ACLS 2017 - Scenarios & Questions

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If patient is in cardiac arrest and the rhythm is asystole and CPR
is beign given. What is the first drug you should give?
(a) Atropine 0.5 mg IV/IO
(d) Epinephrine 1 mg IV/IO
(b) Atropine 1 mg IV/IO
(c) Dopamine 2 to 20 mcg/kg per min IV/IO
(d) Epinephrine 1 mg IV/IO
A patient has a rapid irregular wide-complex tachycardia. The
ventricular rate is 138 bpm. He is asymptomatic, with a blood
pressure of 110/70. He has a history of angina. What action is
recommended next?
(d) Seeking expert consultation
(a) Giving adenosine 6 mg IV bolus
(b) Giving lidocaine 1 to 1.5 mg IV bolus
(c) Performing synchroniczed cardioversion
(d) Seeking expert consultation
A patient is in cardiac arrest. Ventricular fibrillation has been
refractory to a second shock. Which drug should be administered
first?
(a) Atropine 1 mg IV/IO (b) Epinephrine 1 mg IV/IO
(b) Epinephrine 1 mg IV/IO
(c) Lidocaine 1 mg/kg IV/IO
(d) Sodium bicarbonate 50 mEq IV/IO
You arrive on the scene with the code team. High-quality CPR is
in progress. An AED has previously advised "no shock indicated."
A rhythm check now finds asystole. After resuming high-quality
compressions, which action do you take next?
(b) Establish IV or IO access
(a) Call for a pulse check
(b) Establish IV or IO access
(c) Insert a laryngeal airway
(d) Perform endotracheal intubation
A patient is in pulseless ventricular tachycardia. Two shocks and 1
dose of epinephrine have been given. Which drug should be given
next?
(a) Adenosine 6 mg (b) Amiodarone 300 mg
(b) Amiodarone 300 mg
(c) Epinephrine 3 mg
(d) Lidocaine 0.5 mg/kg
A 35 yr old female has palpitation, light-headedness, and a stable
tachycardia. The monitor shows a regular narrow-complex QRS
at a rate of 180/min. Vagal manuevers have not been effective in
terminating the rhythm. An IV has been established. Which drug
should be administered? (a) Adenosine 6 mg
(a) Adenosine 6 mg
(b) Atropine 0.5 mg
(c) Epinephrine 2 to 10 mcg/kg per minute
(d) Lidocaine
Pt is in refractory ventricular fibrilation. CPR is in progress. 1 dose
of epinephrine given after second shock. An antiarrhythmic drug
was given immediately after third shock. Which med is next?
(a) Epinephrine 1 mg (a) Epinephrine 1 mg
(b) Epinephrine 3 mg
(c) Sodium bicarb 50 mEq
(d) Second dose of antiarrhythmic drug
What is the indication for use of magnesium in cardiac arrest?
(a) Ventricular tachycardia associated with a normal QT interval
(b) Shock-refractory monomorphic ventricular tachycardia (c) Pulseless ventricular tachycardia-associated torsades de
(c) Pulseless ventricular tachycardia-associated torsades de pointes
pointes
(d) Shock-refractory ventricular fibrillation

