ACLS A/B Flashcards
You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm shown here, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. Which do you do next?
A. Start a dopamine infusion
B. Give atropine 0.5 mg
C. Give epinephrine 1 mg IV
D. Insert an advanced airway
C. Give epinephrine 1 mg IV
Give epinephrine as soon as IV/IO access become available. A dose of 1 mg IV/IO should be given and repeated every 3 to 5 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: Pulseless Electrical Activity Case > Managing PEA: The Adult Cardiac Arrest Algorithm > Administer Epinephrine; page 111]
A team member is unable to perform an assigned task because it is beyond the team member’s scope of practice. Which action should the team member take?
A. Ask for a new task or role
B. Assign it to another team member
C. Do it anyway
D. Seek expert advice
A. Ask for a new task or role Not only should everyone on the team know his or her own limitations and capabilities, but the team leader should also be aware of them. This allows the team leader to evaluate team resources and call for backup of team members when assistance is needed. High-performance team members should anticipate situations in which they might require assistance and inform the team leader. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics > Elements of Effective High-Performance Team Dynamics > Roles; page 28]
A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation.
Based on this patient’s initial presentation, which condition do you suspect led to the cardiac arrest?
A. Acute coronary syndrome
B. Acute ischemic stroke
C. Acute heart failure
D. Supraventricular tachycardia with ischemic chest pain
A. Acute coronary syndrome Acute life-threatening complications of acute coronary syndromes include ventricular fibrillation, pulseless ventricular tachycardia, symptomatic bradycardias, and unstable tachycardias. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Coronary Syndromes Case > Goals for ACS Patients; page 60]
You are performing chest compressions during an adult resuscitation attempt. Which rate should you use to perform the compressions?
A. Less than 80/min
B. More than 120/min
C. 80 to 90/min
D. 100 to 120/min
D. 100 to 120/min When performing chest compressions, you should compress at a rate of 100 to 120/min. [ACLS Provider Manual, Part 4: The Systematic Approach > The BLS Assessment > Critical Concepts: Quality Compressions; page 37]
To properly ventilate a patient with a perfusing rhythm, how often do you squeeze the bag?
A. Once every 10 seconds
B. Once every 12 seconds
C. Once every 3 to 4 seconds
D. Once every 5 to 6 seconds
D. Once every 5 to 6 seconds For a patient in respiratory arrest with a pulse, deliver ventilations once every 5 to 6 seconds with a bag-mask device or any advanced airway. [ACLS Provider Manual, Part 5: The ACLS Cases > Respiratory Arrest Case > The BLS Assessment > Ventilation and Pulse Check; page 46]
Which is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation?
A. 100 mg
B. 150 mg
C. 250 mg
D. 300 mg
D. 300 mg Consider amiodarone for treatment of ventricular fibrillation or pulseless ventricular tachycardia unresponsive to shock delivery, CPR, and a vasopressor. During cardiac arrest, consider amiodarone 300 mg IV/IO push for the first dose. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Antiarrhythmic Agents > Amiodarone; page 106]
Which best describes the length of time it should take to perform a pulse check during the BLS Assessment?
A. 1 to 4 seconds
B. 5 to 10 seconds
C. 11 to 15 seconds
D. 16 to 20 seconds
B. 5 to 10 seconds Check the pulse for 5 to 10 seconds. If there is no pulse within 10 seconds, start CPR, beginning with chest compressions. [ACLS Provider Manual, Part 4: The Systematic Approach > The BLS Assessment > Overview of the BLS Assessment; page 36]
Which type of atrioventricular block best describes this rhythm?
A. First-degree
B. Second-degree type I
C. Second-degree type II
D. Third-degree
C. Second-degree type II This ECG rhythm strip shows second-degree type II atrioventricular block. [ACLS Provider Manual, Part 5: The ACLS Cases > Bradycardia Case > Rhythms for Bradycardia; page 121]
Which is the primary purpose of a medical emergency team or rapid response team?
