ACLS Practice Questions ACLS PALS
Sedation is rarely necessary for emergency cardioversion.
The best answer is: true
Emergency cardioversion is indicated when an arrhythmia renders a patient unstable. Typically, the unstable patient has severely decreased level of consciousness, thus, sedation is usually not needed. In rare cases where the patient is very responsive, but in a dangerous situation, sedation should be done carefully, with airway protection, a top priority.
Obtaining a 12-lead ECG takes priority over obtaining rapid CT or MRI scans.
The best answer is: false
Although a secondary assessment tool, the 12-lead ECG does not take priority over determining the mechanism of the stroke using CT or MRI scans. ECG monitoring is recommended for the first 24 hours of evaluation in patients with acute ischemic stroke to detect significant arrhythmias and the onset of atrial fibrillation.
In younger patients with a history of palpatations and no cardiac history, what is the most likely diagnosis?
The best answer is: supra-ventricular tachycardia with accessory pathway conduction (WPW)
In younger patients who have neither a history of cardiac disease nor injury, chronic arrhythmias are most often caused by anomalous accessory pathway conduction (Wolff-Parkinson-White syndrome). In patients with cardiac disease history, cardiac ischemia, or acute chest injury, the likelihood is greater for ventricular tachycardia. Adenosine is acceptable for both narrow QRS and broad QRS tachycardia in the stable patient, as long as the rhythm is regular (regular R-R intervals).
When managing pain caused by transcutaneous cardiac pacing (TCP), which of the following is the most effective?
The best answer is: morphine sulfate
Many practitioners mistakenly reach for benzodiazepam agents such as diazepam or midazolam. Neither of these drugs provide analgesia for the patient. The TCP produces significant pain in many patients, thus, the use of carefully titrated IV narcotic analgesia is recommended. In unstable patients, oral drugs should not be given.
Emergency cesarean section should be done when:
The best answer is: 4 minutes of resuscitation has failed to return spontaneous circulation
Because CPR does not maintain fetal blood flow, the more rapidly the flow is restored, the less potential damage to the fetus and the mother. The most recent Guidelines recommend that emergency cesarean section be performed when 4 minutes of resuscitation has been unsuccessful.
Adenosine can be properly used to attempt to convert:
- 1. sinus tachycardia
- 2. narrow QRS, supraventricular tachycardia
- 3. broad QRS, regular tachycardia
- 4. all of the above
The best answer is: (2,3)
Because adenosine stops conduction through the AV node for several seconds, it often converts tachyarrhythmias whose circuitry bisects with the AV node (i.e., AV nodal reentrant tachycardia, etc.). Certain SVT’s have wide QRS complexes, and if the R-R interval is regular, adenosine can be administered as long as the patient is stable. Sinus tachycardia is not an arrhythmia per se, but a response to things such as anxiety, pain, hypovolemia, and fever. Patients with sinus tachycardia need the underlying causes treated. Adenosine will not be of benefit and should not be given.
It is essential to obtain an arterial blood pressure measurement in order to recognize shock in pediatric patients.
The best answer is: false
Because most pediatric patients have intact underlying physiology, they typically possess dramatic abilities to compensate for acute changes. Intense vasoconstriction is a common response to severe hypovolemia. Thus, these young patients may have serious intra-vascular volume loss, and through their ability to compensate, have a “normal” blood pressure. That is why assessing all physiologic parameters should be used to confirm shock. Capillary refill is not affected by compensation, thus, is a valuable measurement. Children with acceptable perfusion will usually have 1 second or less capillary refill time. Rapid breathing (tachypnea) is a common response to tissue hypoxia brought about by shock. Differentiating a primary pulmonary dysfunction causing tachypnea vs. compensatory tachypnea is best done by assessing work of breathing. Patients with pulmonary dysfunction almost always have an increased work of breathing. Patients with compensatory tachypnea do not.
Wheezing is caused by:
The best answer is: all of the above
Wheezing is commonly a symptom of broncospasm, however, swelling of distal airways or mucous may cause or create the wheezing heard on auscultation.
Cyanosis is most often considered a late sign in pediatric patients.
The best answer is: true
Children who desaturate enough hemoglobin to produce cyanosis are at high risk for cardiopulmonary arrest. Cyanosis should be treated immediately to prevent organ damage and/or arrest.
If treating a 10-kg infant with oxygen refractory unstable bradycardia, how much epinephrine should be administered?
The best answer is: 1.0 ml of 1:10,000 solution
The recommended dose of epinephrine is 0.1 ml/kg of the 1:10,000 solution. Expressed in mg: 0.01 mg/kg. The 1:1,000 solution can be used diluted for administration down the ET tube, or for subcutaneous injection. Epinephrine can also be given via the intraosseous route.