ACLS Practice Questions ACLS PALS
Epinephrine should be administered I.V. how?
The best answer is: 10 ml. of 1:10,000 solution I.V.
I.V. epinephrine is recommended to be administered:
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.
Although most treatment algorithms include epinephrine for the treatment of pulseless electrical activity (PEA), its success is unlikely. The primary goal when confronted with a PEA arrest should be to?
The best answer is: rapidly attempt to determine the cause of the PEA
The more rapidly a practitioner can identify a cause, the more rapidly a targeted intervention can occur. There is a small window of time when certain causes of PEA are treatable. The longer a patient stays in arrest, the less likely survival is.
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.
The 12-lead ECG is crucial for proper triage of patients presenting with acute coronary syndromes.
The best answer is: true
The most recent Guidelines repeatedly call for early 12-lead ECG analysis for treating patients with acute coronary syndrome symptoms, emphasizing the use of pre-hospital 12-lead ECG by EMS personnel.
The clinical diagnosis for respiratory failure includes which of the following signs and symptoms?
- 1. decreased level of consciousness associated with a breathing problem
- 2. cyanosis
- 3. bradycardia associated with a breathing problem
- 4. hypercarbia and/or severe hypoxemia (PaCO2 > 50 mmHg and/or a PaO2 < 70 mmHg)
The best answer is: (all of the above)
Children with respiratory distress who become obtunded (decreased level of consciousness) develop cyanosis; become bradycardic; or are unable to maintain ventilation/oxygenation and are in respiratory failure.
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).
“Respiratory distress” is defined as:
The best answer is: increased work of breathing
The presence of cyanosis or apnea constitutes respiratory failure. The definition of respiratory distress is: an increased work of breathing.
Adenosine should be given:
- 1. 0.1 mg/kg (up to a maximum of 6 mg)
- 2. in an IV closest to the central circulation
- 3. by slow IV drip infusion
- 4. followed immediately by a bolus of IV fluid
The best answer is: (1,2,4)
The recommended initial dose of adenosine in pediatrics is 0.1 mg/kg. Once a child is 60 kg or greater, the adult recommendation is an initial dose of 6 mg. If unsuccessful, the initial dose can be doubled. Because adenosine has a rapid alpha half-life, it must be delivered rapidly to the right side of the heart. An IV close to the central circulation (usually antecubital) and pushing the adenosine bolus rapidly with a 20-30 ml bolus of IV fluid is the recommended method.
A young trauma patient is brought into your emergency department, barely responsive, pale, with an 8 second capillary refill. The abdomen is distended and rigid. Stat hemoglobin comes back 6.6 gm. What would be the ideal fluid to treat this patients hypovolemic shock?
The best answer is: whole blood or packed cells
Although normal saline or Lactated Ringer’s Solution are commonly used in hypovolemia caused by hemorrhage, it is only because blood is not immediately available. Crystaloid solutions contain no red blood cells. Because red blood cells carry the majority of oxygen to tissues, it is essential to replete lost red blood cells as soon as possible.