A. Improving care for patients admitted to critical care units
B. Improving patient outcomes by identifying and treating early clinical deterioration
C. Providing diagnostic consultation to emergency department patients
D. Providing online consultation to EMS personnel in the field
B. Improving patient outcomes by identifying and treating early clinical deterioration Many hospitals have implemented the use of medical emergency teams or rapid response teams. The purpose of these teams is to improve patient outcomes by identifying and treating early clinical deterioration. [ACLS Provider Manual, Part 2: Systems of Care > Cardiopulmonary Resuscitation > Foundational Facts: Medical Emergency Teams and Rapid Response Teams; page 15]
Which facility is the most appropriate EMS destination for a patient with sudden cardiac arrest who achieved return of spontaneous circulation in the field?
A. Comprehensive stroke care unit
B. Acute rehabilitation care unit
C. Acute long-term care unit
D. Coronary reperfusion–capable medical center
D. Coronary reperfusion–capable medical center
After return of spontaneous circulation in patients in whom coronary artery occlusion is suspected, providers should transport the patient to a facility capable of reliably providing coronary reperfusion (eg, percutaneous coronary intervention) and other goal-directed post–cardiac arrest care therapies. [ACLS Provider Manual, Part 2: Systems of Care > Post–Cardiac Arrest Care > Immediate Coronary Reperfusion With PCI; page 20]
You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The CT scan was normal, with no signs of hemorrhage. The patient does not have any contraindications to fibrinolytic therapy. Which treatment approach is best for this patient?
A. Hold fibrinolytic therapy for 24 hours
B. Start fibrinolytic therapy as soon as possible
C. Order an echocardiogram before fibrinolytic administration
D. Wait for the results of the MRI
B. Start fibrinolytic therapy as soon as possible
Start fibrinolytic therapy in appropriate patients (those without contraindications) within 1 hour of hospital arrival and 3 hours from symptom onset. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Stroke Case > Approach to Stroke Care > Goals of Stroke Care; page 76]
You are evaluating a 58-year-old man with chest discomfort. His blood pressure is 92/50 mm Hg, his heart rate is 92/min, his nonlabored respiratory rate is 14 breaths/min, and his pulse oximetry reading is 97%. Which assessment step is most important now?
A. Obtaining a 12-lead ECG
B. Evaluating the PETCO 2 reading
C. Requesting a chest x-ray
D. Requesting laboratory testing
A. Obtaining a 12-lead ECG
The 12-lead ECG is at the center of the decision pathway in the management of ischemic chest discomfort and is the only means of identifying STEMI. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Coronary Syndromes Case > Immediate ED Assessment and Treatment > Introduction; page 67]
A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation.
In addition to defibrillation, which intervention should be performed immediately?
A. Advanced airway insertion
B. Chest compressions
C. Vasoactive medication administration
D. Vascular access
B. Chest compressions Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm > VF/pVT (Left Side); page 93]
A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm. Which is the appropriate treatment?
A. Defibrillation
B. Synchronized cardioversion
C. Administration of adenosine 6 mg IV push
D. Administration of epinephrine 1 mg IV push
A. Defibrillation Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. Both are treated with high-energy unsynchronized shocks. The interval from collapse to defibrillation is one of the most important determinants of survival from cardiac arrest. Early defibrillation is critical for patients with sudden cardiac arrest (ventricular fibrillation/pulseless ventricular tachycardia). [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm > VF/pVT (Left Side); page 93, and Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway > Principle of Early Defibrillation; page 97]
A. First-degree atrioventricular block
B. Second-degree atrioventricular block type I
C. Second-degree atrioventricular block type II
D. Third-degree atrioventricular block
D. Third-degree atrioventricular block
This ECG rhythm strip shows third-degree atrioventricular block. [ACLS Provider Manual, Part 5: The ACLS Cases > Bradycardia Case > Rhythms for Bradycardia; page 121]
A patient is being resuscitated in a very noisy environment. A team member thinks he heard an order for 500 mg of amiodarone IV. Which is the best response from the team member?
A. “OK.”
B. “Are you sure?”
C. “Amiodarone 500 mg IV has been given.”
D. “I have an order to give 500 mg of amiodarone IV. Is this correct?”
D. “I have an order to give 500 mg of amiodarone IV. Is this correct?” Unclear communication can lead to unnecessary delays in treatment or to medication errors. Team members should question an order if the slightest doubt exists. [ACLS Provider Manual, Part 4: Effective High-Performance Team Dynamics > Elements of Effective High-Performance Team Dynamics > How to Communicate; page 31]
A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here.
