ACLS Flashcards by Liz White

A 54-year-old man is unresponsive. There is no evidence of trauma
After calling for assistance, your best course of action in this situation will be to:

a. Begin chest compressions
b. Administer intranasal naloxone
c. Apply an automated external defibrillator (AED)
d. Check for a pulse while assessing for absent or gasping breathing

d. Check for a pulse while assessing for absent or gasping breathing

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A 54-year-old man is unresponsive. There is no evidence of trauma

Your assessment reveals no visible chest rise, but a strong pulse is present. You should:

a. Insert an advanced airway
b. Open the airway with a head tilt-chin lift
c. Administer supplemental oxygen by non-rebreather mask
d. Position the patient on his side to aid the drainage of oral secretions

b. Open the airway with a head tilt-chin lift

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A 54-year-old man is unresponsive. There is no evidence of trauma

An oropharyngeal airway has been inserted. You should now:

a. Establish vascular access
b. Apply a transcutaneous pacemaker
c. Begin ventilation using a bag-mask device
d. Analyze the patient’s cardiac rhythm sing an AED

c. Begin ventilation using a bag-mask device

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A 54-year-old man is unresponsive. There is no evidence of trauma

Ventilations should be provided for this patient at a rate of:

a. 1 breath every 3-4 seconds
b. 1 breath every 5-6 seconds
c. 2 breaths every 6-8 seconds
d. 2 breaths every 10-15 seconds

b. 1 breath every 5-6 seconds

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A 49-year-old man with a history of “an irregular heartbeat” presents with an acutely altered mental status. The patient’s SpO2 on RA is 98%, IV access has been established and the patient has been placed on a cardiac monitor.

The rhythm is:

a. Polymorphic VT
b. Monomorphic VT
c. AV reentrant tachy
d. AV nodal reentry tach

a. Polymorphic VT

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Assessment of the pt reveals a weak carotid pulse is present. He is unresponsive to voice commands but does respond to a painful stimulus. His blood pressure is 64/40 mm Hg. This pt should be categorized as:

a. asymptomatic
b. symptomatic but stable.
c. symptomatic and unstable
d. pulseless

c. symptomatic and unstable

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Management of this pt should include which of the following?

a. Fibrinolytic therapy, epi, and amiodarone
b. Defib and possible admin of magnesium sulfate
c. Transcutaneous pacing and admin of amiodarone and procaalnamide
d. Synchronized cardioversion and admin of adenosine, beta-blockers, or Ca channel blockers

b. Defib and possible admin of magnesium sulfate

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An 81-year-old woman is complaining of sudden onset palpitaitons. She denies CP of SOB. Her BP is 134/78 mmHg and vents are 16 bpm. An IV is in place. The cardiac monitor reveals the rhythm below (VT). on the basis of the information provided, your best course of action will be:

a. Give 150mg amiodarone IV over 10 min
b. Admin sedation and defibrillate immediately
c. Begin CPR and prep for transcutaneous pacing
d. Give 2.5 to 5 mg of verapamil IV push over 2 min

a. Give 150mg amiodarone IV over 10 min

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A 72-year-old man is complaining of dizziness. HIs breathing is unlabored at 14/min, breath sounds clear, tidal volume adequate, and SpO2 on RA is 90%.

The cardiac monitor reveals the following rhythm (Lead II). The rhythm is:

a. sinus arrhythmia
b. Third degree HB
c. Second degree Type 1
d. Second degree Type 2

c. Second degree Type 1

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A 72-year-old man is complaining of dizziness. HIs breathing is unlabored at 14/min, breath sounds clear, tidal volume adequate, and SpO2 on RA is 90%.
-Rhythm: Second degree type 1

The pts BP with this rhythm is 54/30. This pt should be categorized as:

a. asymptomatic
b. symptomatic but stable
c. symptomatic and unstable
d. pulseless

c. symptomatic and unstable

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A 72-year-old man is complaining of dizziness. HIs breathing is unlabored at 14/min, breath sounds clear, tidal volume adequate, and SpO2 on RA is 90%.
-Second degree type 1

Management of this pt should include:

a. Admin of 0.5 mg of atropine IV push
b. Admin of 1mg of epi IV push
c. Immediate synchronized cardioversion with 50J
d. Continued monitoring and observation is all that is necessary at this time

a. Admin of 0.5 mg of atropine IV push

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A 64-year-old man is complaining of chest discomfort that has been present for 45 minutes. He rates his discomfort 10/10.

