Advanced | Adult and Pediatric ACLS Flashcards
A 4 year old is presenting with opioid overdose post-operatively. Based on the guideline, what is the recommended dose of NALOXONE to FULLY reverse the opioid effect?
A. 0.1mg/kg
B. 1mg/kg
C. 0.2mg/kg
D. 2mg/kg
A. 0.1mg/kg
The value of PETCO2 that is indicative of a maintained and adequate chest compression:
A. greater than 10mmHg
B. greater than 5 mmHg
C. less than 5 mmHg
D. chest compression ratio of 30:2
A. greater than 10mmHg
A 40 year old patient suddenly presented with this rhythm. There is an indication of a hemodynamic compromise but the pulse is prominently appreciated. Which of the following should be the NEXT step in the management?
A. Synchronized cardioversion
B. Defibrillation
C. Lidocaine
D. Procainamide
A. Synchronized cardioversion
In the presence of hemodynamic compromise, VT with a pulse is treated with immediate synchronized cardioversion, whereas VT without a pulse is treated with immediate defibrillation.
If the patient is stable, with short bursts of ventricular tachycardia, pharmacologic management is
preferred.
This is the recommended shock energy for the INITIAL defibrillation based on the pediatric cardiac arrest algorithm:
A. 2 J/kg
B. 4 J/kg
C. 6 J/kg
D. 3 J/kg
A. 2 J/kg
Identify the presented rhythm:
A. Atrial Flutter
B. Atrial Fibrillation
C. Sinus Arrest
D. SVT
B. Atrial Fibrillation
ADULT TACHYARRYTHMIA WITH A PULSE ALGORITHM
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Identify the rhythm?
Ventricular Fibrillation
Which of the following medication is CONTRAINDICATED in this pathologic ECG rhythm?
A. Digoxin
B. Verapamil
C. Adenosine
D. Sotalol
A. Digoxin
Digoxin should be avoided in the presence of WPW because it
increases conduction through the accessory bypass tract (bundle of Kent) and
decreases AV node conduction; consequently, ventricular fibrillation can
occur.
Identify the rhythm:
A. Atrial Flutter
B. Atrial Fibrillation
C. Ventricular Tachycardia
D. Junctional rhythm
A. Atrial Flutter
If deemed unstable, what is the recommended treatment?
Cardiovert with 50 - 100 J
Which of the following antiarrhythmic and rhythm disorder is correctly paired?
A. Stable wide QRS tachycardia: Loading dose of Procainamide 6mg/min
B. Stable wide QRS tachycardia: Maintenance infusion dose of Procainamide 1-4mg/min
C. Stable wide QRS tachycardia: Sotalol 5mg/kg over 5 minutes as an alternative regimen
D. Stable wide QRS tachycardia: Amiodarone 200mg over 10 mins
B. Stable wide QRS tachycardia: Maintenance infusion dose of Procainamide 1-4mg/min
This type of tachyarrythmia is associated with prolonged QT interval. Which of the following condition will MOST likely present with this type of arrythmia?
A. Status Asthmaticus
B. SLE
C. Hypocalcemia
D. Malignant Hyperthermia
E. Hyperkalemia
C. Hypocalcemia
- Type of ventricular tachycardia associated with prolonged QT
interval. Seen with electrolyte disturbances (e.g., hypokalemia,
hypocalcemia, and hypomagnesemia) and bradycardia.
Administering standard antiarrhythmics (lidocaine, procainamide, etc.) may worsen
torsades de pointes. Prevention includes treatment of the electrolyte disturbance.
Treatment includes shortening of the QT interval, pharmacologically or by pacing; unstable polymorphic VT is treated with immediate defibrillation.
The following are less reliable confirmatory signs of a poor outcome after ROSC (resuscitation) EXCEPT:
A. unreactive burst suppression
B. status epilepticus on electroencephalogram
C. status myoclonus (lasting >30 minutes) during first 72 hours after ROSC
D. Diffuse anoxic injury on computed tomography or MRI
E. Absence of the N20 wave on SSEP at 24 to 72 hours
E. Absence of the N20 wave on SSEP at 24 to 72 hours - This is actually a confirmatory test.
- Confirmatory signs that have nearly a 0% false-positive rate are:
- the absence of a pupillary light reflex at 72 hours
- absence of the N20 wave on somatosensory evoked potentials at 24 to 72 hours.
Brain ATP (adenosine triphosphate) is depleted if there is no blood flow for:
A. 1 - 2 minutes
B. 4 - 6 minutes
C. 2 - 4 minutes
B. 4 - 6 minutes
Brain adenosine triphosphate (ATP) is depleted after 4 to 6 minutes of no blood flow. It returns to nearly normal within 6 minutes of starting effective CPR.
The arrow indicates an “osborne wave” seen in the ECG presented. Which of the following condition would MOST likely present with this type of ECG abnormality?
