team or rapid response team?
Identifying and treating early clinical

deterioration.
Which action improves the quality of chest

compressions delivered during resuscitave
attemepts?
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?
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?
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?
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?
Vagal manuever.
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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?
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?
Divert the pt. to a hospital 15 min away

with CT capabilities.
Choose an appropriate inidication to stop

or withhold resuscitive efforts.
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?
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?
Simple airway manuevers and assisted

ventilations.
What is the appropriate procedure for ET

suctioning after the catheter is selected?
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?
Atropine 0.5mg
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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
shows a sinus rythm. What would be your
next action?
Cinncinati Stroke Scale
You are transporting a pt. with a positive

stroke assessment. BP is 138, pulse is
80/min, resp rate is 12/min, 02 sat is 95%
room air. Glucose levels are normal and
the ECG shows a sinus rythm. What is
next.
Head CT scan
What is the proper ventilation rate for a pt.

in cardiac arrest who has an advanced
airway in place?
8-10 breaths per minute
A 62 y/o male pt. in the ER says his heart

is beating fast. No chest pain or SOB. BP
is 142/98, pulse rate is 200/min, reps rate
is 14/min, O2 sats are 95 at room air. What
should be the next evaluation?
Obtain a 12 lead ECG.
You are evaluating a 48 y/o male with

crushing sub-sternal pain. He is cool, pale,
diaphretic, and slow to respond to your
questions. BP is 58/32, pulse is 190/min,
resp rate is 18, and you are unable to
obtain an 02 sat due to no radial pulse. The
ECG shows a wide complex tach rythm.
What intervention should be next?
Syncronized cardioversion.
What is the initial priority for an

unconscious pt. with any tachycardia on
the monitor?
Determine if a pulse is present.
Which rythm requires synchronized

cardioversion?
Unstable SVT
What is the recommended dose for

adenosine for pt's in refractory, but stable
narrow complex tachycardia?
12mg
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What is the usual post-cardiac arrest target

range for PETCO2 who achieves return of
spontaneous circulation (ROSC)?
35-40mm Hg
Which conditionis a contraindication to

theraputic hypothermia during the postcardiac arrest period for pt's who achieve
return of spontaneous circulation (ROSC)?
Responding to verbal commands
What is the potential danger to using ties

that pass circumfrentially around the pt's
neck when securing an advanced airway?
Obstruction of veneous return from the

brain
What is the most reliable method of

confirming and montioring correct
placement of an ET tube?
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 postcardiac arrest period?
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?
90mm Hg
What is the 1st treatment priority for a pt.

who achieves ROSC?
Optimizing ventilation and oxygenation.
Ventilations during Cardiac Arrest
2 every 30 compressions with a bag mask

or
1 every 6 to 8 seconds w/advanced airway
(8-10 breaths/minute)
ventilations during respiratory arrest
1 every 5 to 6 seconds
10 to 12 breaths/minute
tidal volume delivered w/bag mask
600mL
what does a PETCO2 of <10mmHg

indicate in an intubated patient
their CO is inadequate to to achieve ROSC
which drugs can be given with

endotracheal route?
only epi, vasopressin and lidocaine and

you will need to double the dose
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why do we give a saline bolus after

infusion of a drug via peripheral IV?
to hasten the time for peak response
steps for treating hypotension
1. IV bolus 1-2L normal saline

2. pressor: 0.1-0.5 mcg/kg/min for epi or
norepi
or 5-10mcg/kg/min of dopamine
3. treatable causes? (H's and T's)
4. obtain ECG
Do you shock PEA?
do not shock asystole or PEA!

treatment is vasopressor only!
reperfusion goal: time from door to

balloon inflation (PCI)
90 minutes
reperfusion goal of 30 minutes is for...
door-to-needle (fibrinolysis)
if pt is hemodynamically unstable do you

give nitroglycerin?
No, must have SBP >90mmHg
when is nitroglycerin contraindicated?
inferior wall MI or RT ventricular

infarction
hypotension, brady or tachycardia
recent phosphodiesterase use (Viagra)
4 D's of in-hospital therapy
door to data to decision to drug (or PCI)
treatment of bradyarrhythmia
0.5 mg Atropine every 3-5 minutes, max

of 3 mg
if ineffective:
transutaneous pacing or dopamine 210mcg/kg/min or epi 2-10mcg/min
when do you use synchronized shocks
unstable SVT
unstable afib
unstable a flutter
unstable, regular, monomorphic
tachycardia w/a pulse
therapy for pt w/narrow QRS w/regular

rhythm
vagal maneuver
or
give adenosine
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stroke
general assessment w/in __ minutes of
arrival
CT w/in __ minutes
interpret CT within __ minutes
initiate fibrinolytic therapy within ?
door-to-admission time of 3 hours
general assessment w/in 10 minutes of

arrival
CT w/in 25 minutes
interpret CT within 45 minutes
-initiate fibrinolytic therapy within 1 hour
of arrival and 3 hours from symptom onset
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11/16/2014

AHA ACLS Written Test flashcards | Quizlet

AHA ACLS Written Test

Start with Flashcards

Start chest compressions of at least 100 per

You are evaluating a 58 year old man with

Obtaining a 12 lead ECG.

What is the preferred method of access for

An AED does not promptly analyze a

Begin chest compressions.

You have completed 2 min of CPR. The

Administer 1mg of epinepherine

During a pause in CPR, you see a narrow

What is acommon but sometimes fatal

Prolonged interruptions in chest

Which action is a componant of highquality chest comressions?

Allowing complete chest recoil

AHA ACLS Written Test flashcards | Quizlet

Which action increases the chance of

Providing quality compressions

Which situation BEST describes PEA?

Sinus rythm without a pulse

What is the best strategy for perfoming

Provide continuous chest

3 min after witnessing a cardiac arrest, one

Chest compressions may not be effective.

The use of quantitative capnography in

Allowsfor monitoring CPR quality

For the past 25 min, EMS crews have

Consider terminating resuscitive efforts

Which is a safe and effective practice

Be sure O2 is NOT blowing over the pt's

During your assessment, your pt suddenly

Begin chest compressions.

What is an advantage of using hands-free

Hands-free allows for more rapid d-fib.

What action is recommended to help

Continue CPR while charging the

AHA ACLS Written Test flashcards | Quizlet

Which action is included in the BLS

Which drug and dose are recommended

What is the appropriate intervalfor an

Which of the following is a sign of

PETCO2 = or > 10mm Hg

What is the primary purpose of a medical

Identifying and treating early clinical

Which action improves the quality of chest

Shitch providers about every 2 min or

What is the appropriate ventilation strategy

1 breath every 5-6 seconds

A pt. presents to the ER with a new onset

A pt. presents to the ER with dizziness and

A pt. has an onset of dizziness. The pt.s

AHA ACLS Written Test flashcards | Quizlet

A monitored pt. in the ICU developed a

You receiving a radio report from an EMS

Divert the pt. to a hospital 15 min away

Choose an appropriate inidication to stop

Evidence of rigor mortis.