11/16/2014 AHA ACLS Written Test flashcards |

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AHA ACLS Written Test 67 terms by shaneei

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You find an unresponsive pt. who is not Start chest compressions of at least 100 per
breathing. After activating the emergency min.
response system, you determine there is no
pulse. What is your next action?

You are evaluating a 58 year old man with Obtaining a 12 lead ECG.
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?

What is the preferred method of access for Peripheral IV

epi administration during cardiac arrest in
most pts?

An AED does not promptly analyze a Begin chest compressions.

rythm. What is your next step?

You have completed 2 min of CPR. The Administer 1mg of epinepherine

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?

During a pause in CPR, you see a narrow Resume compressions

complex rythm on the monitor. The pt. has
no pulse. What is the next action?

What is acommon but sometimes fatal Prolonged interruptions in chest

mistake in cardiac arrest management? compressions.

Which action is a componant of high- Allowing complete chest recoil

quality chest comressions?

cards/ 1/8
Which action increases the chance of Providing quality compressions
successful conversion of ventricular immediately before a defibrillation
fibrillation? attempt.
Which situation BEST describes PEA? Sinus rythm without a pulse
What is the best strategy for perfoming Provide continuous chest
high-quality CPR on a pt.with an advanced compressionswithout pauses and 10
airway in place? ventilations per minute.
3 min after witnessing a cardiac arrest, one Chest compressions may not be effective.
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?

The use of quantitative capnography in Allowsfor monitoring CPR quality

intubated pt's does what?

For the past 25 min, EMS crews have Consider terminating resuscitive efforts
attemptedresuscitation of a pt who after consulting medical control.
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?

Which is a safe and effective practice Be sure O2 is NOT blowing over the pt's
within the defibrillation sequence? chest during shock.
During your assessment, your pt suddenly Begin chest compressions.
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?

What is an advantage of using hands-free Hands-free allows for more rapid d-fib.
d-fib pads instead of d-fib paddles?
What action is recommended to help Continue CPR while charging the
minimize interruptions in chest defibrillator.
compressions during CPR?
Which action is included in the BLS Early defibrillation
survey?

Which drug and dose are recommended Amioderone 300mg

for the management of a pt. in refractory
V-FIB?

What is the appropriate intervalfor an 10 seconds or less

interruption in chest compressions?

Which of the following is a sign of PETCO2 = or > 10mm Hg

effective CPR?

What is the primary purpose of a medical Identifying and treating early clinical
emergency team or rapid response team? deterioration.

Which action improves the quality of chest Shitch providers about every 2 min or
compressions delivered during resuscitave every 5 compression cycles.
attemepts?

What is the appropriate ventilation strategy 1 breath every 5-6 seconds

for an adult in respiratory arrest with a
pulse of 80 beats/min?

A pt. presents to the ER with a new onset Atropine 0.5mg

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?

A pt. presents to the ER with dizziness and 2-10mcg/kg/min

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?

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

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?
A monitored pt. in the ICU developed a Adenosine 12mg IV
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?
You receiving a radio report from an EMS Divert the pt. to a hospital 15 min away
team enroute with a pt. who may be having with CT capabilities.
a stroke. The hospital CT scanner is
broken. What should you do?

Choose an appropriate inidication to stop Evidence of rigor mortis.

or withhold resuscitive efforts.

A 49 y/ofmaile arrives in the ER with Obtain a 12 lead ECG.

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?

A pt. in respiratory failure becomes apneic Simple airway manuevers and assisted
but contineues to have a strong pulse. The ventilations.
heart rate is dropping paridly and now
shows a sinus brady rate at 30/min. What
intervention has the highest priority?

What is the appropriate procedure for ET Suction during withdrawl, but not for
suctioning after the catheter is selected? longer than 10 seconds.
While treating a stable pt for dizziness, a Atropine 0.5mg
BP of 68/30, cool and clammy, you see a
brady rythm on the ECG. How do you
treat this?
A 68 y/o female pt. experienced a sudden Cinncinati Stroke Scale
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?

You are transporting a pt. with a positive Head CT scan

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.

What is the proper ventilation rate for a pt. 8-10 breaths per minute
in cardiac arrest who has an advanced
airway in place?
A 62 y/o male pt. in the ER says his heart Obtain a 12 lead ECG.
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?

You are evaluating a 48 y/o male with Syncronized cardioversion.

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?

What is the initial priority for an Determine if a pulse is present.

unconscious pt. with any tachycardia on
the monitor?
Which rythm requires synchronized Unstable SVT
cardioversion?

What is the recommended dose for 12mg

adenosine for pt's in refractory, but stable
narrow complex tachycardia?
What is the usual post-cardiac arrest target 35-40mm Hg
range for PETCO2 who achieves return of
spontaneous circulation (ROSC)?
Which conditionis a contraindication to Responding to verbal commands
theraputic hypothermia during the post-
cardiac arrest period for pt's who achieve
return of spontaneous circulation (ROSC)?

What is the potential danger to using ties Obstruction of veneous return from the
that pass circumfrentially around the pt's brain
neck when securing an advanced airway?

What is the most reliable method of Continuous waveform capnography

confirming and montioring correct
placement of an ET tube?
What is the recommended IV fluid (NS or 1 to 2 Liters
LR) bolus dose for a pt. who achieves
ROSC but is hypotensive during the post-
cardiac arrest period?

What is the minimum systolic BP one 90mm Hg

should attempt to achieve with fluid,
Inotropic, or vasopressor administration in
a hypotensive post-cardiac arrest who
achieves ROSC?

What is the 1st treatment priority for a pt. Optimizing ventilation and oxygenation.
who achieves ROSC?

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 their CO is inadequate to to achieve ROSC
indicate in an intubated patient

which drugs can be given with only epi, vasopressin and lidocaine and
endotracheal route? you will need to double the dose
why do we give a saline bolus after to hasten the time for peak response
infusion of a drug via peripheral IV?
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 90 minutes
balloon inflation (PCI)
reperfusion goal of 30 minutes is for... door-to-needle (fibrinolysis)
if pt is hemodynamically unstable do you No, must have SBP >90mmHg
give nitroglycerin?
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 2-
10mcg/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 vagal maneuver
rhythm or
give adenosine
stroke general assessment w/in 10 minutes of
general assessment w/in minutes of arrival
arrival CT w/in 25 minutes
CT w/in minutes interpret CT within 45 minutes
interpret CT within minutes -initiate fibrinolytic therapy within 1 hour
initiate fibrinolytic therapy within ? of arrival and 3 hours from symptom onset
door-to-admission time of 3 hours