ACLS quiz 2023 questions and answers

ACLS quiz 2023 questions and answers Which are the elements of a system of care? Structure, processes, system, patient outcome What element of a system of care is represented by properly functioning resuscitation equipment? Structure Among others, which factor has been associated with improved survival in patients with cardiac arrest? Immediate high- quality CPR What is the first link in the out-of-hospital cardiac arrest (OHCA) chain of survival? Activation of emergency response What are signs of clinical deterioration that would prompt the activation of a rapid response system? Systemic hypertension, unexplained agitation, seizure What is the primary purpose of a rapid response team (RRT) or medical emergency team (MET)? To improve patient outcomes by identifying and treating early clinical deterioration What happens when teams rapidly assess and intervene when patients have abnormal vital signs? The number of in-hospital cardiac- arrest decreases In addition to decreased IHCA, what are some other benefits of implementing a rapid response system? Decrease ICU length of stay, decreased in total hospital length of stay Which component of effective high-performance teams is represented by the use of real-time feedback devices? Quality What is the main advantage of effective teamwork? Division of tasks Which is the best example of a role of the team leader? Models excellent team behavior Which is the best example of a role of a team member? Prepared to fulfill their role responsibilities What is primary purpose of the CPR coach on a resuscitation team? Increasing CPR quality Which member of the high-performance team has the responsibility for assigning roles (positions)? Team leader Which high-performance team member is part of the resuscitation triangle? Monitor/ defibrillator/ CPR coach Which is an example of knowledge sharing by a team leader? Asking for suggestions about interventions Which is an example of summarizing and reevaluating? Increasing monitoring of the patient's condition deteriorates Which is a step of closed-loop communication? Confirming task completion before assigning another task Which are examples of mutual respect? · Acknowledging correctly completed tasks in a positive way · Ensuring that only 1 person talks at a time What are the components of high-quality CPR? · Compression depth of at least 2 inches (5cm) · Complete chest recoil after each compression · Interruptions limited £ 10 seconds · Switching compressions every 2 minutes · Avoiding excessive ventilation Which of the following defines chest compression fraction (CCF)? CCF= actual chest compression time/ Total code time During CPR, chest compression fraction (CCF) should be at least --- and ideally greater than 80%. 60% How do interruptions in chest compressions negatively impact survival after cardiac arrest? Decrease coronary perfusion pressure Coronary perfusion pressure (CPP) equals aortic ---- pressure minus right atrial diastolic pressure. diastolic What is the only intervention that can restore on organize rhythm in patients with ventricular fibrillation (VF)? Early and effective defibrillation How quickly does the chance of survival describe for every minute of defibrillation delay in patients with ventricular fibrillation (VF) who do not receive bystander CPR? 7-10% What is the advantage of a systematic approach to patient assessment? Reduces the chances of missing important signs and symptoms What is the first step in the systematic approach to patient assessment? Initial impression What is the maximum amount of time you should simultaneously perform the pulse and breathing checks? 10 seconds The BLS Assessment is a systematic approach to BLS for trained healthcare providers. This approach stresses: Early CPR and defibrillation While you performing the BLS Assessment, you initiate high-quality CPR and assist ventilation with a bag-mask device. The AED does not recommend a shock. Which action in the Primary Assessment should you perform first? Determine if the patient's airway is patent The initial assessment reveals a conscious patent. The patient's airway is patent, and an advanced airway is not indicated. Which action is the Primary Assessment should perform next? Administer oxygen as needed Which action is part of the Secondary Assessment of conscious patient? Formulate a differential diagnosis Which of the following are the "H" causes of reversible cardiac arrest? Hypovolemia, hypoxia, acidosis, hyperkalemia/ hypokalemia, hypothermia Which of the following are the "T" causes of reversible cardiac arrest? Tension pneumothorax, cardiac tamponade, toxins, pulmonary thrombosis, coronary thrombosis What is the most common symptom of myocardial ischemia and infraction? Retrosternal chest pain Which demographic group experiencing acute coronary syndrome in more likely to present without chest pain? females Oxygen should be delivered to a patient who has obvious signs of heart failure if the oxygen saturation is less than --- or unknown 90% Obtaining a --- is the most important assessment tool for a patient displaying signs and symptoms of acute coronary syndromes. 