Based on this patient’s initial assessment, which adult ACLS algorithm should you follow?
A. Acute coronary syndromes
B. Tachycardia
C. Suspected stroke
D. Cardiac arrest
B. Tachycardia
This ECG rhythm strip shows ventricular tachycardia. The Adult Tachycardia With a Pulse Algorithm outlines the steps for assessment and management of a patient presenting with symptomatic tachycardia with pulses. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Managing Unstable Tachycardia: The Tachycardia Algorithm > Overview; page 132]
Your patient is in cardiac arrest and has been intubated. To assess CPR quality, which should you do?
A. Monitor the patient’s PETCO 2
B. Obtain a 12-lead ECG
C. Check the patient’s pulse
D. Obtain a chest x-ray
A. Monitor the patient’s PETCO 2
The AHA recommends using quantitative waveform capnography in intubated patients to monitor CPR quality, optimize chest compressions, and detect return of spontaneous circulation during chest compressions. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway > Physiologic Monitoring During CPR; page 102]
EMS providers are treating a patient with suspected stroke. According to the Adult Suspected Stroke Algorithm, which critical action performed by the EMS team will expedite this patient’s care on arrival and reduce the time to treatment?
A. Alert the hospital
B. Establish IV access
C. Review the patient’s history
D. Treat hypertension
A. Alert the hospital Prearrival notification allows the hospital to prepare to evaluate and manage the patient effectively. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Stroke Case > Identification of Signs of Possible Stroke > Activate EMS System Immediately; page 78]
A. First-degree
B. Second-degree type I
C. Second-degree type II
D. Third-degree
C. Second-degree type II This ECG rhythm strip shows second-degree type II atrioventricular block. [ACLS Provider Manual, Part 5: The ACLS Cases > Bradycardia Case > Rhythms for Bradycardia; page 121]
During post–cardiac arrest care, which is the recommended duration of targeted temperature management after reaching the correct temperature range?
A. 0 to 8hours
B. At least 24 hours
C. At least 36 hours
D. At least 48 hours
B. At least 24 hours For targeted temperature management, healthcare providers should select and maintain a constant target temperature between 32°C and 36°C for a period of at least 24 hours. [ACLS Provider Manual, Part 5: The ACLS Cases > Immediate Post–Cardiac Arrest Care Case > Application of the Immediate Post–Cardiac Arrest Care Algorithm > Targeted Temperature Management; page 151]
For STEMI patients, which best describes the recommended maximum goal time for emergency department door–to–balloon inflation time for percutaneous coronary intervention?
A. 90 minutes
B. 120 minutes
C. 150 minutes
D. 180 minutes
A. 90 minutes
For the patient with STEMI, the goals of reperfusion are to give fibrinolytics within 30 minutes of arrival or perform percutaneous coronary intervention within 90 minutes of arrival. The goal for emergency department door–to–balloon inflation time is 90 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases: Acute Coronary Syndromes Case > Immediate ED Assessment and Treatment > Introduction; page 67]
You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The CT scan was normal, with no signs of hemorrhage. The patient does not have any contraindications to fibrinolytic therapy. Which treatment approach is best for this patient?
A. Wait for the results of the MRI
B. Hold fibrinolytic therapy for 24 hours
C. Order an echocardiogram before fibrinolytic administration
D. Start fibrinolytic therapy as soon as possible
D. Start fibrinolytic therapy as soon as possible Start fibrinolytic therapy in appropriate patients (those without contraindications) within 1 hour of hospital arrival and 3 hours from symptom onset. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Stroke Case > Approach to Stroke Care > Goals of Stroke Care; page 76]
A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation.
The patient has return of spontaneous circulation and is not able to follow commands. Which immediate post–cardiac arrest care intervention do you choose for this patient?
A. Initiate targeted temperature management
B. Check the glucose level
C. Administer epinephrine
D. Extubate
A. Initiate targeted temperature management To protect the brain and other organs, the high-performance team should start targeted temperature management in patients who remain comatose (lack of meaningful response to verbal commands) with return of spontaneous circulation after cardiac arrest. [ACLS Provider Manual, Part 5: The ACLS Cases > Immediate Post–Cardiac Arrest Care Case > Application of the Immediate Post–Cardiac Arrest Care Algorithm > Targeted Temperature Management; page 151]
Which is the maximum interval you should allow for an interruption in chest compressions?
