ACLS Practice Questions ACLS PALS
Sinus tachycardia is caused by:
The best answer is: hypovolemia, fever and pain
Sinus tachycardia is most often caused by: (underlying issues)
1. severe anxiety
Based on this patient’s presenting complaint and symptoms, how likely would this event be cardiac asystole vs. severe transient pauses?
The best answer is: not at all likely that this patient has developed asystolic cardiac arrest vs. a transient pause
An asystolic cardiac arrest is almost always observed secondary to fatal issues. In addition, asystolic cardiac arrest is never transient and ends with a rapid return to stability. A diagnosis of asystole usually means essentially no good outcome likely. Thus, this patient presented with a history of what is likely a similar episode. All of this information suggests a transient conduction defect is present. With that in mind, CPR, epinephrine, etc. would be potentially dangerous choices. Atropine or immediate transcutaneous cardiac pacing would be the most efficient interventions. People whose ECG leads become detached do not turn blue and lose consciousness as a result. This young woman may be a candidate for a permanent cardiac pacemaker.
All health care professionals are legally obligated to begin CPR on any person found in cardiac arrest.
The best answer is: b. false
Health care professionals usually have no automatic duty to provide medical care to a person with whom no contract to do so exists. Some states have created certain automatic obligations, thus, a wise practitioner should understand the laws which govern their practice.
Which one of the following is not a usual cause of pulseless electrical activity?
The best answer is: hyperthermia
The most recent ECC Guidelines list hypovolemia; hypoxia; hypothermia; tension pneumothorax; cardiac tamponade; toxins; and, thrombosis as potentially reversible causes of PEA. The clinical reality is that the patient should never die of an undetected/untreated tension pneumothorax. Treatment is simple and straight-forward. The others on the list are often too massive to treat fast enough to achieve return of spontaneous circulation.
Oral beta blocker drug therapy should be initiated within the first 24 hours of ST elevation myocardial infarction (STEMI) unless contraindicated.
The best answer is: true
Initiation of oral beta blocker therapy within the first 24 hours of ST elevation myocardial infarction (STEMI) is recommended unless there is a contraindication.
“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.
Capillary refill in a properly perfused patient should be:
The best answer is: 2 seconds or less
Normal capillary refill is 1 second or less. Although unusual, co-existent conditions such as hypothermia, may make assessment difficult. All physiologic parameters should be looked at to assure a proper diagnosis.
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.
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.
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).