Which of the following statements is true?

a. ST segments should be monitored in all pts experiencing an acute coronary syndrome (ACS).
b. Oxygen should be administered to all patients experiencing an ACS.
c. An initial 12-lead ECG should be obtained within 30 min of pt contact.
d. Pts most likely to benefit from reperfusion therapy are those who show nonspecific ST or T-wave changes on EKG.

a. ST segments should be monitored in all pts experiencing an acute coronary syndrome (ACS).

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A 64-year-old man is complaining of chest discomfort that has been present for 45 minutes. He rates his discomfort 10/10.

A 12-lead is obtained. ST elevation in leads II, III, aVF, V5, and V6. These findings suggest an _____ MI.

a. inferoseptal
b. inferolateral
c. anteroseptal
d. anterolateral

b. interolateral

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A 12-lead is obtained. ST elevation in leads II, III, aVF, V5, and V6.
On the basis of the 12-lead findings in the preceding question, which of the following statements is true?

a. “discomfort” is not pain, no pain meds needed
b. Tachycardias should be anticipated because increased sympathetic NS activity is common
c. Your immediate priority should be to administer nitrates to address the pts chest discomfort.
d. Use right chest leads to quickly r/o RV infarction before giving meds for pain relief

d. Use right chest leads to quickly r/o RV infarction before giving meds for pain relief

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Which of the following statements is true regarding reperfusion therapy in the pt presenting with a STEMI?

a. Fibrinolysis is the preferred strategy for STEMI pts who present in shock.
b. Fibrinolytic therapy is preferred if the STEMI pt presents between 12 and 24 hrs after symptom onset
c. When primary PCI is the chosen reperfusion strategy, the recommended time target is to perform the procedure with 3 hours of the pt arrival.
d. When fibrinolysis is the chosen reperfusion strategy, the recommended time target is to give the fibrinolytic agent within 30 min of pt contact.

d. When fibrinolysis is the chosen reperfusion strategy, the recommended time target is to give the fibrinolytic agent within 30 min of pt contact.

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A pt has experienced a cardiopulmonary arrest. The cardiac monitor displays the following rhythm (lead II).
-Sinus tach

High-quality CPR is in progress. Appropriate interventions for this pt should include:

a. Vascular access, epi, and atropine
b. defibrillation, vascular access, epi, and atropine
c. Vascular access, epi, and search for the cause of arrest
d. Vascular access, vasopressin, transcutenous pacing, and search for cause of arrest

c. Vascular access, epi, and search for the cause of arrest

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A 55-year-old woman is complaining of severe chest discomfort that has persisted after 3 doses of sublingual nitro. Within minutes of administering morphine IV, the pts BP dropped from 114/66 to 76/42 and her HR increased from 88 to 110. The pts breath sounds are clear. Her EKG shows a sinus tach. Your next action should be to:

a. Give another dose of sublingual nitro
b. Perform immediate synchronized cardioversion with 50J
c. Perform vagal maneuvers and give adenosine 6mg rapid IV push
d. Give a fluid challenge of 250 to 500mL of NS and reassess

d. Give a fluid challenge of 250 to 500mL of NS and reassess

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A 57-year-old man is complaining of chest discomfort and difficulty breathing. He is disoriented and extremely anxious. Examination reveals bibasilar crackles, a weak carotid pulse, and a blood pressure of 60/30 mmHg. His SpO2 on RA is 86%.

Based on the information provided, this pt should be categorized as:

a. asymptomatic
b. symptomatic but stable
c. symptomatic and unstable
d. pulseless

c. symptomatic and unstable

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The pt has been placed on oxygen and an IV has been established. The cardiac monitor displays the rhythm below.

a. Sinus tachy
b. narrow QRS tachy
c. polymorphic VT
d. monomorhpic VT

b. narrow QRS tachy

Management of this pt should include:

a. Delivering synchronized cardioversion starting with 50J
b. Performing defibrillation starting with 120J.
c. Performing CPR for 2 min and then defibrillating with 360J.
d. Giving 2.5 mg of verapamil slowly IV bolus and reassessing the pt.

