ACLS Practice Questions ACLS PALS BLS
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What is the term that describes a patient with an organized ECG, where you would expect a pulse, and there is none?
The best answer is: PEA (pulseless electrical activity)
Pulseless electrical activity (PEA), previous known as “electromechanical dissociation” , describes a patient without a pulse, whose ECG shows a rhythm that one would expect to result in a pulse. Ventricular fibrillation and asystole result in pulselessness. However, the ECG is not one that you would expect a pulse with, thus, would not fall in the category of PEA.
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Atropine:
The best answer is: all of the above
Retrospective analysis of true asystolic cardiac arrest reports a virtually null survival rate. Atropine works by altering vagal tone, which may speed up the sinus node and accelerate conduction through the AV node. When treating a defective conduction system, atropine may be quite useful. However, a “dead heart with no electrical activity” suggests atropine will be useless. When history makes the etiology of the ECG uncertain, atropine will cause no harm.
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The proper dose of epinephrine when administered IV during CPR is:
The best answer is: 10 ml of 1:10,000
In adult arrest, epinephrine administration is recommended at 1.0 mg every 3-5 minutes IV; IO; and it may be administered via the endotracheal tube at a dose 2 – 2 ½ times the IV dose diluted in 10 ml of sterile water or saline. (Sterile water is recommended.) Vasopressin can be given in place of the epinephrine or as a second dose following the initial epinephrine. It is given as a bolus of 40 units. Vasopressin can also be given via the endotracheal tube if IV access is not available.
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If a patient receiving emergency synchronized cardioversion develops ventricular fibrillation:
The best answer is: immediately turn off the synchronizer mode and defibrillate
In the event that a synchronized shock induces ventricular fibrillation, the patient should be immediately shocked after turning off the synchronized mode. CPR cannot terminate the ventricular fibrillation, and statistically, the faster the patient receives defibrillation following the onset of the ventricular fibrillation, the more likely successful conversion will be.
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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.
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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.
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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.
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Patients requiring continuous positive airway pressure therapy (mechanical ventilation and/or CPAP) should:
The best answer is: all of the above
Critically ill or unstable patients receiving ventilatory support should be transferred to an intensive care setting where the staff is trained and capable of managing this higher level patient. All patients receiving positive airway pressure are at risk for life-threatening events like the development of a tension pneumothorax. The staff needs to be able to rapidly diagnose and treat this problem to prevent a bad outcome for the patient.
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Which of the following may result in adenosine not being successful in converting a tachyarrhythmia?
The best answer is: all of the above
Adenosine is competitively antagonized by methylxanthines such theophylline drugs and caffeine. Because adenosine is rapidly sequestered by red blood cells, it must be administered in a way to get the drug rapidly to the right heart. Establishing IV sites closest to the central circulation and rapid IV bolus followed immediately by a bolus of IV fluid is the best method to assure a positive result. There are arrhythmias whose mechanism would be unaffected by altering AV node conduction. Some of these include atrial fibrillation, atrial flutter and ventricular tachycardia. Adenosine may be used to unmask underlying arrhythmias like 2:1 atrial flutter by decreasing AV node conduction for a brief period of time allowing more flutter waves to be observed.
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Epinephrine is always required to treat unstable bradycardia in children.
The best answer is: false
The most common cause of bradycardia in sick or injured children is hypoxemia. That is why the first intervention, when receiving an unstable bradycardic child, is positive pressure ventilation using 100% oxygen. If the child is refractory to ventilation/oxygenation interventions, epinephrine is the first line drug recommended. It is given 0.1 ml/kg of the 1:10,000 solution, and may be repeated as needed. In the case of suspected or known vagaltonia, atropine can also be used. It is given 0.02 mg/kg. Both epinephrine and atropine can be given via the ET tube (dilute epinephrine 1:1 using sterile water), and via the intraosseous route.
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Resuscitation is most successful if defibrillation is performed in the first
The best answer is: 5 minutes of collapse
5 minutes of collapse
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CPR is important before and after defibrillation.
The best answer is: True
True
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When 2 or more healthcare providers are performing CPR on an infant, compressions should be done with
The best answer is: The 2 thumb-encircling hand technique
The 2 thumb-encircling hand technique
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When an infant or child is found collapsed, which sequence is best to follow?
The best answer is: Check responsiveness, quickly check pulse, start chest compressions
Check responsiveness, quickly check pulse, start chest compressions
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Healthcare providers should first verify that the victim is unresponsive after witnessing a sudden collapse.
The best answer is: True
True