ACLS

Question 1

What is the dose of adenosine that should be given for first line stable SVT treatment?

Answer 1

6 mg

Second dose is 12 mg

Question 2

What dose of epinephrine drip should be given to those with unstable bradycardia who fail to respond to atropine and pacing?

Answer 2

2-10 mcg/min

Question 3

In a VF/VT cardiac arrest, what is the order of shock, epinephrine, and amiodarone?

Answer 3

1) Shock
2) Establish IV
3) Shock
4) Epinephrine 1 mg
5) Shock
6) Amiodarone
7) Shock
8) Epinephrine
9) Amiodarone

Essentially, it goes shock, epi, shock, amio… forever.

Question 4

Per ACLS, when should you consider intubation?

Answer 4

At two minutes of CPR

Question 5

Those with STEMI should receive what dose of aspirin?

Answer 5

162 to 325 mg

Question 6

What dose of epinephrine is used in cardiac arrest?

Answer 6

1 mg IV/IO every 3 to 5 minutes

Question 7

Before you give nitroglycerin, you need to assess for what medication use?

Answer 7

PDE inhibitors

If a patient has taken Cialis or Viagra, then NO could cause unstable hypotension.

Question 8

What doses of amiodarone are used for cardiac arrest?

Answer 8

First dose is 300 mg and second is 150 mg (both IV dosings)

Question 9

True or false: aspirin should be given to those with tPA therapy.

Answer 9

False

Aspirin needs to be held for 24 hours if tPA is given.

Question 10

What dosing of atropine can be given in unstable bradycardia?

Answer 10

1 mg IV/IO boluses up to 3 mg max

Question 11

The right rate for compressions is _____________.

Answer 11

100-120 compressions per minute

Question 12

The max interval for pausing compressions is ______.

Answer 12

10 seconds

Question 13

To avoid air entering the stomach, you should ventilate only until __________.

Answer 13

the chest rises

Question 14

Adults should receive how much compression depth?

Answer 14

2 inches

Question 15

Bag-mask ventilation should be done every _____ seconds.

Answer 15

6

Question 16

Always attempt ______ first in stable SVT.

Answer 16

vagal maneuvers

Question 17

The ideal chest compression fraction is ________.

Answer 17

60-80%

This is the amount of time that compressions are being done in a resuscitation.

Question 18

Coronary perfusion pressure has to reach ______ mm Hg to achieve ROSC.

Answer 18

15

Question 19

The AHA recommends that people doing compressions should switch every _______ minutes.

Answer 19

2

Question 20

What tidal volume is recommended in resuscitations?

Answer 20

500-600 mL or about half a squeeze of an adult ambubag

Question 21

In addition to gastric inflation, what does excessive ventilation cause?

Answer 21

Increased intrathoracic pressure, decreased preload, and decreased cardiac output

Question 22

What is AVPU?

Answer 22

It’s a part of the primary assessment that documents how alert someone is (the D for disability).

• Alert
• Responds to Voice
• Responds to Pain
• Unresponsive

Question 23

What is the SAMPLE mnemonic?

Answer 23

It’s a tool for taking a focused history in the secondary assessment:
- Signs and symptoms
- Allergies
- Medications
- PMH
- Last meal
- Events that led to presenting illness

Question 24

Review the H’s and T’s.

Answer 24

H’s:
- Hypovolemia
- Hypoxia
- Hyperkalemia
- Hydrogen ion (acidosis)
- Hypothermia

T’s:
- PTX
- Tamponade
- Toxins
- Thrombosis (MI or PE)

Question 25

True or false: intubation should never be performed with compressions running.

Answer 25

False The AHA recommends that intubation be done through compressions if possible.

Question 26

What is an ideal range for ETCO2 in a resuscitation?

Answer 26

35 - 45 mm Hg

Question 27

If someone is unconscious, follow _____.

Answer 27

BLS Check their pulse, check if they're breathing, get an AED, and call 911.

Question 28

If ST segments are elevated in _______, then NO is contraindicated.