a. Delivering synchronized cardioversion starting with 50J

A 72-year-old woman is unresponsive.
After activating the emergency response system you find that the patient is pulseless and apneic. Your next action should be to:

a. open the airway
b. obtain a 12-lead ECG
c. Establish vascular access
d. Begin chest compressions

d. Begin chest compressions

A 72-year-old woman is unresponsive.
CPR is in progress. The cardiac monitor reveals the following rhythm (asystole).
Your next action:
a. Defibrillate immediately
b. Establish vascular access
c. Administer an antiarrhythmic.
d. Assess the patient’s pulse and blood pressure

b. Establish vascular access

A 72-year-old woman is unresponsive.
-asystole
Which of the following is indicated in the management of this pt?
a. atropine
b. lidocaine
c. epinephrine
d. amiodarone

c. epinephrine

A 78-year-old woman is unresponsive. Four ALS personnel and emergency equipment, including an automated external defibrillator are immediately available.

The patient is pulseless and apneic. Which of the following statemetns is correct with regard to your approach to this patient?

a. Begin by opening the airway
b. Begin by delivering 2 rescue breaths
c. Begin b applying the AED to the patient.
d. Begin with chest compressions at the rate of 100-120/min

d. Begin with chest compressions at the rate of 100-120/min

A 78-year-old woman is unresponsive. Four ALS personnel and emergency equipment, including an automated external defibrillator are immediately available. The AED indicates that a shock is advised. Which of the following correctly reflects your priorities of care in this situation? a. High-quality CPR and defibrillation b. High-quality CPR and vascular access c. Defibrillation and advanced airway insertion d. Vascular access and med aministration

a. High-quality CPR and defibrillation

A 78-year-old woman is unresponsive. Four ALS personnel and emergency equipment, including an automated external defibrillator are immediately available. After the delivery of a shock, vascular access has been established and CPR is ongoing. The first medication that should be administered is: a. atropine b. lidocaine c. epinephrine d. amiodarone

c. epinephrine

A 78-year-old woman is unresponsive. Four ALS personnel and emergency equipment, including an automated external defibrillator are immediately available. A trach has been placed. While venting pt you note you are encountering no resistance but there is an absence of chest wall movement. You are unable to auscultate breath sounds on either side of the chest. What is the most likely cause of this situation? a. esophageal intubation b. mucus plug in the tracheal tube c. left primary bronchus intubation d. right primary bronchus intubation

a. esophageal intubation

Upon ROSC after cardiac arrest, priority is given to: a. treating hypotension b. optimizing ventilation and oxygenation c. initiating targeted temperature management d. implementing a coronary reperfusion strategy

b. optimizing ventilation and oxygenation

Current resuscitation guidelines consider it reasonable to avoid and correct hypotension after resuscitation from cardiac arrest. The minimum systolic BP that should be targeted is: a. 60 mmHg b. 70 mmHg c. 80 mmHg d. 90 mmHg

d. 90 mmHg

Which of the following is true with regard to post-cardiac arrest care? a. Emergency coronary angiography is recommended for all patients with ST elevation. b. The prophylactic administration of anticonvulsants is recommended to minimize the occurrence of sz c. If epi is necessary to improve BP, the recommended infusion rate is 5-10 mcg/kg/min d. Avoiding the detrimental effects of hyperoxia after the ROSC is more important than the prevention of hypoxia

a. Emergency coronary angiography is recommended for all patients with ST elevation.

A 50-year-old woman is complaining of dizziness and palpitations. She denies CP. THe cardiac monitor reveals a narrow QRS tachycardia at 200 bpm. Her BP 110/70 mmHg and her vent rate is 20 breaths/min. You should: a. Start an IV and give a 300 mg dose of amiodarone b. Establish vascular access and give 1 mg of 1:10,000 epi c. Attempt a vagal maneuver; if unsuccessful, give adenosine rapid IV push d. Perform synchronized cardioversion with 100 joules or equivalent biphasic energy.