A. 10 seconds
B. 15 seconds
C. 20 seconds
D. 25 to 30 seconds
A. 10 seconds ACLS providers must make every effort to minimize any interruptions in chest compressions. Try to limit interruptions in chest compressions (eg, defibrillation and rhythm analysis) to no longer than 10 seconds. When you stop chest compressions, blood flow to the brain and heart stops. [ACLS Provider Manual, Part 4: The Systematic Approach > The BLS Assessment > Critical Concepts: Minimizing Interruptions; page 37]
What is the recommended range from which a temperature should be selected and maintained constantly to achieve targeted temperature management after cardiac arrest?
A. 26°C to 28°C
B. 29°C to 31°C
C. 32°C to 36°C
D. 35°C to 37°C
C. 32°C to 36°C For targeted temperature management, healthcare providers should select and maintain a constant target temperature between 32°C and 36°C for a period of at least 24 hours. [ACLS Provider Manual, Part 5: The ACLS Cases > Immediate Post–Cardiac Arrest Care Case > Application of the Immediate Post–Cardiac Arrest Care Algorithm > Targeted Temperature Management; page 151]
Which is the recommended oral dose of aspirin for a patient with a suspected acute coronary syndrome?
A. 40mg
B. 81mg
C. 160 to 325 mg
D. 350 to 650 mg
C. 160 to 325 mg If the patient has not taken aspirin and has no history of true aspirin allergy and no evidence of recent gastrointestinal bleeding, give the patient aspirin (160 to 325 mg) to chew. In the initial hours of an acute coronary syndrome, aspirin is absorbed better when chewed than when swallowed. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Coronary Syndromes Case > EMS Assessment, Care, and Hospital Preparation > Administer Oxygen and Drugs; page 65]
A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here.
The patient’s pulse oximeter shows a reading of 84% on room air. Which initial action do you take?
A. Apply oxygen
B. Perform bag-mask ventilation
C. Intubate the patient
D. Check the pulse oximeter probe
A. Apply oxygen
In the application of the Tachycardia Algorithm to an unstable patient, identify and treat the underlying cause. Give oxygen, if indicated, and monitor oxygen saturation. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Application of the Tachycardia Algorithm to the Unstable Patient > Identify and Treat the Underlying Cause; page 134]
As the team leader, when do you tell the chest compressors to switch?
A. Only when they tell you that they are fatigued
B. About every 2 minutes
C. About every 5 minutes
D. About every 7 minutes
B. About every 2 minutes Switch compressors about every 2 minutes, or earlier if they are fatigued. [ACLS Provider Manual, Part 4: The Systematic Approach > The BLS Assessment > Critical Concepts: High-Quality CPR; page 38]
A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm. Which is the appropriate treatment?
A. Administration of adenosine 6 mg IV push
B. Administration of epinephrine 1 mg IV push
C. Defibrillation
D. Synchronized cardioversion
C. Defibrillation
Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. Both are treated with high-energy unsynchronized shocks. The interval from collapse to defibrillation is one of the most important determinants of survival from cardiac arrest. Early defibrillation is critical for patients with sudden cardiac arrest (ventricular fibrillation/pulseless ventricular tachycardia). [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm > VF/pVT (Left Side); page 93, and Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway > Principle of Early Defibrillation; page 97]
Which of these tests should be performed for a patient with suspected stroke within 25 minutes of hospital arrival?
A. 12-lead ECG
B. Noncontrast CT scan of the head
C. Cardiac enzymes
D. Coagulation studies
B. Noncontrast CT scan of the head A critical decision point in the assessment of the patient with acute stroke is the performance and interpretation of a noncontrast CT scan to differentiate ischemic from hemorrhagic stroke. The CT scan should be completed within 25 minutes of the patient’s arrival in the emergency department and should be read within 45 minutes from emergency department arrival. [ACLS Provider Manual, Part 5: The ACLS Cases > Acute Stroke Case > CT Scan: Hemorrhage or No Hemorrhage > Introduction; page 84]
If a team member is about to make a mistake during a resuscitation attempt, which best describes the action that the team leader or other team members should take?
