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ACLS Provider 2015

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1.

The sequence for BLS for an Adult or


Child who is unresponsive and
pulseless.

C-A-B (Chest
compressions,
Airway, Breathing)

2.

A pulse check during the BLS survey


should be performed for this length of
time.

5 to 10 seconds

3.

A likely indicator of a cardiac arrest


in the unresponsive patient.

Agonal gasps

4.

After discovering an unresponsive


patient, what is the next step in the
assessment and management of this
patient?

Check the patient's


breathing and pulse

5.

Compressions rate in an arrest.

100/min to 120/min

6.

The ratio of compressions to breaths


for the Adult, Child and 1 rescuer
infant arrest.

30 compressions to
2 breaths

7.

The ratio of compressions to breaths


for Infant 2-rescuer arrest.

15 compressions to
1 breath

8.

What you should do if the patient is


unconscious and apneic and you are
uncertain rather or not a patient has a
pulse

Begin compressions

To properly ventilate a patient with a


perfusing rhythm, what is the rate to
squeeze the bag (BVM)

Once every 5 to 6
seconds

10.

The potential complication of


excessive ventilations.

Decreased cardiac
output

11.

Where to measure to appropriately


size an oropharyngeal airway.

Measure from the


corner of the mouth
to the angle of the
mandible

12.

When an advanced airway is in place,


how should compressions be
delivered?

Continuous chest
compressions
without pauses

13.

In the intubated patient, the technique


to assess the quality of CPR.

Monitor the patient's


PETCO2

Your next action if after 2 minutes of


CPR an organized, nonshockable
rhythm is identified.

Check a carotid
pulse

The recommendation for chest


compression depth for an Adult and
CHILD.

At least 2 inches (5
cm) but not more
than 2.4 inches

9.

14.

15.

16.

Components of HighQuality CPR

Compress the chest hard and fast


Allow complete recoil after each
compression
Chest compressions should be
interrupted 10 seconds or less
Switching providers every 2
minutes or every 5 compression (if
unable to determine exact time)
cycles improves the quality of chest
compressions
Continue CPR while the defibrillator
charges

17.

The AHA position on


routine use of cricoid
pressure in cardiac
arrest.

The guidelines do not recommend


routine use of cricoid pressure in
cardiac arrest.

18.

The definitive
treatment for
ventricular fibrillation

Prompt defibrillation

19.

The recommended next


step after a
defibrillation attempt

Resume CPR, starting with chest


compressions

20.

One measure to
minimize interruptions
in chest compressions

Continue CPR while charging the


defibrillator

21.

Action to take if during


the use of an AED you
are not directed to
check the rhythm

Continue CPR (starting with chest


compressions) then check the
equipment.

22.

Measures to provide
electrical safety during
cardioversion or
defibrillation.

Being sure oxygen is not blowing


over the patient's chest during the
shock
Verbally and visually "clear" the
field
Charge defibrillator when paddles
are in place on the chest
Consider hands free pads

23.

An advantage of handsfree pads verses


defibrillator paddles

Hands-free pads allows for more


rapid defibrillation

24.

Physiology of how CPR


is a survival advantage

Supplying a small amount of blood


flow to the heart and reducing
ischemia

25.

Problem and
management of using
of an AED with a hairy
chest

If skin contact is not made AED


pads the machine will not be able to
analyze; remove the hair.

26.

Problem and
management of using
of an AED when the
patient is partially
submerged in water

Remove the patient from the water


and dry off

27.

Problem and management of using


of an AED when patient is lying on
snow or ice

Use the AED

41.

If a patient has respiratory


failure but is perfusing and
gradually becomes
bradycardic, the management
and treatment focus

Treat the respiratory cause


of the bradycardia by airway
maneuvers and assisting
ventilation

28.

If a patient has an implantable


device such as a pacemaker/AICD
that is not functioning the location
you should place the universal pads

Place the AED pads on


either side not directly
on top of an
implantable device

42.

The rationale for defibrillation


of pulseless ventricular
tachycardia

Pulseless ventricular
tachycardia is treated like
ventricular fibrillation
because both are nonperfusing shockable rhythms

Special consideration where to


locate AED pads if a patient has a
medication patch who requires
defibrillation

Do not place AED


directly over a
medication patch
43.

The initial priority for an


unconscious patient with a
tachycardia

Determine rather or not a


pulse is present

The recommended initial biphasic


energy dose for cardioversion of
atrial fibrillation

120 to 200 Joules


44.

Signs and symptoms of


decreased perfusion

Synchronized
cardioversion initial
energy of 100 Joules
(or biphasic equivalent)

Hypotension
Chest pain
Change in Level of
Consciousness
New or worsening heart
failure

31.

The recommended initial


monophasic energy dose for
cardioversion of atrial fibrillation

200 Joules

32.

Initial energy recommendation for


an adult in unstable monomorphic
ventricular tachycardia or SVT

45.