12 lead EKG What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department? 10 minutes A patient without dyspnea has signs of acute coronary syndrome. There are no obvious signs of heart failure. You assess a noninvasively monitored oxyhemoglobin saturation. What is the oxygen saturation threshold below which supplemental oxygen would be required? 90% What are signs of clinical deterioration that would prompt the activation of a rapid system? Unexplained agitation, symptomatic hypertension, seizure What blood component is acted upon by aspirin administration during the management of a patient with acute coronary syndromes? Platelets Which is a contraindication to the administration of aspirin for the management of a patient with a cute coronary syndrome? Recent GI bleeding What is a physiologic effect of nitroglycerin? Reduces preload Which clinical finding represents a contraindication to the administration of nitroglycerin? Confirmed right ventricular infarction Which class of medications commonly given to patients with acute coronary syndromes may be adversely affected by morphine administration? Oral antiplatelet medications What is a benefit of morphine when given for the management of acute coronary syndromes? Central nervous system analgesia You obtain a 12-lead EKG in a patient with retrosternal chest pain. Which EKG finding is suggestive of high-risk non-ST-Segment Elevation acute coronary syndromes? Dynamic T-wave inversion Upon reviewing a patient's 12-lead EKG, you note ST-Segment elevation of 2mm in leads II, III and AVF. How would you classify the EKG findings? ST-segment elevation myocardial infraction What happens when teams rapidly assess and intervene when patients have abnormal vital signs? The number of in-hospital cardiac arrests decreases In addition to decreased IHCA, what are some other benefits of implementing a rapid response system? Decreased ICU length to stay, decrease in total hospital length to stay What is the goal for first medical contact-to-balloon inflation time for a patient receiving percutaneous coronary intervention? 90 minutes What is the longest acceptable emergency department-door-to-needle time when fibrinolysis is the intended reperfusion strategy? 30 minutes Upon reviewing a patient's 12-lead EKG, you note ST-segment elevation of 2mm in leads II, III, and AVF. How would you classify the EKG findings? ST segment elevation myocardial infraction What is recommended time window after symptom onset for early fibrinolytic therapy or direct catheter- based reperfusion for patients with St-segment elevation myocardial infraction and no contraindications? Within 12 hours What is the benefit of morphine when given for the management of ACS? Central nervous system analgesia What is the most common type of stroke? Ischemic stroke What type of stroke occurs when a blood vessel is the brain suddenly ruptures into the surrounding tissue? Hemorrhagic stroke What is the benefit of morphine when given for the management of ACS? Central nervous system analgesia Which is a sign of stroke? Trouble speaking Which is a symptom of stroke? Sudden trouble seeing What validated abbreviated out-of-hospital neurologic evaluation tool contains 3 components: the facial droop, arm drift, and abnormal speech tests? (CPSS) Cincinnati Prehospital Stroke Scale What is the estimated probability of the Cincinnati Prehospital Stroke Scale with 1 abnormal finding when scored by prehospital provides? 72% Which is a stroke severity tool that helps EMS differentiate occlusion from non-large-vessel occlusion stroke? Los Angeles Motor Scale What is the primary advantage of using a stroke severity tool? It helps identify large-vessel occlusion stroke What is the most appropriate destination for patients with suspected acute ischemic stroke? Certified stroke center What is the highest level of stroke center certification? Comprehensive stroke center which is an advantage of EMS transport to a stroke hospital for a patient with suspected acute ischemic stroke? Responding providers can stabilize critical issues What is the longest acceptable emergency department door-to-needle time when fibrinolysis is the intended reperfusion strategy? 30 minutes What is the advantage of EMS alerting the receiving facility of the impending arrival of a patient with suspected acute ischemic stroke? The hospital can perform more efficient evaluation and management What is the goal for neurologic assessment by the stroke team or design and noncontrast computed tomography or magnetic resonance imaging performed after hospital arrival? 