A. Reassign the team tasks
B. Address the team member immediately
C. Conduct a debriefing after the resuscitation attempt
D. Remove the team member from the area
B. Address the team member immediately During a resuscitation attempt, the leader or a member of a high-performance team may need to intervene if an action that is about to occur may be inappropriate at the time. Team members should question a colleague who is about to make a mistake. [ACLS Provider Manual, Part 3: Effective High-Performance Team Dynamics > Elements of Effective High-Performance Team Dynamics > Roles; page 29]
A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here.
If the patient became apneic and pulseless but the rhythm remained the same, which would take the highest priority?
A. Administer amiodarone 300 mg
B. Administer atropine 0.5 mg
C. Insert an advanced airway
D. Perform defibrillation
D. Perform defibrillation
Pulseless ventricular tachycardia is included in the algorithm because it is treated as ventricular fibrillation. Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. Both are treated with high-energy unsynchronized shocks. The interval from collapse to defibrillation is one of the most important determinants of survival from cardiac arrest. Early defibrillation is critical for patients with sudden cardiac arrest. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm > VF/pVT (Left Side); page 93, and Application of the Adult Cardiac Arrest Algorithm: VT/pVT Pathway > Principle of Early Defibrillation; page 97]
For STEMI patients, which best describes the recommended maximum goal time for emergency department door–to–balloon inflation time for percutaneous coronary intervention?
A. 180 minutes
B. 150 minutes
C. 120 minutes
D. 90 minutes
D. 90 minutes For the patient with STEMI, the goals of reperfusion are to give fibrinolytics within 30 minutes of arrival or perform percutaneous coronary intervention within 90 minutes of arrival. The goal for emergency department door–to–balloon inflation time is 90 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases: Acute Coronary Syndromes Case > Immediate ED Assessment and Treatment > Introduction; page 67]
Which of the following signs is a likely indicator of cardiac arrest in an unresponsive patient?
A. Agonal gasps
B. Cyanosis
C. Irregular, weak pulse rate
D. Slow, weak pulse rate
A. Agonal gasps Agonal gasps are not normal breathing. They are a sign of cardiac arrest. Agonal gasps may be present in the first minutes after sudden cardiac arrest. [ACLS Provider Manual, Part 4: The Systematic Approach > The BLS Assessment > Caution: Agonal Gasps; page 35]
In addition to clinical assessment, which is the most reliable method to confirm and monitor correct placement of an endotracheal tube?
A. Arterial blood gases
B. Chest radiography
C. Continuous waveform capnography
D. Hemoglobin levels
C. Continuous waveform capnography The AHA recommends continuous waveform capnography in addition to clinical assessment as the most reliable method of confirming and monitoring correct placement of an endotracheal tube. [ACLS Provider Manual, Part 5: The ACLS Cases > Respiratory Arrest Case > The Primary Assessment > FYI 2015 Guidelines: Correct Placement of ET Tube; page 46]
A 45-year-old man had coronary artery stents placed 2 days ago. Today, he is in severe distress and is reporting “crushing” chest discomfort. He is pale, diaphoretic, and cool to the touch. His radial pulse is very weak, blood pressure is 64/40 mm Hg, respiratory rate is 28 breaths/min, and oxygen saturation is 89% on room air. When applied, the cardiac monitor initially showed ventricular tachycardia, which then quickly changed to ventricular fibrillation. Despite 2 defibrillation attempts, the patient remains in ventricular fibrillation.
Which drug and dose should you administer first to this patient?
A. Amiodarone 300 mg
B. Atropine 1 mg
C. Epinephrine 1 mg
D. Lidocaine 1 mg/kg
C. Epinephrine 1 mg For persistent ventricular fibrillation/pulseless ventricular tachycardia, give 1 shock and resume CPR immediately for 2 minutes after the shock. When IV/IO access is available, give epinephrine 1 mg IV/IO during CPR after the second shock and repeat epinephrine 1 mg IV/IO every 3 to 5 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Application of the Adult Cardiac Arrest Algorithm: VF/pVT Pathway > Shock and Vasopressors; page 99]
A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient’s lead II ECG is displayed here. Which best characterizes this patient’s rhythm?