If rhythm is unresponsive to the


initial cardioversion attempt, the
energy recommendation for next
attempt for an adult in unstable
monomorphic ventricular
tachycardia or SVT

Increase the dose in a


stepwise fashion for
monophasic 200
joules, 300 joules, then
360 joules (or biphasic
equivalent)

Management of a patient is in
a bradycardic rhythm (even
3rd degree AV Block) who is
asymptomatic with stable vital
signs

Conduct a problem-focused
history and physical exam
Consider having a
transcutaneous pacemaker
on stand-by

46.

The first medications to be


given in any cardiac arrest

Oxygen and epinephrine

47.

Amiodarone 300 mg

34.

Management for a patient who is


rapidly deteriorating in SVT or
monomorphic V-Tach with a pulse
(even if profoundly hypotensive)

Immediately
synchronized
cardioversion starting
at 100 joules (or
biphasic equivalent)

The next recommended


medication after epinephrine
is administered for refractory
ventricular fibrillation or
pulseless ventricular
tachycardia

35.

If equipment is available, the


management of a witnessed arrest
of V-Fib or pulseless V-Tach

Immediately
defibrillation at 360
joules or biphasic
equivalent

48.

Medication that is NO longer


used in the management of
pulseless electrical activity
(PEA) or asystole

Atropine

36.

In addition to the clinical


assessment, ________________ is
the most reliable method of
confirming and monitoring correct
placement of an endotracheal tube.

Continuous Waveform
Capnography

49.

Indications for Adenosine

37.

High quality chest compressions


are achieved when the PETCO2
value reaches

At least, 10-20 mmHg

Initial diagnosis and


treatment of stable,
undifferentiated regular,
monomorphic wide complex
tachycardia (ventricular
tachycardia) and SVT

50.

Dosing of Adenosine

38.

The indication of a PETCO2 level <


10 mmHg

Potential poor
perfusion from
ineffective CPR

Adenosine is 6 mg IVP
rapidly followed by 12 mg
IVP rapidly

51.

Dosing range for Dopamine

2 to 20 mcg/Kg/min

52.

The treatment priority for


patients who achieve return to
spontaneous circulation

Optimize ventilation and


oxygenation

53.

SBP goal is to achieve by


using fluid administration or
vasoactive agents.

At least 90 mmHg,

54.

Initial management of
hypotension with return to
spontaneous circulation

1 to 2 liters of NS or LR

29.

30.

33.

39.

40.

PETCO2 target range for the patient


with return of spontaneous
circulation

35-40 mmHg

Algorithm indicated for the


tachycardic patient with a pulse

ACLS Tachycardia
Algorithm

55.

The recommended dose of an


Epinephrine infusion, for
management of hypotension
with return to spontaneous
circulation

0.1 to 0.5 mcg/Kg/min

67.

The next step once the primary survey is


performed on a potential stroke victim

Perform the
Cincinnati
Prehospital
Stroke Scale
assessment

56.

An important intervention to
manage an out-of-hospital
resuscitation that achieves
return to spontaneous
circulation

Transport to a facility capable


of coronary reperfusion
(performing a PCI)

68.

According to the Adult Suspected Stroke


Algorithm a critical action that should be
performed by the EMS team to expedite
the patient's care on arrival and reduce
time to treatment

Alert the hospital

57.

Danger if you routinely


administer high concentration
of oxygen in the post arrest
management of patients

Oxygen toxicity

69.

Recommended time for a noncontrast CT


scan of the head should be performed
once a potential stroke victim arrives at
the hospital

Within 25
minutes

58.

The cardiopulmonary and


neurologic support during the
post arrest

Therapeutic hypothermia and


percutaneous coronary
interventions (PCIs),

70.

Meaning of F.A.S.T. Acronym in a


potential stroke victim

59.

Therapeutic hypothermia
should be considered in these
populations of adult patients
who achieves return to
spontaneous circulation

Patients who remain


comatose after the arrest
defined as the lack ability to
follow commands without
contraindications to inducing
hypothermia

Facial Droop
Arm Drift
Speech
ineffective
Time of onset
of symptoms

71.

Diverted to a
hospital that has
CT capabilities

Contraindications to inducing
hypothermia

Patients responding to
verbal commands
Patients with potential to
bleed or recent bleeding
Hemorrhagic stroke
Arrest due to trauma

Action if a radio report is received in the


pre-hospital setting that the CT scanner is
inoperable and you are transporting a
potential stroke patient

72.

One of the first intervention in the ED,


once a CT scan is obtained, for a stroke
victim

61.

Target temperature goal and


duration when inducing
therapeutic hypothermia who
achieves return to
spontaneous circulation after
an arrest

32 Degrees C to 36 Degrees
C for a recommended
duration of at least 24 hours.

62.

