ACLS Practice Questions   ACLS PALS

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.

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).

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.

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.

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.