ACLS

Question 1

Which four therapies are managed during post-cardiac arrest treatment?

Answer 1

• Target Temperature Management: Maintain between 32-36°C for at least 24 hours.
• Oxygen: Aim for SpO₂ 94% or greater.
• Ventilation: Start VR at 10 breaths/min; ETCO₂ 35-45mmHg
• Pressure: Keep MAP at 65 mmHg or greater.

Question 2

What are the tasks of the team leader?

Answer 2

• Clearly define roles for each person.
• Ask that a new intervention be performed if it is a greater priority.
• Seek input for diagnoses.
• Confirm actions and be clear and provide instructions.

Question 3

List the key roles involved in cardiac arrest.

Answer 3

• Airway manager
• Chest compressor
• Defibrillator operator
• Team leader
• Medication administrator
• Time/recorder

Question 4

What is the role of a team member.

Answer 4

• Ask for a new task or role if unable to perform assigned task.
• Suggest an alternative drug dose in a confident manner.
• Question a colleague who is about to make a mistake.

Question 5

What should you do if you are unsure about detecting a pulse?

Answer 5

start CPR

Question 6

What is coronary perfusion pressure?

Answer 6

Aortic relaxation pressure during diastole

Question 7

What is a quality chest compression?

Answer 7

Includes:

• at least 2 inches in depth
• full chest recoil
• 100-120 compressions/min

Question 8

Fill in the blank:

If ETCO₂ is <10 mmHg, you should reassess _____ of CPR.

Answer 8

quality

Question 9

List the H’s

Answer 9

• Hypovolemia
• Hypoxia
• Hydrogen ion
• Hypo-/Hyperkalemia
• Hypothermia

Question 10

What is the normal ACLS tidal volume of an adult?

Answer 10

6-8 ml/kg

Question 11

Define:

Respiratory Failure

Answer 11

Inadequate oxygenation

Question 12

Define:

Respiratory Arrest

Answer 12

Absent breathing

Question 13

What is bad about excessive ventilation?

Answer 13

• Increases thoracic pressure
• Decreases venous return to the heart
• Decreases cardiac output

Question 14

What is the tidal volume you give for a patient not breathing?

Answer 14

6-7 ml/kg

Question 15

What is a common airway obstruction?

Answer 15

tongue

Question 16

Treatment:

Unresponsive airway obstruction

Answer 16

• Begin CPR immediately.
• Every two minutes, check the mouth before giving ventilations.
• Remove visible obstructions with fingers.
• Use direct laryngoscopy with Magill forceps if trained.

Question 17

How much pressure should be applied when squeezing a BVM during ventilations?

Answer 17

Until you see the chest rise.

Question 18

What suctioning pressure (mmHg) should be used?

Answer 18

80-120 mmHg

Question 19

What are the reperfusion goals?

Hint: duration in minutes

Answer 19

• Door to balloon: 90 minutes
• Door to needle: 30 minutes

Question 20

Fill in the blanks:

1. A rigid suction should be measured the same as an ____.
2. Suctioning should not exceed ____ seconds.

Answer 20

1. OPA
2. 15

Question 21

List the ACS algorithm.

Answer 21

• Assess ABCs and obtain a 12-lead ECG.
• Administer O₂ if saturation is below 90% and give aspirin.
• Provide nitroglycerin.
• Administer morphine if pain persists despite nitroglycerin.

Question 22

What is the dosage for aspirin?

Acute myocardial infarction

Answer 22

160-325 mg

Chewable, non-enteric coated preferred.

Question 23

What is the dosage for Nitroglycerine?

Answer 23

400 mcg Q 3-5 minutes MAX 3 doses

Question 24

What medication should be avoided in patients who have recently used Phosphodiesterase Inhibitors?

Answer 24

nitroglycerine

Question 25

Why is **morphine** given for chest discomfort?

Answer 25

It decreases pain which also **decreases myocardial oxygen demand**.

Question 26

What is an **NSTEMI**?

Answer 26

ST depression or T wave inversion indicating ischemia, not injury.

Question 27

Why is **heparin** given?

Answer 27

It is given as an adjunct to PCI therapy.

Question 28

What type of medication is **streptokinase**?