c. Attempt a vagal maneuver; if unsuccessful, give adenosine rapid IV push

A 70-year-old man presents with acute AMS and dizziness. His bp is 70/40, his vent rate is 18 breaths/min, and his skin is pale, cool and moist. The pts SpO2 on RA is 97%. The cardiac monitor reveals the rhythm below. -2nd degree Type 2 HB Your best course of action will be: a. Give atropine 1mg every 3-5 min b. Perform immediate synchronized cardioversion c. Observe the pt and monitor for signs of deterioration d. Begin a dopamine infusion or prepare for transcutaneous pacing

d. Begin a dopamine infusion or prepare for transcutaneous pacing

A pt presents with a regular, monomorphic, wide-QRS tachycardia. He is symptomatic but stable IV access has been obtained and a 12-lead EKG has been ordered. Additional interventions to consider at this time include: a. Verapamil 2.5 to 5 mg IV push b. Amiodarone 150 mg IV over 10 min c. Procainmide 1.5 mg/kg over 5 min d. Sotalol 20 to 50 mg/min until the dysrhythmia is suppressed

b. Amiodarone 150 mg IV over 10 min

A 66-year-old man has experienced a cardiac arrest. Which of the following routes are preferred for drug delivery in this situation? a. peripheral IV or intraosseous b. Intraosseous or endotracheal c. endotracheal or central IV d. peripheral IV or central IV

a. peripheral IV or intraosseous

Suspected Stroke Time requirements

ED arrival- 10 min CT done- 25 min CT read- 45 min Drug intervention (fibrinolytics?)- 60 min Stroke admission- 3 hrs from time of onset

Acute Coronary Syndromes Reperfusion Goals

30 minutes: door-to-needle (fibrinolysis "clot busting") | 90 minutes: door-to balloon inflation (PCI) in cath lab

Synchronized cardioversion rhythms and what to set machine to

REGULAR: Narrow (SVT)-50 Wide (tach with pulse)- 100 IRREGULAR: Narrow (a-fib)-120 Wide=DEFIB

Amiodarone

LOWERS HR - Pulseless VT or VF - Stable narrow QRS - Initial bolus "dead dose"- 300 mg IV or IO rapid and repeat 1/2 dose in 5 min Other: Stable VT w/ pulse A-fib ---150 mg over 10 min (15 mg/min)

Amiodarone

LOWERS HR - Pulseless VT or VF - Stable narrow QRS - Initial bolus "dead dose"- 300 mg IV or IO rapid and repeat 1/2 dose in 5 min Other: Stable VT w/ pulse A-fib ---150 mg over 10 min (15 mg/min) Side effects: hypotension and brady

Epinephrine

Cardiac arrest: VF, pulseless VT, asystole, pulseless electrical activity ``` DOSE: Treat brady? 2-10 mcg/min Post-resuscitation: 0.1-0.5 mcg/kg/min 7-35 mcg/min ET Tube: 2-2.5x normal dose (2 boxes) ``` Systolic BP of at least 90 1: 10,000- 1mg=10cc 1: 1,000- for allergies, 0.3 mg/unit Increases oxygen demand Avoid mixing with bicarb Epi infusion--Central Line

Lidocaine

-Stable monomorphic VT -Pulseless VT or VF post defibrillation (if amiodorone unavailable) -Decreased conduction in ischemic cardiac tissue -IV or IO or ET tube -1.0-1.5 mg/kg -1-4 mg/min DO NOT give >100 mg at a time -ET tube- 2-3 mg/kg LETHAL FOR PT WITH BRADY IN VENTRICULAR ESCAPT RHYTHM

Atropine

1st line drug for symptomatic bradycardia DOSE: -0.5 mg IV every 2-5 min 3mg dose total Anticholinergic: - increased HR - increased conduction velocity - NO change in contraction - relaxes bronchial smooth muscle - may not work in high heart blocks - DOES NOT usually work in heart transplants d/t cut vegal nerve

Adenosine

SVT 6 mg RAPID IV 1-3 seconds 1/2 life 10 seconds Not working? 12mg repeat 1-2 min later 20mL flush 3mg dose via central line, 1/2 IV dose Constant EKG monitoring

Calcium channel blockers

Stable narrow QRS tachy (SVT) IF vagal nerve and adenosine not working Fib and flutter

Diltiazem

A-fib and flutter Initial dose- 0.25 mg/kg IV over 2 min Increase .35 mg/kg over 2 min Convert? Yes- dilt drip

Beta Blockers

Stable narrow QRS V-rate ontrol Do not give to people with reactive airway disease Caution: liver failure and kidney issues

Magnesium

Torsades de Pointes Polymorphic VT Pulseless pt 1-2g IV FAST Pulse? 1-2 diluted in 50-100mL of D5W over 10-15 min Caution: pts taking dig, poor renal fn, and heart blocks