ACLS Exam Version B PDF

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Summary

ACLS 2018: Pre and Posttest 166 terms Rucker139 PLUSTerms in this set (166)Supraventricular TachycardiaAtrial fibrillationSecond deg AV block: Mobitz 1Second deg AV block: Mobitz 2Intermittent non-conducted P waves without progressive prolongation of the PR interval (compare this to Mobitz I).Ventri...

Description

ACLS 2018: Pre and Posttest

166 terms

R

Terms in this set (166) Supraventricular Tachycardia

Atrial fibrillation

Second deg AV block: Mobitz 1

Second deg AV

Intermittent non-conducted P waves without

block: Mobitz 2

progressive prolongation of the PR interval (compa this to Mobitz I).

Third deg AV block

Sinus bradycardia

Ventricular fibrillation

Atrial flutter

Pulseless electrical activity

Second deg AV block: Mobitz 2

Supraventricular tachycardia

Polymorphic

Push Epi Always

Sinus bradycardia

Sinus tachycardia

Ventricular fibrillation

Agonal rhythm into asystole

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

(d) Epinephrine 1 mg IV/IO

A patient has a rapid irregular wide-

(d) Seeking expert consultation

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 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

(b) Epinephrine 1 mg IV/IO

You arrive on the scene with the code

(b) Establish IV or IO access

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 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

(b) Amiodarone 300 mg

A 35 yr old female has palpitation, light-

(a) Adenosine 6 mg

headedness, and a stable tachycardia. The monitor shows a regular narrowcomplex 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 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

(a) Epinephrine 1 mg

What is the indication for use of magnesium

(c) Pulseless ventricular tachycardia-associated torsades de pointes

in cardiac arrest? (a) Ventricular tachycardia associated with a normal QT interval (b) Shock-refractory monomorphic ventricular tachycardia (c) Pulseless ventricular tachycardiaassociated torsades de pointes (d) Shock-refractory ventricular fibrillation 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

(d) IV or IO

Which intervention is most appropriate for

(c) Epinephrine

the treatment of a patient in asystole? (a) Atropine (b) Defibrillation (c) Epinephrine (d) Transcutaneous pacing 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

(a) Aspirin

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

(c) 150 mg IV push

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

(a) Administer adenosine 6 mg IV push

In which situation does bradycardia

(b) Hypotension

require treatment? (a) 12-lead ECG showing a normal sinus rhythm (b) Hypotension (c) Diastolic blood pressure > 90 (d) Systolic blood pressure > 100 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

(c) Perform electrical cardioversion

Pt w/ sinus bradycardia and a

(b) 0.5 mg

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 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-

(a) Give aspirin 160 to 325 mg to chew

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

(d) Hold aspirin for at least 24 hrs if rtPA is administered

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

(b) Epinephrine 2 to 10 mcg/min

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

(a) Administer adenosine 12 mg IV

Which action is likely to cause air to enter

(b) Ventilating too quickly

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 What is the recommended depth of chest compressions for an adult victim?

At least 2 inches

You are the code team leader and

(c) Epinephrine 1 mg

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. Bagmask 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 How often should you

Every 2 minutes

switch chest compressors to avoid fatigue? You are providing bag-mask ventilation to a pt in respiratory

About every 5-6 secs

Which intervention is most important in

(d) Reperfusion therapy

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 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

(a) Allows maximum blood return to the heart

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 highquality chest compressions

(d) Resume high-quality chest compressions

A patient has been rususcitated from

(a) Give an immediate unsynchronized high-energy shock (defibrillation dose)

cardiac arrest. During post-ROSC treatment, pt becomes unresponsive, with ventricular fibrillation. Which action is indicated next? (a) Give an immediate unsynchronized highenergy shock (defibrillation dose) (b) Give lidocaine 1 to 1.6 mg/kg IV (c) Perform synchronized cardioversion (d) Repeat amiodarone 300 mg IV What is the recommended compression rate for high-quality CPR?

100-120 compressions per min

What action minimizes the risk of air entering

(a) Ventilating until you see the chest rise

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 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

(c) Resume chest compressions

After initiation of CPR and 1 shock for

(c) Give epinephrine 1 mg IV/IO

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 What is the maximum interval for pausing

10 seconds

A 35 yr old woman presents w/ a chief

(d) Vagal manuevers

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 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

What is more important to start for

Starting rescue breathing

a nonresponsive patient with no pulse, putting on an AED or starting rescue breathing? 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

(b) Epinephrine 1 mg IV

A patient becomes unresponsive. You are

(b) Start high-quality CPR

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 If cases where ______ is

hypoxia

the likely cause of cardiac arrest, VENTILATION becomes much more important ___________ correlates w/

High quality CPR

ROSC What are the

coronary perfusion falls

consequences of interrupting CPR? __________ can help indicate coronary perfusion pressure

Capnography

Why should chest compressions recoil?

