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11/16/2014

AHA ACLS Written Test flashcards | Quizlet

AHA ACLS Written Test

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You find an unresponsive pt. who is not
breathing. After activating the emergency
response system, you determine there is no
pulse. What is your next action?

Start chest compressions of at least 100 per


min.

You are evaluating a 58 year old man with


chest pain. The BP is 92/50 and a heart
rate of 92/min, non-labored respiratory
rate is 14 breaths/min and the pulse O2 is
97%. What assessment step is most
important now?

Obtaining a 12 lead ECG.

What is the preferred method of access for


epi administration during cardiac arrest in
most pts?

Peripheral IV

An AED does not promptly analyze a


rythm. What is your next step?

Begin chest compressions.

You have completed 2 min of CPR. The


ECG monitor displays the lead below
(PEA) and the pt. has no pulse. You
partner resumes chest compressions and an
IV is in place. What management step is
your next priority?

Administer 1mg of epinepherine

During a pause in CPR, you see a narrow


complex rythm on the monitor. The pt. has
no pulse. What is the next action?

Resume compressions

What is acommon but sometimes fatal


mistake in cardiac arrest management?

Prolonged interruptions in chest


compressions.

Which action is a componant of highquality chest comressions?

Allowing complete chest recoil

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Which action increases the chance of


successful conversion of ventricular
fibrillation?

Providing quality compressions


immediately before a defibrillation
attempt.

Which situation BEST describes PEA?

Sinus rythm without a pulse

What is the best strategy for perfoming


high-quality CPR on a pt.with an advanced
airway in place?

Provide continuous chest


compressionswithout pauses and 10
ventilations per minute.

3 min after witnessing a cardiac arrest, one


memeber of your team inserts an ET tube
while another performs continuous chest
comressions. During subsequent
bentilation, you notice the presence of a
wavefom on the capnogrophy screen and a
PETCO2 of 8 mm Hg. What is the
significance of this finding?

Chest compressions may not be effective.

The use of quantitative capnography in


intubated pt's does what?

Allowsfor monitoring CPR quality

For the past 25 min, EMS crews have


attemptedresuscitation of a pt who
originally presented with V-FIB. After the
1st shock, the ECG screen displayed
asystole which has persisted despite 2
doses of epi, a fluid bolus, and high quality
CPR. What is your next treatment?

Consider terminating resuscitive efforts


after consulting medical control.

Which is a safe and effective practice


within the defibrillation sequence?

Be sure O2 is NOT blowing over the pt's


chest during shock.

During your assessment, your pt suddenly


loses consciousness. After calling for help
and determining that the pt. is not
breathing, you are unsure whether the pt.
has a pulse. What is your next action?

Begin chest compressions.

What is an advantage of using hands-free


d-fib pads instead of d-fib paddles?

Hands-free allows for more rapid d-fib.

What action is recommended to help


minimize interruptions in chest
compressions during CPR?

Continue CPR while charging the


defibrillator.

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Which action is included in the BLS


survey?

Early defibrillation

Which drug and dose are recommended


for the management of a pt. in refractory
V-FIB?

Amioderone 300mg

What is the appropriate intervalfor an


interruption in chest compressions?

10 seconds or less

Which of the following is a sign of


effective CPR?

PETCO2 = or > 10mm Hg

What is the primary purpose of a medical


emergency team or rapid response team?

Identifying and treating early clinical


deterioration.

Which action improves the quality of chest


compressions delivered during resuscitave
attemepts?

Shitch providers about every 2 min or


every 5 compression cycles.

What is the appropriate ventilation strategy


for an adult in respiratory arrest with a
pulse of 80 beats/min?

1 breath every 5-6 seconds

A pt. presents to the ER with a new onset


of dizziness and fatugue. Onexamination,
the pt's heart rate is 35 beats/min, BP is
70/50, resp. rate is 22 per min, O2 sat is
95%. What is the appropriate 1st
medication?

Atropine 0.5mg

A pt. presents to the ER with dizziness and


SOB with a sinus brady of 40/min. The
initial atropine dose was ineffective and
your monitor does not provide TCP. What
is the appropriate dose of Dopamine for
this pt?

2-10mcg/kg/min

A pt. has an onset of dizziness. The pt.s


heart rate is 180, BP is 110/70, resp. rate is
18, O2 sat is 98%. This is a reg narrow
complex tach rythm. What is the next
intervention?

Vagal manuever.

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A monitored pt. in the ICU developed a


suddent onset of narrow complex tach at a
rate of 220/min. The pt's BP is 128/58, the
PETCO2 is 38mm Hg, and the O2 sat is
98%. There is an EJ established for
vascular access. The pt. denies taking any
vasodialators. A 12 lead shows no
ischemia or infarction. Vagal manuevers
are ineffective. What is the next
intervention?

Adenosine 12mg IV

You receiving a radio report from an EMS


team enroute with a pt. who may be having
a stroke. The hospital CT scanner is
broken. What should you do?

Divert the pt. to a hospital 15 min away


with CT capabilities.

Choose an appropriate inidication to stop


or withhold resuscitive efforts.

Evidence of rigor mortis.

A 49 y/ofmaile arrives in the ER with


persistant epigastric pain. She has been
taking antacids PO for the past 6 hours
because she she had heartburn. BP is
118/72, heart rate is 92/min, resp. rate is
14 non-labored and O2 sat is 96%. What is
the most appropriate next action?

Obtain a 12 lead ECG.