A. Perfusing ventricular tachycardia
B. Sinus tachycardia
C. Stable supraventricular tachycardia
D. Unstable supraventricular tachycardia
D. Unstable supraventricular tachycardia
This ECG rhythm strip shows supraventricular tachycardia, and the patient is showing signs and symptoms of unstable tachycardia. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Rhythms for Unstable Tachycardia; pages 129-130, and The Approach to Unstable Tachycardia > Signs and Symptoms; page 131]
A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the lead II ECG rhythm shown here. Which is the appropriate treatment?
A. Performing vagal maneuvers
B. Administering adenosine 6 mg IV push
C. Performing synchronized cardioversion
D. Performing defibrillation
C. Performing synchronized cardioversion Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. Synchronized cardioversion uses a lower energy level than attempted defibrillation. Low-energy shocks should always be delivered as synchronized shocks to avoid precipitating ventricular fibrillation. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Cardioversion > Unsynchronized vs Synchronized Shocks; page 136, and Recommendations; page 137]
Which is the primary purpose of a medical emergency team or rapid response team?
A. Improving patient outcomes by identifying and treating early clinical deterioration
B. Improving care for patients admitted to critical care units
C. Providing online consultation to EMS personnel in the field
D. Providing diagnostic consultation to emergency department patients
A. Improving patient outcomes by identifying and treating early clinical deterioration Many hospitals have implemented the use of medical emergency teams or rapid response teams. The purpose of these teams is to improve patient outcomes by identifying and treating early clinical deterioration. [ACLS Provider Manual, Part 2: Systems of Care > Cardiopulmonary Resuscitation > Foundational Facts: Medical Emergency Teams and Rapid Response Teams; page 15]
A. First-degree atrioventricular block
B. Second-degree atrioventricular block type I
C. Second-degree atrioventricular block type II
D. Third-degree atrioventricular block
B. Second-degree atrioventricular block type I
This ECG rhythm strip shows second-degree atrioventricular block type I. [ACLS Provider Manual, Part 5: The ACLS Cases > Bradycardia Case > Rhythms for Bradycardia; page 121]
A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here.
After your initial assessment of this patient, which intervention should be performed next?
A. Immediate defibrillation
B. Synchronized cardioversion
C. Administration of amiodarone 150 mg IM
D. Endotracheal intubation
B. Synchronized cardioversion
Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Cardioversion > Recommendations; page 137]
You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm shown here, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. Which do you do next?
A. Give atropine 0.5 mg
B. Give epinephrine 1 mg IV
C. Insert an advanced airway
D. Start a dopamine infusion
B. Give epinephrine 1 mg IV
Give epinephrine as soon as IV/IO access become available. A dose of 1 mg IV/IO should be given and repeated every 3 to 5 minutes. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: Pulseless Electrical Activity Case > Managing PEA: The Adult Cardiac Arrest Algorithm > Administer Epinephrine; page 111]
A. Supraventricular tachycardia
B. Monomorphic ventricular tachycardia
C. Polymorphic ventricular tachycardia
D. Ventricular fibrillation
B. Monomorphic ventricular tachycardia
This ECG rhythm strip shows a monomorphic ventricular tachycardia. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Rhythms for Unstable Tachycardia; page 130]
A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here.
Based on this patient’s initial assessment, which adult ACLS algorithm should you follow?
A. Tachycardia
B. Suspected stroke
C. Cardiac arrest
D. Acute coronary syndromes
A. Tachycardia This ECG rhythm strip shows ventricular tachycardia. The Adult Tachycardia With a Pulse Algorithm outlines the steps for assessment and management of a patient presenting with symptomatic tachycardia with pulses. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Managing Unstable Tachycardia: The Tachycardia Algorithm > Overview; page 132]
A. First-degree atrioventricular block
B. Second-degree atrioventricular block type I
C. Second-degree atrioventricular block type II
D. Third-degree atrioventricular block
D. Third-degree atrioventricular block
This ECG rhythm strip shows third-degree atrioventricular block. [ACLS Provider Manual, Part 5: The ACLS Cases > Bradycardia Case > Rhythms for Bradycardia; page 121]
A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient’s lead II ECG is displayed here. Which best characterizes this patient’s rhythm?