To ensure adequate coronary perfusion pressure

Chest compression

60-80%

fraction should be around Don't spend more

10 seconds

than ____ seconds without compressions What should the tidal

500-600 mL or half of a bag squeeze

volume be for adequate ventilations? What should be the

See if patient is conscious or unconscious

first thing you do when you arrive on scene? What do you do next

Initiate BLS

If the patient is unconscious when you first arrive on scene? If a patient is not

Call code

responsive when you

Get AED

first arrive on scene, what should you do next? During BLS, should you check breathing and pulse ( )S

t l

(b) Simultaenously

If pt is not breathing normally but has

Bypass chest compressions and ventilate every 5-6 seconds

pulse, what should you do? After intubating

Provide 1 ventilation every 6 seconds

someone, what should you do next? What should you

Neurologic function

assess for in the

- Alert

Disability function of

- Pain

ABCDE?

- Voice - Unresponsive

What are the H's of

Hypovolemia

PEA?

Hypoxia H+ (acidosis) HyperK+ HypoK+ Hypothermia

What are the T's of

Trauma

PEA?

Tension PTX Tamponade Toxins Thrombosis (Pulmonary or Coronary)

Why should you not

Causes gastric insufflation

excessively ventilate?

Incr intrathoracic pressure Decr venous return and CO Decr survival

When do you use

Unconscious pts

oropharyngeal

No gag reflex pts

Oropharyngeal airway

Nasopharyngeal airway

When should you

Difficult to bag mask vent

proceed with an

Airway compromise

advanced airway?

Need to isolate airway

What should you use

Waveform capnography

to monitor ET tube? If waveform

ROSC

capnography jumps up, it may indicate... If a patient is in

(1) CPR

cardiac arrest what

(2) Attach AED

are the first two steps? What rhythms are

VFib or pulseless VTach

shockable? What rhythms are

Asystole or PEA

NOT shockable How often should you

Every 3-5 minutes

give epinephrine? When should you

After you have given 3 shocks and 3 CPR sessions a

consider giving

they are still in VF or pVT

amiodarone?

When should you determine if the

After the first CPR session (2 minutes)

rhythm is shockable for asystole or PEA in the cardiac arrest algorithm? When should you

After the second CPR session

start treating reversible causes of asystole or PEA? Bradycardia is

50

categorized as a HR less than... When should you

When there is bradycardia and perfusion is low

give atropine? If atropine fails in

(1) Transcutaneous pacing

treating bradycardia,

(2) Dopamine

what should you do?

(3) Epinephrine

If atropine, tcp,

(1) Seek expert consultation

dopamine,

(2) Transcutaneous pacing

epinephrine all fail to tx bradycardia, what should you do? When should you use

If the pt is hemodynamically unstable

synchronized cardioversion in tachycardia? What should you do if you encounter a pt

Manage it like a cardiac arrest algorithm

Most symptomatic tachycardias will

150

present with a HR of greater than If a tachycardia

If QRS is wide (>= 0.120 sec)

patient is hemodynamically stable, what is the next thing you should assess? If QRS is not wide for

(1) Vagal manuevers

a tachycardia patient,

(2) Adenosine

what should you do

(3) Bblock or CCB

next?

(4) Expert consultation

What things do you

(1) Optimize ventilation and oxygenation

need to do after

(2) Treat Hypotension

ROSC?

(3) EKG (4) See if pt follows commands

During post ROSC,

- O2 > 94%

what things do you

- Advanced airway + capnography

need to do to

- Don't hyperventilate

optimize ventilation and oxygenation? During post ROSC, if

Initiate targeted temperature management

a pt cannot follow commands, what do you need to do? If a patient is responsive and

Obtain a 12 lead ECG

What is the dosing of nitroglycerin

Every 3-5 minutes for a maximum of 3 doses

according to the ACS algorithm? What are the

- Severe bradycardia

contraindications of

- Tachycardia

nitroglycerin

- Hypotension

according to the ACS

- Phosphodiesterase inhibitors

algorithm? Initiation of

Initiation of fibrinolytic therapy, if appropriate, withi

fibrinolytic therapy, if

hour of hospital arrival and 3 hours from onset of

appropriate, within

symptoms

_____ of hospital arrival and ______ from onset of symptoms In ACS algorithm,

Whether or not the sxs of onset are less than 12 hrs

what determines whether or not a STEMI gets reperfusion or not? Sinus Bradycardia

Please identify the rhythm by selecting the best sin answer.

Reentry

Please identify the rhythm by selecting the best sing

supraventricular

answer.

tachycardia