A. Hypothermia
B. Hyperthermia
C. Myasthenia Gravis
D. SLE
A. Hypothermia
Chest compression adequacy is reflected through which of the following parameter:
A. sCVO2 less than 30%
B. pETCO2 greater than 5mmHg
C. sCVO2 greater than 30%
D. arterial diastolic blood pressure of greater than 10mmHg
C. sCVO2 greater than 30%
THE RULE of TENS
less than 10s to check for a pulse
less than 10s to place and secure the airway
target compression adequacy to maintain pETCO greater than 10 mmHg
target sCVO2 greater than 30%
Identify the rhythm?
A. Sinus rhythm with PVC
B. Sinus Arrest
C. 2nd degree AV block
D. 3rd degree AV block
C. 2nd degree AV block (Mobitz type II)
ADULT BRADYCARDIA ALGORITHM
TRUE or FALSE
The severity of the underlying cardiac disease is the major determining factor in the success or failure of resuscitation attempts.
TRUE
Which of the following is INACCURATE regarding the cardiac arrest algorithm?
A. The most rapid and highest drug levels occur with administration into the endotracheal tube
B. Aortic diastolic pressure (mmHg) of <40 is indicative of a good perfusion
C. The minimum ETCO2 that corresponds to an effective CPR is >10 mmHg
D. Myocardial blood flow 10mL/min/100 g is indicative of a good perfusion
C. The minimum ETCO2 that corresponds to an effective CPR is >10 mmHg
Maximum dose of LIDOCAINE in the ACLS cardiac arrest algorithm?
A. 3.0 mg/kg
B. 2.0 mg/kg
C. 1.5 mg/kg
A. 3.0 mg/kg
Flow rate via humeral IO access is:
A. 50 cc/min
B. 100 cc/min
C. 150 cc/min
B. 100 cc/min
Flow rate via humeral IO access is about 100 cc/min
under pressure, about six times the rate of tibial IO flow
Identify the rhythm:
A. Atrial pacing
B. Ventricular pacing
C. DDD pacing
A. Atrial pacing
Which of the following medications CANNOT be given via ET during ACLS?
A. Lidocaine
B. Na bicarbonate
C. Vasopressin
D. Atropine
B. Na bicarbonate
If IV or IO access cannot be established, the endotracheal tube is an alternative route for administration of epinephrine, vasopressin, lidocaine, and atropine.
TRUE or FALSE
In general, doses 2 to 2.5 times higher than the intravenous dose are recommended when endotracheal route is used.
TRUE
How to administer Epinephrine during CPR?
Current AHA recommendations are to give 1 mg of epinephrine IV every 3 to 5 minutes in the adult. The easiest way to manage this is to administer 1 mg of epinephrine approximately every other 2-minute cycle of CPR
Ho to administer Vasopressin during CPR?
What is the dose of bolus Vasopressin during CPR?
40 u IV or IO (intraosseous)
Arginine vasopressin (antidiuretic hormone) has been used as an alternative to epinephrine in a dose of 40 U administered IV or IO
TRUE or FALSE
The half-life Vasopressin in the intact circulation is longer than epinephrine during CPR.
TRUE
The half-life in the intact circulation is 10 to 20
minutes and much longer than epinephrine during CPR.
Compared with epinephrine, the hemodynamic effects of vasopressin are especially impressive during long cardiac arrests.
- However, Vasopressin is not superior to Epinephrine during ACLS.
This drug is used to aid defibrillation when VF is refractory to electrical countershock therapy during ACLS:
A. Lidocaine
B. Vasopressin
C. Adenosine
D. Na bicarbonate
A. Lidocaine
Amiodarone and lidocaine are used during cardiac arrest to aid defibrillation when VF is refractory to electrical countershock therapy or when fibrillation recurs following successful conversion.
Lidocaine, primarily an anti-ectopic agent with few hemodynamic effects, tends to reverse the reduction in VF threshold caused by ischemia or infarction. It depresses automaticity by reducing the slope of phase 4 depolarization and reducing the heterogeneity of ventricular refractoriness.
What is the total dose of Amiodarone when used during ACLS?
A. 2g
B. 1g
C. 3g
In cardiac arrest, amiodarone is initially administered as a
300-mg rapid infusion. Supplemental infusions of 150 mg can be repeated as necessary for recurrent or resistant dysrhythmias to a maximum total daily dose of 2 g.
Total dose: 2g
TRUE or FALSE
The most important treatment for asystole and PEA is effective chest compressions, ventilation, and epinephrine to improve coronary perfusion and myocardial oxygenation.