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 ACLS 2017 - Scenarios & Questions
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A pt is in cardiac arrest. Ventricular fibrillation has been refractory
to an initial shock. If no pathway for medication administration is
in place, which method is preferred?
(a) Central line (d) IV or IO
(b) Endotracheal tube
(c) External jugular vein
(d) IV or IO
Which intervention is most appropriate for the treatment of a
patient in asystole?
(a) Atropine
(c) Epinephrine
(b) Defibrillation
(c) Epinephrine
(d) Transcutaneous pacing
You are caring for a 66 yr old man with a hx of a large intracerebral
hemorrhage 2 months ago. He is being evaluated for another
acute stroke. The CT scane is negative for hemorrhage. The pt
is receiving oxygen via nasal cannula at 2 L/min, and an IV has
been established. His BP is 180/100. Which drug do you anticipate
(a) Aspirin
giving to this pt?
(a) Aspirin
(b) Glucose (D50)
(c) Nicardipine
(d) rTPA
Pt is in refractory ventricular fibrillation and has received multiple
appropriate defibrillation shocks, epinephrine 1 mg IV twice, and
an initial dose of amiodarone 300 mg IV. Pt is intubated. Which
best describes the recommended second dose of amiodarone for
this pt? (c) 150 mg IV push
(a) 1 mg/kg IV push
(b) 1 to 2 mg/min infusion
(c) 150 mg IV push
(d) 300 mg IV push
A monitored pt in the ICU developed a sudden onset of nar-
row-complex tachycardia at a rate of 200. Pt's BP is 128/58, PET-
CO2 is 38, and pulse oximetry reading is 98%. There is vascular
access in the left arm, and pt has not been given any vasoactive
drugs. 12 lead EKG confirms a supraventricular tachycardia w/ no
evidence of ischemia or infarction. Heart rate has not responded (a) Administer adenosine 6 mg IV push
to vagal manuevers. What is your next action?
(a) Administer adenosine 6 mg IV push
(b) Administer amiodarone 300 mg IV push
(c) Perform synchronized cardioversion at 50 J
(d) Perform synchronized cardioversion at 200 J
In which situation does bradycardia require treatment?
(a) 12-lead ECG showing a normal sinus rhythm
(b) Hypotension (b) Hypotension
(c) Diastolic blood pressure > 90
(d) Systolic blood pressure > 100
A 67 yr old woman has palpitations, chest discomfort, and tachy-
cardia. The monitor shows a regular wide-complex QRS at a rate
of 180/min. She becomes diaphoretic, and her blood pressure is
80/60. Which action do you take next?
(c) Perform electrical cardioversion
(a) Establish IV access
(b) Obtain a 12 lead EKG
(c) Perform electrical cardioversion
(d) Seek expert consultation
Pt w/ sinus bradycardia and a heart rate of 42 has diaphoresis and
a blood pressure of 80/60. What is the initial dose of atropine?
(b) 0.5 mg
(a) 0.1 mg
(b) 0.5 mg
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(c) 1 mg
(d) 3 mg
A pt w/ STEMI has ongoing chest discomfort. Heparin 4000 units
IV bolus and a heparin infusion of 1000 units per hr are being
administered. The pt did not take aspirin because he has a hx of
gastritis, which was treated 5 yrs ago. What is your next action?
(a) Give aspirin 160 to 325 mg to chew
(a) Give aspirin 160 to 325 mg to chew
(b) Give clopidogrel 300 mg orally
(c) Give enteric-coated aspirin 75 mg orally
(d) Give enteric-coated aspirin 325 mg rectally
62 yr old man suddenly expereinced difficulty speaking and
left-sided weakness. He meets initial criteria for fibrinolytic thera-
py, and a CT scan of the brain is ordered. Which best describes
the guidelines for antiplatelet and fibrinolytic therapy?
(d) Hold aspirin for at least 24 hrs if rtPA is administered
(a) Give aspirin 160 to 325 mg to be chewed immediately
(b) Give aspirin 160 mg and clopidogrel 75 mg orally
(c) Give heparin if the CT scan is negative for hemorrhage
(d) Hold aspirin for at least 24 hrs if rtPA is administered
A patient has sinus bradycardia w/ a heart rate of 36. Atropine
has been administered to a total dose of 3 mg. A transcutaneous
pacemaker has failed to capture. The pt is confused, and her BP
is 88/56. Which therapy is now indicated?
(b) Epinephrine 2 to 10 mcg/min
(a) Atropine 1 mg
(b) Epinephrine 2 to 10 mcg/min
(c) Adenosine 6 mg
(d) Normal saline 250 mL to 500 mL bolus
A 45 yr old woman with a hx of palpitations develops light-head-
edness and palpitations. She has received adenosine 6 mg IV for
the rhythm shown here, without conversion of the rhythm. She is
now extremely apprehensive. Her BP is 128/70 mm Hg. What is
the next appropriate intervention? (a) Administer adenosine 12 mg IV
(a) Administer adenosine 12 mg IV
(b) Perform unsynchronized cardioversion
(c) Perform vagal maneuvers
(d) Perform synchronized cardioversion
Which action is likely to cause air to enter the victim's stomach
(gastric inflation) during bag-mask ventilation?
(a) Giving breaths over 1 second
(b) Ventilating too quickly
(b) Ventilating too quickly
(c) Providing a good seal btwn the face and mask
(d) Providing just enough volume for chest to rise
What is the recommended depth of chest compressions for an
At least 2 inches
adult victim?
You are the code team leader and arrive to find a patient with CPR
in progress. On the next rhythm check, you see electrical activity
on the monitor. She has no pulse or respirations. Bag-mask ven-
tilations are producing visible chest rise, and IO access has been
established. Which intervention would be your next action? (c) Epinephrine 1 mg
(a) Atropine 1 mg
(b) Dopamine at 10 to 20 mcg/kg per min
(c) Epinephrine 1 mg
(d) Intubation and administration of 100% oxygen
How often should you switch chest compressors to avoid fatigue? Every 2 minutes
You are providing bag-mask ventilation to a pt in respiratory arrest.
About every 5-6 secs
How often should you provide ventilations?
Which intervention is most important in reducing this patient's
in-hospital and 30 day mortality rate?
(d) Reperfusion therapy