Answer 28

II, III, and aVF The inferior leads indicate possible RV involvement.

Question 29

Which type of stroke is more common in the US?

Answer 29

Ischemic These account for 87% of strokes.

Question 30

The stroke team should perform the stroke assessment within ______ minutes of patient arrival.

Answer 30

20

Question 31

Fibrinolytic therapy can be given up to ______ hours after stroke-symptom onset.

Answer 31

3

Question 32

In addition to starting compressions, you should also immediately do what for a pulseless patient?

Answer 32

- Attach an AED - Obtain IV access - Begin giving supplemental oxygen

Question 33

AHA says you should treat hypotension less than _____ mm Hg with IVF.

Answer 33

90

Question 34

What temperature range goes with post-ROSC care?

Answer 34

32-36

Question 35

The goal door-to-balloon time for STEMI patients is __________.

Answer 35

90 minutes

Question 36

The minimum systolic BP that should be maintained after ROSC is _________.

Answer 36

90 mm Hg

Question 37

What is the code dose of lidocaine?

Answer 37

1-1.5 mg/kg IV/IO as a bolus If they are in refractory VF or pulseless VT then you can repeat 0.5-0.75 mg/kg every 5-10 minutes.

Question 38

True or false: perform synchronized cardioversion on unstable ventricular tachycardia.

Answer 38

False Perform defibrillation on unstable VT.

Question 39

What are the differences in where you do compressions based on age?

Answer 39

Children and adults go midway between nipples at the nipple line. Infants go midway between the nipples just below the nipple line.

Question 40

True or false: it's ok to do the hand encircling technique only in newborns, not infants.

Answer 40

False The technique can be done in both infants and newborns.

Question 41

The shock dose for VF and pulseless VT is ___________.

Answer 41

200 J

Question 42

When do you give epinephrine in a code?

Answer 42

If CPR has been going on for 2 minutes and a shock has failed to convert.

Question 43

What is the adult code dose for epinephrine?

Answer 43

1 mg IV

Question 44

What is code dose of amiodarone?

Answer 44

300 mg IV for the first dose then 150 mg for the subsequent doses

Question 45

What is adult dosing of atropine for bradycardia?

Answer 45

1.0 mg IV Q 3 min for max of 3 doses

Question 46

What is the usual initial current dose for pacing?

Answer 46

40-80 mA

Question 47

If the second round of adenosine fails to convert SVT in a stable patient, what two therapies could you try next?

Answer 47

Diltiazem 20 mg or metoprolol 5 mg

Question 48

Other than amiodarone and lidocaine, what agent could you use in stable, regular, wide-complex tachycardia?

Answer 48

Procainamide 20 mg/min

Question 49

Therapeutic hypothermia must be initiated within ____ hours of ROSC.

Answer 49

12

Question 50

How often should you shock pulseless shockable rhythms?

Answer 50

With every 2 minute pulse check if shockable

Question 51

Therapeutic hypothermia is only for patients who remain ___________ after ROSC.

Answer 51

comatose

Question 52

What doses of shock are indicated in each of the following cardioversions (with pulse): - Narrow regular - Narrow irregular - Wide regular

Answer 52

- Narrow regular: 50-100 Joules - Narrow irregular: 120-200 Joules - Wide regular: 100 Joules - Wide irregular (defibrillation for TDP, VF, or pulseless VT): 200

Question 53

Give antiarrhythmics after ______________ rounds of CPR.

Answer 53

3 (so after two shocks and one epi)

Question 54

What H's/T's have widened QRS on telemetry?

Answer 54

Toxins and hyperkalemia

Question 55

What H's/T's are diagnosable by POCUS?

Answer 55

Tamponade PTX Massive/submassive PE's

Question 56

What form of calcium is given in codes?

Answer 56

Calcium chloride (usually 1 g given over 5 minutes) CaCl can be given peripherally, but it typically ruins PIVs so only give if you feel you can spare an IV.

Question 57

For cardiac arrest, both in and out of the hospital, the evidence suggests that _____________ is the best predictor of survival.