A pt. in respiratory failure becomes apneic


but contineues to have a strong pulse. The
heart rate is dropping paridly and now
shows a sinus brady rate at 30/min. What
intervention has the highest priority?

Simple airway manuevers and assisted


ventilations.

What is the appropriate procedure for ET


suctioning after the catheter is selected?

Suction during withdrawl, but not for


longer than 10 seconds.

While treating a stable pt for dizziness, a


BP of 68/30, cool and clammy, you see a
brady rythm on the ECG. How do you
treat this?

Atropine 0.5mg

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A 68 y/o female pt. experienced a sudden


onset of right arm weakness. BP is 140/90,
pulse is 78/min, resp rate is non-labored
14/min, 02 sat is 97%. Lead 2 in the ECG
shows a sinus rythm. What would be your
next action?

Cinncinati Stroke Scale

You are transporting a pt. with a positive


stroke assessment. BP is 138, pulse is
80/min, resp rate is 12/min, 02 sat is 95%
room air. Glucose levels are normal and
the ECG shows a sinus rythm. What is
next.

Head CT scan

What is the proper ventilation rate for a pt.


in cardiac arrest who has an advanced
airway in place?

8-10 breaths per minute

A 62 y/o male pt. in the ER says his heart


is beating fast. No chest pain or SOB. BP
is 142/98, pulse rate is 200/min, reps rate
is 14/min, O2 sats are 95 at room air. What
should be the next evaluation?

Obtain a 12 lead ECG.

You are evaluating a 48 y/o male with


crushing sub-sternal pain. He is cool, pale,
diaphretic, and slow to respond to your
questions. BP is 58/32, pulse is 190/min,
resp rate is 18, and you are unable to
obtain an 02 sat due to no radial pulse. The
ECG shows a wide complex tach rythm.
What intervention should be next?

Syncronized cardioversion.

What is the initial priority for an


unconscious pt. with any tachycardia on
the monitor?

Determine if a pulse is present.

Which rythm requires synchronized


cardioversion?

Unstable SVT

What is the recommended dose for


adenosine for pt's in refractory, but stable
narrow complex tachycardia?

12mg

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What is the usual post-cardiac arrest target


range for PETCO2 who achieves return of
spontaneous circulation (ROSC)?

35-40mm Hg

Which conditionis a contraindication to


theraputic hypothermia during the postcardiac arrest period for pt's who achieve
return of spontaneous circulation (ROSC)?

Responding to verbal commands

What is the potential danger to using ties


that pass circumfrentially around the pt's
neck when securing an advanced airway?

Obstruction of veneous return from the


brain

What is the most reliable method of


confirming and montioring correct
placement of an ET tube?

Continuous waveform capnography

What is the recommended IV fluid (NS or


LR) bolus dose for a pt. who achieves
ROSC but is hypotensive during the postcardiac arrest period?

1 to 2 Liters

What is the minimum systolic BP one


should attempt to achieve with fluid,
Inotropic, or vasopressor administration in
a hypotensive post-cardiac arrest who
achieves ROSC?

90mm Hg

What is the 1st treatment priority for a pt.


who achieves ROSC?

Optimizing ventilation and oxygenation.

Ventilations during Cardiac Arrest

2 every 30 compressions with a bag mask


or
1 every 6 to 8 seconds w/advanced airway
(8-10 breaths/minute)

ventilations during respiratory arrest

1 every 5 to 6 seconds
10 to 12 breaths/minute

tidal volume delivered w/bag mask

600mL

what does a PETCO2 of <10mmHg


indicate in an intubated patient

their CO is inadequate to to achieve ROSC

which drugs can be given with


endotracheal route?

only epi, vasopressin and lidocaine and


you will need to double the dose

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why do we give a saline bolus after


infusion of a drug via peripheral IV?

to hasten the time for peak response

steps for treating hypotension

1. IV bolus 1-2L normal saline


2. pressor: 0.1-0.5 mcg/kg/min for epi or
norepi
or 5-10mcg/kg/min of dopamine
3. treatable causes? (H's and T's)
4. obtain ECG

Do you shock PEA?

do not shock asystole or PEA!


treatment is vasopressor only!

reperfusion goal: time from door to


balloon inflation (PCI)

90 minutes

reperfusion goal of 30 minutes is for...

door-to-needle (fibrinolysis)

if pt is hemodynamically unstable do you


give nitroglycerin?

No, must have SBP >90mmHg

when is nitroglycerin contraindicated?

inferior wall MI or RT ventricular


infarction
hypotension, brady or tachycardia
recent phosphodiesterase use (Viagra)

4 D's of in-hospital therapy

door to data to decision to drug (or PCI)

treatment of bradyarrhythmia

0.5 mg Atropine every 3-5 minutes, max


of 3 mg
if ineffective:
transutaneous pacing or dopamine 210mcg/kg/min or epi 2-10mcg/min

when do you use synchronized shocks

unstable SVT
unstable afib
unstable a flutter
unstable, regular, monomorphic
tachycardia w/a pulse

therapy for pt w/narrow QRS w/regular


rhythm

vagal maneuver
or
give adenosine

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stroke
general assessment w/in __ minutes of
arrival
CT w/in __ minutes
interpret CT within __ minutes
initiate fibrinolytic therapy within ?
door-to-admission time of 3 hours

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general assessment w/in 10 minutes of


arrival
CT w/in 25 minutes
interpret CT within 45 minutes
-initiate fibrinolytic therapy within 1 hour
of arrival and 3 hours from symptom onset

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