ACLS FINAL EXAM (QUESTIONS & ANSWERS)
Dosing of epinephrine in the setting of VF/pVT and asystole/PEA
CORRECT ANSWER 1 mg every 3-5 minutes
Dosing of amiodarone (first and second dose) in the setting of cardiac arrest
CORRECT ANSWER 300mg first dose
150mg second dose after 3-5 min
Dosing of lidocaine (first and second dose) in the setting of cardiac arrest
CORRECT ANSWER 1-1.5mg/kg first dose
0.5-0.75 mg/kg second dose, repeat in 5-10 min
What is the maximum dose of lidocaine?
CORRECT ANSWER 3 doses or 3mg/kg
ROSC is typically signified by a PETCO2 of what?
CORRECT ANSWER 40 mm Hg or more
The "Hs" of reversible causes of cardiac arrest
CORRECT ANSWER 1. Hypovolemia
2. Hypoxia
3. Hydrogen ions (acidosis)
4. Hypo/hyperkalemia
5. Hypothermia
The "Ts" of reversible causes of cardiac arrest
CORRECT ANSWER 1. Tension pneumothorax
2. Tamponade, cardiac
3. Toxins
4. Thrombosis, pulmonary
,5. Thrombosis, coronary
In the setting of cardiac arrest, once an advanced airway is in place, 1 breath should be given
every ______ seconds. Should chest compressions be interrupted once an advanced airway is
in place?
CORRECT ANSWER 6-8 seconds (8-10 breaths/min) with continuous chest compressions
If PETCO2 falls below ______, attempts should be made to improve chest compressions
CORRECT ANSWER 10
If intra-arterial pressure monitoring is being utilized during a resuscitation attempt, if the
diastolic pressure falls below ___mm Hg, attempts should be made to improve chest
compressions
CORRECT ANSWER 20
depth of adequate chest compressions
CORRECT ANSWER 2 inches
rate of adequate chest compressions
CORRECT ANSWER 100-120/min
If no advanced airway is in place, what is the ratio of chest compressions to ventilations?
CORRECT ANSWER 30:2
Shock energy that should be used on a biphasic machine for defibrillation
CORRECT ANSWER 120-200 J, if recommended setting not known, use maximum
available
Shock energy that should be used on a monophasic machine for defibrillation
CORRECT ANSWER 360J
In the setting of cardiac arrest, when should vasopressors be administered?
CORRECT ANSWER after the patient has failed CPR and defibrillation (shock-refractory
arrhythmias)
,The only vasopressor recommended in the cardiac arrest algorithm
CORRECT ANSWER epinephrine
Why is vasopressin no longer recommended in the cardiac arrest algorithm as a vasopressor?
CORRECT ANSWER no additional benefit and may increase delays in medication
administration
Are higher doses of epinephrine recommended in certain situations of cardiac arrest? If so,
what situations are higher doses of epinephrine recommended?
CORRECT ANSWER no; no benefit to support use, possible harm
When is endotracheal medication administration recommended?
CORRECT ANSWER not recommended unless unable to give meds IV or IO
Which medications can be administered via endotracheal tube?
CORRECT ANSWER lidocaine, epinephrine, atropine, naloxone
What is different about the dosing of medications if endotracheal medication administration is
performed?
CORRECT ANSWER Typically ETT dose 2-2.5 higher than IV due to lower absorption and
dilution in 5-10mL of fluid is recommended
When can antiarrhythmics be considered in the setting of cardiac arrest?
CORRECT ANSWER use may be considered in patients with VF/VT who have failed high-
quality CPR, shocks, and vasopressors
Why must antiarrhythmics never interfere with CPR and shocks?
CORRECT ANSWER never been shown to increase survival to discharge
Antiarrhythmics that could be considered in the setting of VF/VT
CORRECT ANSWER amiodarone and lidocaine
, The traditional formulation of amiodarone contains what component that may cause
bradycardia and hypotension
CORRECT ANSWER polysorbate 80
Premixed bags of amiodarone contain what component instead of polysorbate 80?
CORRECT ANSWER captisol
Are premixed bags (360mg/200mL) of amiodarone typically found in the code cart?
CORRECT ANSWER no; used in the ICU
Sodium bicarbonate is not typically used in the setting of cardiac arrest, except under what
circumstances?
CORRECT ANSWER -known preexisting hyperkalemia
-known preexisiting bicarbonate-responsive acidosis such as DKA
-OD of TCAs, aspirin, cocaine, or diphenhydramine
-prolonged resuscitation with effective ventilation; on return of spontaneous circulation after
long arrest interval
Calcium is not typically used in the setting of cardiac arrest, except under what circumstances?
CORRECT ANSWER -beta blocker or calcium channel blocker overdose
-may be helpful in patients who have received high volume of blood products (citrate in
transfusions may bind calcium)
Is chloride salt or calcium gluconate more potent? What is the potential downside to using
formulations that contain more calcium?
CORRECT ANSWER -chloride salt is 3x more potent than gluconate
-more calcium = more vascular damage
Magnesium sulfate is not typically used in the setting of cardiac arrest, except under what
circumstances?