Once the patient with chest


discomfort is assessed as
being stable, the most
important assessment or next
step

Obtain a 12-Lead ECG

Start fibrinolytic
therapy as soon
as possible as
long as
CT is normal
without signs of
hemorrhage
The patient has
arrived within the
3 to 4 hours
from the onset of
symptoms
No assessed
contraindications
are present

73.

The recommended goal from


door-to-balloon inflation time
for percutaneous coronary
intervention (PCI)

90 minutes.

Target range for Blood pressure prior to


administering thrombolytics in a stroke
victim

SBP less than


185 mmHg
DBP less than
110 mmHg

74.

Management of a patient who


is hemodynamically stable
without chest pain in a
tachycardic rhythm

12-lead done before another


procedure to different the
cause of the tachycardia
(AMI).

Right ventricular infarcts are most often


associated with __________ myocardial
infarctions

Inferior MI
(Leads II, III,
AVF)

75.

Considerations if right ventricular infarct


suspected

65.

The recommended dose of


aspirin for a patient with
chest pain

160 to 325 mg.

66.

Target goal for


oxyhemoglobin saturations in
patients with acute coronary
syndromes and/or stroke

Greater than or equal to 94%

Obtain rightsided ECG


Nitrates and
morphine may be
contraindicated
Patient may
require IV fluids
for hypotension

76.

Caveat to obtain vascular access, drug


delivery, or advanced airway placement

Should NOT
interrupt CPR

60.

63.

64.

77.

The location and leads used by Bob Page's


mnemonic "I See All Leads" to describe
location of infarcts

I = Inferior (
Leads II, III,
AVF)
See = Septal
(V1 and V2)
All = Anterior
left ventricle
(V3 and V4)
Leads = High
lateral (I and
AVL)
Low lateral left
ventricle (V5
and V6)

78.

ECG changes associated with an acute MI


(Injury)

ST segment
elevation

79.

ST segment elevation in lead I and III


considered

Nondiagnostic

80.

The preferred access for medications in


the arrest is a large peripheral vein such
as the antecubital. If unable to obtain a
peripheral access, the next most preferred
route

Intraosseous
(IO)

81.

What the team leader should do to avoid


inefficiencies during resuscitation

Clearly delegate
tasks

82.

Team leader instructs a team member to


give 0.5 mg of Atropine, to which the team
member responds with "I'll draw up 0.5 mg
of Atropine." This type of communication
is called

Closed-loop
communication

83.

Action the team leader or other team


members should do if a team member is
about to make a mistake during
resuscitation attempt

Address the
team member
immediately

84.

The action that a Team Member is


responsible to perform they feel they are
unable to perform an assigned task
because it is beyond the team member's
scope of practice

Ask for a new


task or role

Action required by the Team Member Team


member if they are uncertain if the correct
amount of amiodarone was order by team
leader, so the team member because of
noise or other distractions

Should repeat
the order and
ask for
verification

Medical Emergency Teams (MET) or rapid


response teams (RRT) have demonstrated
the reduction of cardiac arrest in the
inpatient environment. The primary
purpose of a MET or RRT

Improving
patient
outcomes by
identifying and
treating early
clinical
deterioration

85.

86.

87.

Conditions where
resuscitation
efforts should be
withheld

There is a perceived safety threat to


the provider
Signs of irreversible death (e.g.,
decapitation, rigor mortis, or
decomposition) are present
If the patient has a medical directive
excluding advanced cardiac life support
techniques.

88.

ST elevation in
V1 through V4

Anterior MI (anteroseptal)

89.

ST depression in
V1 through V4

Potential Posterior MI

90.

Considerations
with return of
spontaneous
circulation

Ventilation and Vital Signs


Oxygenation
Medications
IV access, IV fluid administration
Therapeutic interventions (Induction of
hypothermia, 12-Lead ECG, Chest x-ray

91.

Ventricular
Fibrillation

92.

Complete Heart
Block

93.

2nd Degree AV
Block Type II

94.

SVT

95.

Monomorphic VTach

96.

Torsades de
Pointes

97.

Antidote Tricyclic
Overdose

Sodium Bicarb

98.

Dose of Sodium
Bicarb in an
arrest

1 meq/Kg

99.

Management
hyperkalemia in
the emergency

Sodium Bicarb
Insulin and D50%
Calcium Chloride

100.

ECG changes
associated with
hyperkalemia

Tall peaked T waves


Wide QRS

101.

ECG changes
associated with
hypokalemia

Flat T waves
U wave

102.

Antidote for opioid overdose

Narcan

103.

Antidote for benzodiazepines

Flumazenil

104.

Antidote for digoxin toxicity

Digibind

105.

Antidote for organophosphate poisoning

Atropine
Pralidoxime (2 PAM)

106.

Asystole

107.

Sinus Brady

108.

Wenchebache

109.

Atrial Fibrillation

110.

Atrial Flutter