Post-ACLS Megacode Test 2023
SCENARIO 1: You witness a middle-aged, obese male pedestrian collapse on an
escalator in an airport. He is clutching his chest and slumps over on the person behind
him. The bystander places him on the floor at the end of the down-moving escalator
track. As a first responder certified in ACLS, which of the following is your first course of
action? - ANSWER Move the man out of the way of pedestrian traffic on the escalator
1: You have moved the man to a seating area near the bottom of the escalator. The man
is gasping for breath but does not appear to be effectively breathing. You yell at him
"Are you alright?" but he does not respond. What is your next action? - ANSWER send
someone to get AED
1: After sending for EMS and waiting for an AED to arrive, you continue to attend to the
man. The man is unresponsive and he is now only gasping. What is your next action? -
ANSWER check for a pulse
The rescuer must determine if this is respiratory failure alone or cardiac arrest. Checking
for a pulse follows sending people for help.
1: You find a definite pulse on his carotid artery. It is fast, but clearly present. What is
your next action? - ANSWER Give one breath every 5-6 s
The man has a pulse, so he needs rescue breathing, not chest compressions. One
ventilation every 5-6 seconds is appropriate in an adult without an advanced airway in
place.
1: The AED device has not yet arrived. You have been delivering breaths for two
minutes, spaced 5-6 seconds apart. He is not breathing spontaneously. What is your
next action? - ANSWER check for a pulse
you must determine if the victim's situation has deteriorated. Respiratory arrest may lead
to cardiac arrest. Pulse checks should be done every two minutes in respiratory arrest.
1: You pause rescue breathing to check for a pulse. You cannot feel a definite pulse
after 10 seconds of trying. What is your next action? - ANSWER begin CPR
Since there is no pulse, the man is now in cardiac arrest. He needs CPR, including chest
compressions.
1: You start high-quality CPR at a rate of 100-120 compressions per minute. The AED
arrives moments later. You open the man's shirt to find a copious amount of thick hair
covering his chest and he is damp with sweat. The AED cannot get a good signal
, through the pads because of the hair, even though you have pressed them down very
hard. What is your next action? - ANSWER Rip the pads off the man's chest and apply
new pads in the same locations
Chest hair can interfere with electrical contact through the AED pads. The adhesive on
the pads can act as a rapid depilatory (i.e. it rips the chest hair out). New pads can then
be used on the bare skin.
1: With hair removed and new pads placed, the AED gets a good signal from the patient.
It reports that there is a shockable rhythm. You clear everyone from the patient,
announce the shock, and then deliver one shock. What is your next action? - ANSWER
resume CPR ASAP
Regardless of patient response, resume high-quality CPR immediately and continue for
two minutes. Even if a pulse returns, it may not be adequate to pump blood for a few
minutes. A pulse check at this point is irrelevant. An AED automatically controls the level
of energy delivered.
1: After two minutes of CPR, what is your next action? - ANSWER check for a pulse
It is important to determine if the man has regained spontaneous circulation. This can be
done with a pulse check.
1: The man has a strong, regular pulse. He is not responsive, but appears to be
breathing. You feel air movement through his mouth. What is your next action? -
ANSWER Continue to monitor pulse, breathing, and rhythm until EMS arrives
CPR can stop at this point, as the man has had a return of spontaneous circulation
(ROSC). He should be monitored very closely until EMS arrives. It is unwise to remove
the AED pads in case his condition deteriorates.
SCENARIO 2: You are called to a patient's hospital room by family members. According
to the family, the 63-year-old patient was awaiting discharge for a diabetes
mellitus-related complication when she suddenly started to slur her speech. This started
about 10 minutes ago. You examine the woman and ask her to smile. One side of her
face does not lift symmetrically with the other. You then ask her to close her eyes and
hold both arms in front of her, palms up. She cannot lift one arm. She is in no acute pain.
What is most likely occurring in this patient? - ANSWER *acute ischemic stroke*
Facial droop, pronator arm drift, and slurred speech are strong indicators of acute
stroke. You cannot know for sure at this point if the stroke is ischemic or hemorrhagic,
but ischemic strokes are more than 4 times more common than hemorrhagic strokes
are.