(a) Application of transcutaenous pacemaker
(b) Atropine administration
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(c) Nitroglycerin administration
(d) Reperfusion therapy
How does complete chest recoil contribute to effective CPR?
(a) Allows maximum blood return to the heart
(b) Reduces rescuer fatigue (a) Allows maximum blood return to the heart
(c) Reduces the risk of rib fractures
(d) Increases the rate of chest compressions
A patient was in refractory ventricular fibrillation. A third shock has
just been administered. Your team looks to you for instructions.
What is your next action?
(a) Check the carotid pulse (d) Resume high-quality chest compressions
(b) Give amiodarone 300 mg IV
(c) Give atropine 1 mg IV
(d) Resume high-quality chest compressions
A patient has been rususcitated from cardiac arrest. During
post-ROSC treatment, pt becomes unresponsive, with ventricular
fibrillation. Which action is indicated next?
(a) Give an immediate unsynchronized high-energy shock (defib- (a) Give an immediate unsynchronized high-energy shock (defib-
rillation dose) rillation dose)
(b) Give lidocaine 1 to 1.6 mg/kg IV
(c) Perform synchronized cardioversion
(d) Repeat amiodarone 300 mg IV
What is the recommended compression rate for high-quality
100-120 compressions per min
CPR?
What action minimizes the risk of air entering the victim's stomach
during bag-mask ventilation?
(a) Ventilating until you see the chest rise
(a) Ventilating until you see the chest rise
(b) Ventilating as quickly as you can
(c) Squeezing the bag with both hands
(d) Delivering the largest breath you can
Which action should you take immediately after providing an AED
shock?
(a) Check pulse rate
(c) Resume chest compressions
(b) prepare to deliver a second shock
(c) Resume chest compressions
(d) Start rescue breathing
After initiation of CPR and 1 shock for ventricular fibrillation, pt is
still in ventricular fibrillation at next rhythm check. A second shock
is given, and chest compressions are resumed immediately. An IV
is in place, and no drugs have been given. BBag-mask ventilations
are producing visible chest rise. What is your next intervention?
(c) Give epinephrine 1 mg IV/IO
(a) Administer 3 sequential (stacked) shocks at 360 J (monopha-
sic defibrillator)
(b) Give amiodarone 300 mg IV/IO
(c) Give epinephrine 1 mg IV/IO
(d) Intubate and administer 100% oxygen
What is the maximum interval for pausing chest compressions? 10 seconds
A 35 yr old woman presents w/ a chief complaint of palpitations.
She has no chest discomfort, shortness of breath, or light-head-
edness. Her BP is 120/78. On EKG, it shows she is in SVT. Which
intervention is indicated first?
(d) Vagal manuevers
(a) Adenosine 3 mg IV bolus
(b) Adenosine 12 mg IV slow push (over 1 to 2 min)
(c) Metoprolol 5 mg IV and repeat if necessary
(d) Vagal manuevers
Your patient is not responsive and is not breathing. You can pal-
pate a carotid pulse. Which action do you take next?
(d) Start rescue breathing
(a) Apply an AED
(b) Obtain a 12 lead EKG
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(c) Start an IV
(d) Start rescue breathing
What is more important to start for a nonresponsive patient with
Starting rescue breathing
no pulse, putting on an AED or starting rescue breathing?
You arrive on scene to find CPR in progress. Nursing staff report
the pt was recovering from a pulmonary embolism and suddenly
collapsed. Two shocks have been delivered, and an IV has been
initiated. What do you administer now?
(b) Epinephrine 1 mg IV
(a) Atropine 0.5 mg IV
(b) Epinephrine 1 mg IV
(c) Endotracheal intubation
(d) Transcutaneous pacing
A patient becomes unresponsive. You are uncertain if a faint pulse
is present. An IV is in place. Which action do you take next?
(a) Begin transcutaneous pacing
(b) Start high-quality CPR
(b) Start high-quality CPR
(c) Administer atropine 1 mg
(d) Administer epinephrine 1 mg IV
If cases where ______ is the likely cause of cardiac arrest, VEN-
hypoxia
TILATION becomes much more important
___________ correlates w/ ROSC High quality CPR
What are the consequences of interrupting CPR? coronary perfusion falls
__________ can help indicate coronary perfusion pressure Capnography
Adequate CPR compression are at least 2 inches
Why should chest compressions recoil? To ensure adequate coronary perfusion pressure
Chest compression fraction should be around 60-80%
Don't spend more than ____ seconds without compressions 10 seconds
What should the tidal volume be for adequate ventilations? 500-600 mL or half of a bag squeeze
What should be the first thing you do when you arrive on scene? See if patient is conscious or unconscious
What do you do next If the patient is unconscious when you first
Initiate BLS
arrive on scene?
If a patient is not responsive when you first arrive on scene, what Call code
should you do next? Get AED
During BLS, should you check breathing and pulse
(a) Separately (b) Simultaenously
(b) Simultaenously
If pt is not breathing normally but has pulse, what should you do? Bypass chest compressions and ventilate every 5-6 seconds
After intubating someone, what should you do next? Provide 1 ventilation every 6 seconds
Neurologic function
- Alert
What should you assess for in the Disability function of ABCDE? - Pain
- Voice
- Unresponsive
Hypovolemia
Hypoxia
H+ (acidosis)
What are the H's of PEA?
HyperK+
HypoK+
Hypothermia
Trauma
Tension PTX
What are the T's of PEA? Tamponade
Toxins
Thrombosis (Pulmonary or Coronary)
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Causes gastric insufflation
Incr intrathoracic pressure
Why should you not excessively ventilate?
Decr venous return and CO
Decr survival
Unconscious pts
When do you use oropharyngeal airways?
No gag reflex pts
Conscious, semiconscious, or unconscious pts with or without gag
When do you use a nasopharyngeal airway?
flex