Answer 57

early defibrillation

Question 58

True or false: you should not defibrillate pulseless torsades de pointes.

Answer 58

False It's a polymorphic ventricular tachycardia and should be treated like VF but also given Mg.

Question 59

Why is sodium bicarb not indicated in codes?

Answer 59

- There is not evidence that it helps in the arrest setting (from a randomized controlled trial). There is actually a worse survival rate and worse neurologic recovery rate (from a prospective observational trial). - It is a high sodium load (it is the equivalent of 8% hypertonic saline). - It leads to intracellular acidosis.

Question 60

What is TNK?

Answer 60

Tenectaplase

Question 61

What does the literature say about giving thrombolytics in the setting of arrest?

Answer 61

Research shows that people with a confirmation or a high suspicion of PE have some benefit (PEAPETT) of thrombolytics. Note: the research shows that people benefit when CPR is continued for 60 minutes after thrombolytics. You don't necessarily need to do CPR for this long, but don't stop immediately after thrombolytics don't work.

Question 62

What is the downside of code epinephrine?

Answer 62

It causes cerebral vasoconstriction and decreased tissue oxygenation that may compromise neurologic recovery. Expert recommendations say to stop after 3 rounds of epinephrine (code dose 1 mg) or to lower the dose after the third dose. As a comparison, vasopressor dose of epinephrine is 10-20 mcg/min. Thus, 3 mg of epinephrine would be given over 2.5 - 5.0 hours in the ICU setting. Never give IV epinephrine to a conscious patient. The 0.3 mg given in anaphylaxis should only be given IM.

Question 63

The PARAMEDIC2 trial showed what?

Answer 63

It was a double blind RCT that showed that epinephrine increased the rates of ROSC but did not increase rates of neurological recovery.

Question 64

What does the data show on bicarb in codes?

Answer 64

RCTs have demonstrated no benefit. Still, if you have a reason to give it (like known severe acidosis) then can be given.

Question 65

What are the dosing guidelines for tPA for PE in a code setting?

Answer 65

Give alteplase 50 mg IV over 2 minutes then continue CPR for 15 minutes

Question 66

A study in which pigs were shocked into VF showed that waiting even seconds to start CPR (up to 20 seconds) led to __________.

Answer 66

extremely different outcomes; at 20 s 0% of pigs came back, whereas at 3 s 100% came back

Question 67

In a trial of resuscitation in pigs who had VF, what was the difference between survival in the groups who had bagging at RR of 12 vs 30?

Answer 67

12 = ~80% 30 = ~15%

Question 68

An intense resuscitation beats a ___________ resuscitation.

Answer 68

prolonged

Question 69

ETCO2 should be what in CPR?

Answer 69

At least 12-15 Above 20 suggests ROSC

Question 70

When you do an icepack for SVT, how should it be done?

Answer 70

Apply ice to the forehead and eyes for 10-15 seconds.

Question 71

What are the ACLS criteria for termination of resuscitation?

Answer 71

- Arrest not witnessed - No bystander CPR - No ROSC - No shockable rhythms

Question 72

How is auto-PEEP thought to cause the lazarus effect?

Answer 72

CPR causes auto-PEEP. Stopping CPR allows for the breaths to leave and decrease intrathoracic pressure, allowing for venous return.

Question 73

What is the dose, route, and concentration of code epi?

Answer 73

1 mg IV 1 : 10,000 (think, it's not the 1 : 1,000 form given IM because the IM needs to be more concentrated)

Question 74

According to the boards, TTM to goal 32-34 is indicated for which age group?

Answer 74

Adults

Question 75

Review the ventilation management for two-person resuscitation in children, adults, and advanced airway?

Answer 75

Children 2:15 Adults 2:30 Advanced airway (ETT or supraglottic): every 2-3 seconds for kidss, 5-6 seconds adults

Question 76

True or false: unstable patients with torsades who have a pulse should undergo synchronized cardioversion.

Answer 76

False Defibrillation for both pulseless TDP and unstable TDP