CORRECT ANSWER -torsades de pointes
-suspected hypomagnesemia
-life threatening ventricular arrhythmias due to digitalis toxicity
Dosing of epinephrine in the setting of VF/pVT and asystole/PEA
CORRECT ANSWER 1 mg every 3-5 minutes
Dosing of amiodarone (first and second dose) in the setting of cardiac arrest
CORRECT ANSWER 300mg first dose
150mg second dose after 3-5 min
Dosing of lidocaine (first and second dose) in the setting of cardiac arrest
CORRECT ANSWER 1-1.5mg/kg first dose
0.5-0.75 mg/kg second dose, repeat in 5-10 min
What is the maximum dose of lidocaine?
CORRECT ANSWER 3 doses or 3mg/kg
ROSC is typically signified by a PETCO2 of what?
CORRECT ANSWER 40 mm Hg or more
The "Hs" of reversible causes of cardiac arrest
CORRECT ANSWER 1. Hypovolemia
2. Hypoxia
3. Hydrogen ions (acidosis)
4. Hypo/hyperkalemia
5. Hypothermia
The "Ts" of reversible causes of cardiac arrest
CORRECT ANSWER 1. Tension pneumothorax
2. Tamponade, cardiac
3. Toxins
4. Thrombosis, pulmonary
,5. Thrombosis, coronary
In the setting of cardiac arrest, once an advanced airway is in place, 1 breath should be given
every ______ seconds. Should chest compressions be interrupted once an advanced airway is
in place?
CORRECT ANSWER 6-8 seconds (8-10 breaths/min) with continuous chest compressions
If PETCO2 falls below ______, attempts should be made to improve chest compressions
CORRECT ANSWER 10
If intra-arterial pressure monitoring is being utilized during a resuscitation attempt, if the
diastolic pressure falls below ___mm Hg, attempts should be made to improve chest
compressions
CORRECT ANSWER 20
depth of adequate chest compressions
CORRECT ANSWER 2 inches
rate of adequate chest compressions
CORRECT ANSWER 100-120/min
If no advanced airway is in place, what is the ratio of chest compressions to ventilations?
CORRECT ANSWER 30:2
Shock energy that should be used on a biphasic machine for defibrillation
CORRECT ANSWER 120-200 J, if recommended setting not known, use maximum
available
Shock energy that should be used on a monophasic machine for defibrillation
CORRECT ANSWER 360J
In the setting of cardiac arrest, when should vasopressors be administered?
CORRECT ANSWER after the patient has failed CPR and defibrillation (shock-refractory
arrhythmias)
,The only vasopressor recommended in the cardiac arrest algorithm
CORRECT ANSWER epinephrine
Why is vasopressin no longer recommended in the cardiac arrest algorithm as a vasopressor?
CORRECT ANSWER no additional benefit and may increase delays in medication
administration
Are higher doses of epinephrine recommended in certain situations of cardiac arrest? If so,
what situations are higher doses of epinephrine recommended?
CORRECT ANSWER no; no benefit to support use, possible harm
When is endotracheal medication administration recommended?
CORRECT ANSWER not recommended unless unable to give meds IV or IO
Which medications can be administered via endotracheal tube?
CORRECT ANSWER lidocaine, epinephrine, atropine, naloxone
What is different about the dosing of medications if endotracheal medication administration is
performed?
CORRECT ANSWER Typically ETT dose 2-2.5 higher than IV due to lower absorption and
dilution in 5-10mL of fluid is recommended
When can antiarrhythmics be considered in the setting of cardiac arrest?
CORRECT ANSWER use may be considered in patients with VF/VT who have failed high-
quality CPR, shocks, and vasopressors
Why must antiarrhythmics never interfere with CPR and shocks?
CORRECT ANSWER never been shown to increase survival to discharge
Antiarrhythmics that could be considered in the setting of VF/VT
CORRECT ANSWER amiodarone and lidocaine
, The traditional formulation of amiodarone contains what component that may cause
bradycardia and hypotension
CORRECT ANSWER polysorbate 80
Premixed bags of amiodarone contain what component instead of polysorbate 80?
CORRECT ANSWER captisol
Are premixed bags (360mg/200mL) of amiodarone typically found in the code cart?
CORRECT ANSWER no; used in the ICU
Sodium bicarbonate is not typically used in the setting of cardiac arrest, except under what
circumstances?
CORRECT ANSWER -known preexisting hyperkalemia
-known preexisiting bicarbonate-responsive acidosis such as DKA
-OD of TCAs, aspirin, cocaine, or diphenhydramine
-prolonged resuscitation with effective ventilation; on return of spontaneous circulation after
long arrest interval
Calcium is not typically used in the setting of cardiac arrest, except under what circumstances?
CORRECT ANSWER -beta blocker or calcium channel blocker overdose
-may be helpful in patients who have received high volume of blood products (citrate in
transfusions may bind calcium)
Is chloride salt or calcium gluconate more potent? What is the potential downside to using
formulations that contain more calcium?
CORRECT ANSWER -chloride salt is 3x more potent than gluconate
-more calcium = more vascular damage
Magnesium sulfate is not typically used in the setting of cardiac arrest, except under what
circumstances?
CORRECT ANSWER -torsades de pointes
-suspected hypomagnesemia
-life threatening ventricular arrhythmias due to digitalis toxicity