2: You believe the woman is having an acute stroke and it is likely ischemic. You assess
SCENARIO 1: You witness a middle-aged, obese male pedestrian collapse on an
escalator in an airport. He is clutching his chest and slumps over on the person behind
him. The bystander places him on the floor at the end of the down-moving escalator
track. As a first responder certified in ACLS, which of the following is your first course of
action? - ANSWER Move the man out of the way of pedestrian traffic on the escalator
1: You have moved the man to a seating area near the bottom of the escalator. The man
is gasping for breath but does not appear to be effectively breathing. You yell at him
"Are you alright?" but he does not respond. What is your next action? - ANSWER send
someone to get AED
1: After sending for EMS and waiting for an AED to arrive, you continue to attend to the
man. The man is unresponsive and he is now only gasping. What is your next action? -
ANSWER check for a pulse
The rescuer must determine if this is respiratory failure alone or cardiac arrest. Checking
for a pulse follows sending people for help.
1: You find a definite pulse on his carotid artery. It is fast, but clearly present. What is
your next action? - ANSWER Give one breath every 5-6 s
The man has a pulse, so he needs rescue breathing, not chest compressions. One
ventilation every 5-6 seconds is appropriate in an adult without an advanced airway in
place.
1: The AED device has not yet arrived. You have been delivering breaths for two
minutes, spaced 5-6 seconds apart. He is not breathing spontaneously. What is your
next action? - ANSWER check for a pulse
you must determine if the victim's situation has deteriorated. Respiratory arrest may lead
to cardiac arrest. Pulse checks should be done every two minutes in respiratory arrest.
1: You pause rescue breathing to check for a pulse. You cannot feel a definite pulse
after 10 seconds of trying. What is your next action? - ANSWER begin CPR
Since there is no pulse, the man is now in cardiac arrest. He needs CPR, including chest
compressions.
1: You start high-quality CPR at a rate of 100-120 compressions per minute. The AED
arrives moments later. You open the man's shirt to find a copious amount of thick hair
covering his chest and he is damp with sweat. The AED cannot get a good signal
, through the pads because of the hair, even though you have pressed them down very
hard. What is your next action? - ANSWER Rip the pads off the man's chest and apply
new pads in the same locations
Chest hair can interfere with electrical contact through the AED pads. The adhesive on
the pads can act as a rapid depilatory (i.e. it rips the chest hair out). New pads can then
be used on the bare skin.
1: With hair removed and new pads placed, the AED gets a good signal from the patient.
It reports that there is a shockable rhythm. You clear everyone from the patient,
announce the shock, and then deliver one shock. What is your next action? - ANSWER
resume CPR ASAP
Regardless of patient response, resume high-quality CPR immediately and continue for
two minutes. Even if a pulse returns, it may not be adequate to pump blood for a few
minutes. A pulse check at this point is irrelevant. An AED automatically controls the level
of energy delivered.
1: After two minutes of CPR, what is your next action? - ANSWER check for a pulse
It is important to determine if the man has regained spontaneous circulation. This can be
done with a pulse check.
1: The man has a strong, regular pulse. He is not responsive, but appears to be
breathing. You feel air movement through his mouth. What is your next action? -
ANSWER Continue to monitor pulse, breathing, and rhythm until EMS arrives
CPR can stop at this point, as the man has had a return of spontaneous circulation
(ROSC). He should be monitored very closely until EMS arrives. It is unwise to remove
the AED pads in case his condition deteriorates.
SCENARIO 2: You are called to a patient's hospital room by family members. According
to the family, the 63-year-old patient was awaiting discharge for a diabetes
mellitus-related complication when she suddenly started to slur her speech. This started
about 10 minutes ago. You examine the woman and ask her to smile. One side of her
face does not lift symmetrically with the other. You then ask her to close her eyes and
hold both arms in front of her, palms up. She cannot lift one arm. She is in no acute pain.
What is most likely occurring in this patient? - ANSWER *acute ischemic stroke*
Facial droop, pronator arm drift, and slurred speech are strong indicators of acute
stroke. You cannot know for sure at this point if the stroke is ischemic or hemorrhagic,
but ischemic strokes are more than 4 times more common than hemorrhagic strokes
are.
2: You believe the woman is having an acute stroke and it is likely ischemic. You assess
