ACLS FINAL EXAM WITH ALL CORRECT &
VERIFIED ANSWERS (UPDATED TO PASS)
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 magnesium sulfate in the setting of cardiac arrest? Correct answer-1-2g IV/IO bolus
diluted in 10mL D5W administered via slow IV push
Should magnesium sulfate be administered in a shared line? Correct answer-no
2015 AHA recommendation for in-hospital cardiac arrest patients regarding steroids Correct
answer-AHA does not recommend for or against routine steroid administration for patients; further
studies needed
2015 AHA recommendation for out of hospital cardiac arrest patients regarding steroids Correct
answer-uncertain benefit; no recommendation
Dosing of adenosine in the adult tachycardia algorithm Correct answer-first dose: 6mg
second dose in 1-2 minutes if needed: 12 mg
When would the initial dose of adenosine be reduced to 3 mg instead of 6mg? Correct answer-1.
patients receiving dipyridamole or cabamazepine
2. heart transplant patients
3. if given via central venous access
Contraindications to adenosine Correct answer-second or third degree heart block, sick-sinus
syndrome, known hypersensitivity to the drug
(use caution in patients with asthma)
Side effects of adenosine Correct answer-facial flushing, headache, SOB, dizziness, and nausea
half-life of adenosine Correct answer-<10 seconds
When is adenosine used? Correct answer--stable narrow-complex SVT (terminates reentrant
rhythms in SA or AV node)
-does NOT convert afib/flutter or VT but may be used as a diagnostic aid (slow rate down enough to
diagnose)
Describe how to administer adenosine Correct answer--connect drug and flush syringe(s) to
patient
-give medication as rapid IV injection in the port closest to patient and hold plunger down
-immediately give 20mL NS IV flush
VERIFIED ANSWERS (UPDATED TO PASS)
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 magnesium sulfate in the setting of cardiac arrest? Correct answer-1-2g IV/IO bolus
diluted in 10mL D5W administered via slow IV push
Should magnesium sulfate be administered in a shared line? Correct answer-no
2015 AHA recommendation for in-hospital cardiac arrest patients regarding steroids Correct
answer-AHA does not recommend for or against routine steroid administration for patients; further
studies needed
2015 AHA recommendation for out of hospital cardiac arrest patients regarding steroids Correct
answer-uncertain benefit; no recommendation
Dosing of adenosine in the adult tachycardia algorithm Correct answer-first dose: 6mg
second dose in 1-2 minutes if needed: 12 mg
When would the initial dose of adenosine be reduced to 3 mg instead of 6mg? Correct answer-1.
patients receiving dipyridamole or cabamazepine
2. heart transplant patients
3. if given via central venous access
Contraindications to adenosine Correct answer-second or third degree heart block, sick-sinus
syndrome, known hypersensitivity to the drug
(use caution in patients with asthma)
Side effects of adenosine Correct answer-facial flushing, headache, SOB, dizziness, and nausea
half-life of adenosine Correct answer-<10 seconds
When is adenosine used? Correct answer--stable narrow-complex SVT (terminates reentrant
rhythms in SA or AV node)
-does NOT convert afib/flutter or VT but may be used as a diagnostic aid (slow rate down enough to
diagnose)
Describe how to administer adenosine Correct answer--connect drug and flush syringe(s) to
patient
-give medication as rapid IV injection in the port closest to patient and hold plunger down
-immediately give 20mL NS IV flush