Answer 28

fibrinolytic

Question 29

# Fill in the blank: **Fibrinolytic therapy** should be initiated within ____ minutes of hospital arrival time.

Answer 29

30 - 60

Question 30

List the types of strokes.

Answer 30

* **Ischemic** ~87% * **Hemorrhagic** ~13%

Question 31

What are the **signs/symptoms** of **stroke**?

Answer 31

* confusion * trouble speaking * sudden weakness * dizziness * trouble walking * severe headache

Question 32

What are the **three** components of the **Cincinnati Stroke Scale?**

Answer 32

* facial droop * arm drift * abnormal speech ## Footnote If one of these signs is identified, there is a 72% chance the patient is having a stroke.

Question 33

When should you provide oxygen to a **stroke** patient?

Answer 33

< 94% SPO₂

Question 34

What type of medication is **rTPA**? | recombinant tissue plasminogen activator

Answer 34

alteplase ## Footnote A clot buster used for stroke patients.

Question 35

What is the **defibrillation shock dosage**?

Answer 35

200 J, 300 J, 360 J.

Question 36

What is the **rate of decline** in survival chances for patients without CPR?

Answer 36

For every minute without CPR, survival chances **decrease by 7-10%**.

Question 37

# Mechanism of action. Amiodarone

Answer 37

It blocks **sodium** and **potassium** channels.

Question 38

What is the dosage for **Lidocaine**? ## Footnote Cardiac arrhythmias

Answer 38

* **1 - 1.5mg/kg** bolus * **0.5 - 0.75mg/kg**, MAX of **3 mg/kg**

Question 39

# Indication: Magnesium Sulfate

Answer 39

**Torsades** in patients with long QT interval.

Question 40

Termination of CPR

Answer 40

* If ETCO₂ \<10 mmHg after 20 minutes * No bystander during CPR * No defibrillations

Question 41

What conditions are considered indicative of **symptomatic unstable bradycardia**?

Answer 41

* hypotension * AMS * ischemic chest pain * shock

Question 42

What are the signs/symptoms of **symptomatic bradycardia**?

Answer 42

* dizziness * weakness * fatigue * light headed * syncope

Question 43

# Indication: Transcutaneous Pacing

Answer 43

* hypotension * AMS * shock * ischemic chest discomfort

Question 44

What **rhythms** are commonly treated with **cardioversion**?

Answer 44

* Atrial fibrillation/flutter with RVR * V-tachycardia * SVT

Question 45

# Treatment: Symptomatic/Stable **SVT**

Answer 45

* Vagal maneuvers * Adenosine * Amiodarone ## Footnote Ensure it is a pathological rhythm.

Question 46

At what point does the monitor **synchronize a rhythm**?

Answer 46

Highest point of the **R wave**.

Question 47

# Treatment: symptomatic but stable **A-fib with RVR**

Answer 47

* **Vagal** maneuvers * **Diltiazem** (Cardiazem): Initial dose: **0.25 mg/kg** If needed, a subsequent dose: **0.35 mg/kg** * Maintenance infusion: **5-15 mg/hr**

Question 48

List some key components of **post-cardiac arrest care**.

Answer 48

* Avoid excessive ventilation: **10 breaths/min, maintain PaCO₂ at 35-40 mmHg**. * Keep oxygen saturation **>94%**. * Consider advanced airway and capnography. * Treat hypotension **(SBP < 90 mmHg)**: IV/IO fluid bolus (1-2 liters). Vasopressor infusion. * Address reversible causes. * Perform a **12-lead ECG**. * Implement temperature management **(32-36°C)**.

Question 49

What is the dosage for **post-arrest vasopressor infusion**?

Answer 49

* Epinephrine: **0.1-0.5 mcg/kg/min** * Dopamine: **5-10 mcg/kg/min**

Question 50

What is the dosage for **epinephrine** infusion in **unstable bradycardia**?

Answer 50

2-10 mcg/min

Question 51

What is the dosage for **epinephrine** infusion in **persistent hypotension**?

Answer 51

0.1 - 0.5 mcg/kg/min

Question 52

What are the **T's** of **reversible causes for cardiac arrest**?

Answer 52

* Tension pneumothorax * Cardiac tamponade * Toxins * Thrombosis (coronary and pulmonary embolism)