TRUE
When employed or used during ACLS, the usual dose of Calcium in the form of calcium gluconate or calcium chloride is:
A. 1 - 1.5 mg/kg
B. 0.8 - 1.2 mg/kg
C. 2 - 4 mg/kg
C. 2 - 4 mg/kg
When calcium is administered, the chloride salt is recommended because it produces higher and more consistent levels of ionized calcium than other salts. The usual dose is 2 to 4 mg/kg of the 10% solution administered slowly intravenously.
Calcium gluconate contains one-third as much molecular calcium as does calcium chloride and requires metabolism of gluconate in the liver.
This is the most common ECG pattern found during witnessed sudden cardiac arrest in adults:
A. Ventricular Fibrillation
B. Ventricular tachycardia
C. PEA
D. Asystole
VF is the most common ECG pattern found during witnessed sudden cardiac arrest in adults.
The most important controllable determinant of failure to
resuscitate a patient with VF is the duration of fibrillation.
TRUE or FALSE
If defibrillation occurs within 1 minute of fibrillation, CPR is unnecessary for resuscitation.
TRUE
The only consistently effective treatment is electrical
defibrillation.
1 minute
Defibrillate
Successful Resuscitation
TRUE or FALSE
The AED recognizes VF, charges automatically, and gives a defibrillatory shock.
TRUE
What PHASE of the UNTREATED Ventricular fibrillation does defibrillation plays a critical role?
A. Electrical phase
B. hemodynamic phase
C. metabolic phase
A. Electrical phase
The electrical phase occurs during the first 4 to 5 minutes of the arrest, and early defibrillation is critical for success during this time.
The hemodynamic phase follows for the next 10 to 15 minutes, when perfusing the myocardium and brain with oxygenated blood is critical.
This is followed by what has been called the metabolic phase, when the ischemic injury to the heart is so great that it is not clear what interventions will be successful.
The most important intervention during the hemodynamic phase of cardiac arrest is:
A. CPR
B. Defibrillation
C. Securing the airway
A. CPR
By about 4 minutes, the ATP levels in the heart have fallen to levels that make restoration of normal contractile function problematic.
Effective chest compressions help replete or delay reductions in ATP by generating an adequate coronary perfusion pressure to restore myocardial blood flow.
Therefore, the most important intervention during the hemodynamic phase of cardiac arrest is producing coronary perfusion with chest compressions before any attempt to defibrillate.
What is the recommended compression-to-ventilation ratio when there 2 providers during BLS :
A. 15:2
B. 30:2
C. 15:1
B. 30:2
What is the recommended chest rate compression for an infant or small child?
For both infants and children, compressions should be at least one-third the depth of the chest at a rate of 100 to 120/min. For a single rescuer, a 30:2 compression-to-ventilation ratio should be used and with two or more rescuers a 15:2 ratio is recommended.
What is the recommended starting energy when providing defibrillation to a child?
A. 1.5 J/kg
B. 2 J/kg
C. 2.5 J/kg
The recommended starting energy is 2 J/kg.
First shock: 2J/kg
Second shock: 4J/kg
Which of the following confirmatory signs of a poor neurologic outcome after ROSC has the highest reliability?
A. absence of the N20 wave on somatosensory evoked
potentials at 24 to 72 hours
B. unreactive burst suppression on electroencephalogram
C. diffuse anoxic injury on computed tomography or magnetic resonance imaging
D. markedly and persistently elevated neuron-specific endolase
A. absence of the N20 wave on somatosensory evoked
potentials at 24 to 72 hours
Confirmatory signs that have nearly a 0% false-positive rate are the absence of a pupillary light reflex at 72 hours and absence of the N20 wave on somatosensory evoked
potentials at 24 to 72 hours.
Less reliable confirmatory signs include unreactive burst suppression or status epilepticus on electroencephalogram, status myoclonus (lasting >30 minutes) during first 72 hours after ROSC, diffuse anoxic injury on computed tomography or magnetic resonance imaging of the brain, and markedly and persistently elevated neuron-specific endolase
The most common type of cardiac arrest in the OR is:
A. PEA
B. Asystole
C. VF
D. VT
A. PEA
In the adult algorithm, What is the maximum dose of LIDOCAINE during ACLS?
A. 2mg/kg
B. 1.5mg/kg
C. 3mg/kg
C. 3mg/kg
Pediatric Bradycardia Algorithm
In the absence of organophosphate poisoning, the maximum single dose of Atropine that can be given to a child is:
A. 0.5 mg
B. 1 mg
C. 10mg
D. 5mg
A. 0.5 mg
0.02 mg/kg IV/IO/ ET
- May repeat once
- Maximum single dose 0.5 mg in
child
*May give higher doses in the presence of organophosphate poisoning.
ADULT CARDIAC ARREST ALGORITHM
PEDIA TACHYARRYTHMIA ALGORITHM
ADULT BRADYCARDIA ALGORITHM
Biphasic versus Monophasic Defibrillator
Biphasic versus Monophasic Defibrillator
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Pregnant ACLS Algorithm