A. Unstable supraventricular tachycardia
B. Stable supraventricular tachycardia
C. Perfusing ventricular tachycardia
D. Sinus tachycardia
A. Unstable supraventricular tachycardia
This ECG rhythm strip shows supraventricular tachycardia, and the patient is showing signs and symptoms of unstable tachycardia. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Rhythms for Unstable Tachycardia; pages 129-130, and The Approach to Unstable Tachycardia > Signs and Symptoms; page 131]
A. Monomorphic ventricular tachycardia
B. Polymorphic ventricular tachycardia
C. Supraventricular tachycardia
D. Ventricular fibrillation
A. Monomorphic ventricular tachycardia
This ECG rhythm strip shows a monomorphic ventricular tachycardia. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Rhythms for Unstable Tachycardia; page 130]
A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here.
The patient’s pulse oximeter shows a reading of 84% on room air. Which initial action do you take?
A. Perform bag-mask ventilation
B. Intubate the patient
C. Apply oxygen
D. Check the pulse oximeter probe
C. Apply oxygen
In the application of the Tachycardia Algorithm to an unstable patient, identify and treat the underlying cause. Give oxygen, if indicated, and monitor oxygen saturation. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Application of the Tachycardia Algorithm to the Unstable Patient > Identify and Treat the Underlying Cause; page 134]
A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here.
After your initial assessment of this patient, which intervention should be performed next?
A. Synchronized cardioversion
B. Administration of amiodarone 150 mg IM
C. Immediate defibrillation
D. Endotracheal intubation
A. Synchronized cardioversion Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Cardioversion > Recommendations; page 137]
A. Third-degree atrioventricular block
B. Second-degree atrioventricular block type I
C. First-degree atrioventricular block
D. Second-degree atrioventricular block type II
B. Second-degree atrioventricular block type I
This ECG rhythm strip shows second-degree atrioventricular block type I. [ACLS Provider Manual, Part 5: The ACLS Cases > Bradycardia Case > Rhythms for Bradycardia; page 121]
A 68-year-old woman presents with light-headedness, nausea, and chest discomfort. Your assessment finds her awake and responsive but ill-appearing, pale, and grossly diaphoretic. Her radial pulse is weak, thready, and fast. You are unable to obtain a blood pressure. She has no obvious dependent edema, and her neck veins are flat. Her lung sounds are equal, with moderate rales present bilaterally. The cardiac monitor shows the rhythm seen here.
If the patient became apneic and pulseless but the rhythm remained the same, which would take the highest priority?
A. Administer amiodarone 300 mg
B. Administer atropine 0.5 mg
C. Insert an advanced airway
D. Perform defibrillation
D. Perform defibrillation
Pulseless ventricular tachycardia is included in the algorithm because it is treated as ventricular fibrillation. Ventricular fibrillation and pulseless ventricular tachycardia require CPR until a defibrillator is available. Both are treated with high-energy unsynchronized shocks. The interval from collapse to defibrillation is one of the most important determinants of survival from cardiac arrest. Early defibrillation is critical for patients with sudden cardiac arrest. [ACLS Provider Manual, Part 5: The ACLS Cases > Cardiac Arrest: VF/Pulseless VT Case > Managing VF/Pulseless VT: The Adult Cardiac Arrest Algorithm > VF/pVT (Left Side); page 93, and Application of the Adult Cardiac Arrest Algorithm: VT/pVT Pathway > Principle of Early Defibrillation; page 97]
A patient in respiratory distress and with a blood pressure of 70/50 mm Hg presents with the lead II ECG rhythm shown here. Which is the appropriate treatment?
A. Administering adenosine 6 mg IV push
B. Performing synchronized cardioversion
C. Performing vagal maneuvers
D. Performing defibrillation
B. Performing synchronized cardioversion
Synchronized shocks are recommended for patients with unstable supraventricular tachycardia, unstable atrial fibrillation, unstable atrial flutter, and unstable regular monomorphic tachycardia with pulses. Synchronized cardioversion uses a lower energy level than attempted defibrillation. Low-energy shocks should always be delivered as synchronized shocks to avoid precipitating ventricular fibrillation. [ACLS Provider Manual, Part 5: The ACLS Cases > Tachycardia: Stable and Unstable > Cardioversion > Unsynchronized vs Synchronized Shocks; page 136, and Recommendations; page 137]