Oropharyngeal airway

Nasopharyngeal airway

Difficult to bag mask vent

When should you proceed with an advanced airway? Airway compromise
Need to isolate airway
What should you use to monitor ET tube? Waveform capnography
If waveform capnography jumps up, it may indicate... ROSC
(1) CPR
If a patient is in cardiac arrest what are the first two steps?
(2) Attach AED
What rhythms are shockable? VFib or pulseless VTach
What rhythms are NOT shockable Asystole or PEA
How often should you give epinephrine? Every 3-5 minutes
After you have given 3 shocks and 3 CPR sessions and they are
When should you consider giving amiodarone?
still in VF or pVT
When should you determine if the rhythm is shockable for asystole
After the first CPR session (2 minutes)
or PEA in the cardiac arrest algorithm?
When should you start treating reversible causes of asystole or
After the second CPR session
PEA?
Bradycardia is categorized as a HR less than... 50
When should you give atropine? When there is bradycardia and perfusion is low
(1) Transcutaneous pacing
If atropine fails in treating bradycardia, what should you do? (2) Dopamine
(3) Epinephrine
If atropine, tcp, dopamine, epinephrine all fail to tx bradycardia, (1) Seek expert consultation
what should you do? (2) Transcutaneous pacing
When should you use synchronized cardioversion in tachycardia? If the pt is hemodynamically unstable
What should you do if you encounter a pt who has a pulseless
Manage it like a cardiac arrest algorithm
tachycardia?
Most symptomatic tachycardias will present with a HR of greater
150
than
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If a tachycardia patient is hemodynamically stable, what is the next
If QRS is wide (>= 0.120 sec)
thing you should assess?
(1) Vagal manuevers
If QRS is not wide for a tachycardia patient, what should you do (2) Adenosine
next? (3) Bblock or CCB
(4) Expert consultation
(1) Optimize ventilation and oxygenation
(2) Treat Hypotension
What things do you need to do after ROSC?
(3) EKG
(4) See if pt follows commands
- O2 > 94%
During post ROSC, what things do you need to do to optimize
- Advanced airway + capnography
ventilation and oxygenation?
- Don't hyperventilate
During post ROSC, if a pt cannot follow commands, what do you
Initiate targeted temperature management
need to do?
If a patient is responsive and talking, what is the next step of the
Obtain a 12 lead ECG
ACS algorithm?
What is the dosing of nitroglycerin according to the ACS algo-
Every 3-5 minutes for a maximum of 3 doses
rithm?
- Severe bradycardia
What are the contraindications of nitroglycerin according to the - Tachycardia
ACS algorithm? - Hypotension
- Phosphodiesterase inhibitors
Initiation of fibrinolytic therapy, if appropriate, within _____ of Initiation of fibrinolytic therapy, if appropriate, within 1 hour of
hospital arrival and ______ from onset of symptoms hospital arrival and 3 hours from onset of symptoms
In ACS algorithm, what determines whether or not a STEMI gets
Whether or not the sxs of onset are less than 12 hrs
reperfusion or not?

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