ACLS Practice Questions ACLS PALS
When using an older, conventional defibrillator, (non-biphasic) the recommended energy used for adult defibrillation is:
The best answer is: 360, 360, 360
With the newer biphasic defibrillators, lower energy is used because of its greater effectiveness via refined waveform delivery patterns. The current recommendation for those using the older, conventional defibrillator is to start at maximum (360 joules) and remain there.
This patient developed:
The best answer is: broad QRS unstable tachycardia
The response to the arrhythmia appeared to be cardiovascular collapse. This unstable condition mandated immediately shock rather than drug therapy. The R-R intervals appear equidistant, ruling out wide QRS atrial fibrillation. However, if they were irregularly spaced, (atrial fibrillation) the emergency cardioversion would still be the indicated treatment. Although regular R-R intervals suggest circuitry, and are most often amenable to lower levels of energy (20-50 joules), pre-existing tissue damage and the presence of anti-arrhythmic drugs may increase the energy requirement for conversion. Atrial fibrillation requires a critical mass of fibrillating muscle to be simultaneously depolarized for conversion to occur, thus, often requires a much higher level of therapeutic energy (100-360 joules).
Regarding emergency ventilation during CPR:
The best answer is: All of the above
Based on the 2015 Guidelines for CPR & ECC, chest compressions, rather than ventilation is encouraged when finding a collapsed victim. As soon as other trained rescuers arrive, ventilation should begin. Once an advanced airway (ET tube, etc.) is in place, ventilation should be given at a rate of 8 – 10 per minute. In the event a collapsed victim is no longer breathing and has a pulse, rescue breathing should be immediately initiated.
If atropine was administered to this patient, the likely response would be:
The best answer is: speeding up the sinus discharge rate (speed up p-p)
Because atropine (parasympatholytic agent) alters vagal tone, the only two possible cardiac responses to its administration would be: 1. Increased sinus node discharge rate; and, 2. Improvement or acceleration of AV node conduction. With an ventricular escape rate of 30 and wide QRS complexes, the distal pathology is far below the AV node and would not be altered by atropine.
Which of the following would be considered EXCLUSION criteria when considering fibrinolytic therapy?
The best answer is: all of the above
According to the most recent Guidelines, the following are relative exclusion criteria:
- Symptoms that seem minor and are clearing rapidly
- Onset of symptoms accompanied by seizure with residual impairment
- Significant trauma or surgery in the previous 14 days
- GI or GU hemorrhage with the last 21 days
- Acute MI within 3 months
The above need to be considered by carefully weighing the risk vs. the benefit when deciding to employ fibrinolytic therapy.
When providing fluid resuscitation, what should be carefully monitored?
- 1. response to the aggressive fluid administration
- 2. airway and breathing
- 3. circulation
- 4. serum electrolytes
The best answer is: (all of the above)
When providing aggressive fluid repletion therapy, the patient should be carefully monitored for airway, breathing and circulation. Also, it is essential to observe and understand the unstable patient’s response to the fluid. Whether vomiting, diarrhea or hemorrhage, rapid volume loss is often accompanied by significant electrolyte imbalances, which may be life-threatening. Careful monitoring and repletion of electrolytes can prevent many secondary disasters.
Vagal maneuvers can be appropriately considered in patients with stable tachyarrhythmias.
The best answer is: true
Patients who are stable (tolerating the arrhythmia) may be good candidates for vagal maneuvers, although many practitioners may opt to employ drug therapy initially, instead.
A normal respiratory frequency for a 16-month-old child is:
The best answer is: 20-30/minute
Although a “normal” respiratory rate range for a 16-month old is approximately 20-30/minute, always consider all potential causes of tachypnea: anxiety; increased body temperature; hypoxia; pain; and airway resistance. Assess each patient comprehensively to best determine the cause(s) of the rapid breathing.
Atropine is most likely to work in which of the following conditions?
- 1. 3rd degree heart block (complete heart block)
- 2. sinus bradycardia
- 3. bradycardia caused by inserting a nasogastric tube
- 4. a bradycardic patient whose implanted pacemaker has failed
The best answer is: (2,3)
Atropine works by altering vagal tone by increasing the rate of sinus discharge and enhance conduction through the AV node. Most children with symptomatic complete heart block have disease below the AV node, thus atropine has no ability to speed infranodal escape pacemakers. However, once oxygen has been ruled out, atropine is an agent that can accelerate sinus node rate. This is specifically true when the bradycardia is caused by increased parasympathetic tone (e.g., caused by invasive procedures, etc.). The majority of pediatric patients who have had artificial pacemakers inserted have disease below the AV node, making atropine ineffective. In such a case, epinephrine would be a wiser choice of drug therapy. (Transcutaneous cardiac pacemaker would be a better choice, if available).
After stabilizing a patient in respiratory failure, the most important clinical goal is:
The best answer is: to identify and treat the disease that is causing the respiratory failure
After establishing clinical stabilization of the patient in respiratory failure, it is essential to determine the cause of the respiratory failure and begin aggressive treatment. Simply maintaining adequate minute ventilation with a ventilator will do nothing to treat an underlying condition such as bacterial pneumonia. Obviously, antibiotic therapy is the proper treatment, not the mechanical ventilator.