Advanced Cardiac Life Support (ACLS)

Question 1

What is cardiac arrest, what are signs it is present

Answer 1

Abrupt loss of heart function/ absence of pulse, unresponsiveness, apnea (no breathing)

Question 2

Why do patients develop cardiac arrest

Answer 2

Coronary artery disease, cardiomyopathy, structural abnormality, electrical abnormality, asthma, trauma

Question 3

What is the chain of survival for cardiac arrest

Answer 3

Immediate recognition and activation of the emergency response system, early CPR (emphasis on chest compressions), Rapid defibrilation, effective advanced life support, intergrated post cardiac arrest care

Question 4

When giving CPR for cardiac arrest what is the target compression per minute, depth

Answer 4

100-120 compressions per minute, 2-2.4 inches (rotate compressions every two minutes if needed to meet target)

Question 5

What is acronym for Basic Life Support for Cardiac Arrest

Answer 5

Circulation: chest compressions through CPR (little interruptions)
Airway: Open and secure airway (endotracheal intubation)
Breathing: Rescue breaths (endotracheal intubation)
Defibrillation: AED (automatic external defibrillator)/Rapid defibrillation if necessary

Question 6

If there is a break in compressions what is the longest it should last

Answer 6

10 seconds

Question 7

What are the best routes of administration for cardiac arrest

Answer 7

Intravenous (central or peripheral), Intraosseous, Endotracheal (not preferred)

Question 8

What drugs can be administered endotracheal

Answer 8

Naloxone, Atropine, Versed/Vallium/Vasopressin, Epinephrine, Lidocaine

Question 9

How must the dose be changed if given Endotracheal

Answer 9

2-2.5 times the normal dose, followed by 10 ml normal saline flush

Question 10

What are the intraosseous lines placed, how

Answer 10

Femoral head or tibia, Drill

Question 11

What are the various rhythms that indicate Cardiac arrest

Answer 11

Ventricular fibrillation (VF), Pulseless ventricular tachycardia (VT), Asystole (flatline), Pulseless electrical activity (PEA)

Question 12

What are the Hs that cause PEA

Answer 12

Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyperkalemia, Hypothermia

Question 13

What are the Ts that cause PEA

Answer 13

Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary or coronary)

Question 14

When a person goes into cardiac arrest what is the first thing that should be done

Answer 14

Give CPR and attach monitor/defibrillator

Question 15

What are the rhythm shockable states of Cardiac Arrest

Answer 15

Ventricular Fibrillation and Pulseless ventricular Tachycardia

Question 16

What are the non rhythm shockable states of cardiac arrest

Answer 16

Asystole and Pulseless electrical Activity

Question 17

If a patient is giving CPR and they have VF/pVT what should be done

Answer 17

Shock with defibrillator, CPR for 2 mins (within 10 seconds after defibrillator) while also searching for IV/IO access

Question 18

If after giving CPR for 2 mins after the first shock what should be done next if rhythm shockable

Answer 18

Shock with defibrillator, CPR for 2 mins (within 10 seconds after defibrillator) PLUS give Epinephrine 1 mg Every 3 to 5 minutes
(consdier advancerd airway and capnography)

Question 19

If after giving CPR for 2 minutes after the 2nd shock plus Epinephirne what should be done next if rhythm shockable

Answer 19

Shock with defibrillator, CPR for 2 mins (within 10 seconds after defibrillator) PLUS either Amiodarone 300 mg bolus AND 150 mg second dose OR Lidocaine 1-1.5 mg/kg for the first dose AND 0.5-0.75 mg/kg for the second dose while also fixing the underlying problem

Question 20

What should be done if a patient is NOT rhythm shockable since they are in asystole or pulseless electrical activity

Answer 20

CPR for 2 minutes with IV/IO accest found, Epinephrine 1 mg every 3 to 5 minutes (consider advanced airway,capnography)

Question 21

What should be done if the patient still is not rhythm shocable after epinipherine dose

Answer 21

CPR for 2 minutes then treat reversible causes

Question 22

T/F: If the patient never becomes rhythm shockable they should not receive Lidocaine or Amiodarone

Answer 22

True

Question 23

What are ways of knowing the CPR quality

Answer 23

If PETCO2 is less than 10 mmHg improve CPR quality, If diastolic pressure is less than 20 mmHG improve CPR quality

Question 24

When advanced airway is in place how many breaths is given per minute

Answer 24

10 breaths per min

Question 25

What is a good return of spontaneous circulation

Answer 25

Abrupt sustained increased PETCO2 (typically greater than 40 mmHg)

Question 26

What are the drugs that can be given if a patient is in cardiac arrest

Answer 26

Epinephrine, Amiodarone, Lidocaine

Question 27

What drugs can be given as infusions and when is that circumstance

Answer 27

Norepinephrine, epinephrine, dopamine, and phenylephrine BUT only if Return of spontaneous criculation occurs

Question 28

What is the goals of using epinephrine in cardiac arrest

Answer 28

Reduce vascular resistance, increase cerebral and coronary perfusion pressure, reduction of blood flow to muscle and visceral tissues

Question 29

T/F: If a patient achieves ROSC epinephrine can be given as a continous infusion

Answer 29

True

Question 30

T/F: Epinephrine is indicated for any type of cardiac arrest that occurs

Answer 30

True

Question 31

What are the goals of using antiarrhythimic drugs

Answer 31

blocking sodium, potassium, and calcium channels crital to the cardiac conduction in order to achieve return of spontaneous criculation and further suppress arrhythmias

Question 32

What is amiodarone indicated for in cardiac arrest

Answer 32

Ventricular fibrillation, pulseless ventricular tachycardia, recurrent atrial and ventricular tachycardias

Question 33

What is the dosing of amiodarone in pulseless ventricular tachycardia, Ventricular Fibrillation, if ROSC occurs

Answer 33

300 mg rapid IV bolus, may repeat with 150 mg IV bolus, 150 mg in 50 ml IV over 10 minutes (rate 300 ml/hour), 1mg/min for 6 hours, then 0.5 mg/min for 18 hours

Question 34

What types of cardiac arrest is lidocaine indicated for

Answer 34

Pulseless VF/VT, prevention of arrhythmias after ROSC

Question 35

What is the dose for lidocaine to treat Pulseless VF/VT, After ROSC

Answer 35

First dose: 1-1.5 mg/kg, Second dose: 0.5-0.75 mg/kg/ 1-4mg/min in a continous infusion

Question 36

When would Sodium bicarbonate be used in cardiac arrest, dose

Answer 36

If the cause is hyperkalemia, TCA overdose or preexisting acidosis/ 1 amp= 50 mEq (flush line since not compatible with catecholamines)

Question 37

When would dextrose be used in hear failure, dose

Answer 37

Hypoglycemia OR if insulin is used to treat hyperkalemia/ 1 amp of 50% = 25 grams

Question 38

When is magnesium sulfate indicated in cardiac arrest

Answer 38

Treatment of polymorphic ventricular fibrillation (Torsades) and arrhythmias 2nd to digoxin or hypomagnesemia

Question 39

When magnesium sulfate is used to treat cardiac arrest what is the dose for pulseless arrest, pulse present

Answer 39

1-2 grams in 10ml D5W IV over at least 5 minutes (5-20 minutes recommended)/ 1-2 grams in 50-100 ml D5W over 60 minutes