20 minutes What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindications after hospital arrival? 45 minutes What is the door-to-needle time goal for 85% or more of acute ischemic stroke patients treated with IV thrombolytics? 60 minutes What is the door-to-device time goal for direct-arriving patients with acute ischemic stroke treated with endovascular therapy? 90 minutes Evidence suggests that there is a higher likelihood of good to excellent functional outcome when alteplase is given to adults with an acute ischemic stroke within what time frame? 3 hours What is the maximum time from last known normal when endovascular therapy can be performed? 24 hours What is the maximum time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment? 6 hours Identify the systolic BP threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke. 185mmHg What is the diastolic blood pressure times hold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke? 110mmHg Which action is NOT part of the acute stroke pathway? Seizure prophylaxis What blood glucose level should trigger the administration of IV or subcutaneous insulin for a patient with acute ischemic stroke? 180mg/dl What is the average RR for an adult at rest? 12 to 20/min What is tidal volume typically maintaining normal oxygenation and elimination of carbon dioxide? 6 to 8 mL/kg An 18 yo patient is reporting difficulty breathing and is displaying increased respiratory effort. Auscultation reveals bilateral wheezing; the respiratory rate is 28 breaths per minute. Oxygen saturations is 91%. PETCO2 is 44 mmHg. How would you categorize this patient's condition? Respiratory distress A 59 yo patient is reporting difficulty breathing. Physical exam reveals nasal flaring, intercostal interaction and use of accessory muscles. RR is 28 breaths per minute. O2 sat is 92% PTCO2 is 36 mmHg. How would you categorize this patent's condition? Respiratory distress A 75 yo patient is having difficulty breathing, with increased respiratory effort. The patient has history of emphysema. The patient is drowsy, auscultation reveals bilateral wheezing, although the lung sounds are difficult to appreciate. RR is 38/min. O2 sat = 85%, PETCO2= 49mmHg. How would you categorize this patient's condition? Respiratory failure What is the term of the rise in arterial CO2 levels typically associated with respiratory failure? Hypercapnia How much tidal volume must provide with a bag-mask device to produce visible chest rise for an adult patient in respiratory arrest? 6 to 7 mL/kg What device on a resuscitation bag-mask device may prevent sufficient tidal volume in patients with poor lung compliance? Pressure-relief value Patients with perfusing rhythms should receive ventilations once every 6 seconds What is the most effective way to deliver bag-mask ventilation? Using a 2 person technique How long should the second rescuer squeeze the bag mask device when providing 2-rescuer ventilation? 1 second When performing the jaw-thrust maneuver on patients with suspected cervical spine injury, where should you place your fingers? Just under the angel of the lower jaw When you use a bag-mask device, you should deliver approximately ---tidal volume. 500 to 600 mL What is a contraindication to the use of an oropharyngeal airway? Conscious patient In which of the following patients can nasopharyngeal airways be used? Unconscious, semiconscious, conscious Select the first step in the use of an oropharyngeal airway Clear the mouth and pharynx What is a potential complication of inserting an oropharyngeal airway that is too small? Pushing the base of the tongue back The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patient's nose to the earlobe What is the potential complication of using a nasopharyngeal airway that is too long? Entering the esophagus What is the most serious potential complication of nasopharyngeal airway insertion into a patient with facial trauma? Misplacement into the cranial cavity What is the maximum length of suction catheter that should be inverted into the patient's oropharynx beyond the tongue? The tip of the nose to the earlobe When should you include the side opening of a suction catheter when performing oropharyngeal suctioning? While withdrawing the catheter What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube? Quantitative waveform capnography What is the recommended ventilation for an adult in cardiac arrest with an advanced airway device in place? Once every 6 seconds Which signs and symptoms indicate a symptomatic bradycardia? SOB, chest pain, pulmonary edema EKG: during the EKG you note the presence of more P waves than QRS complexes. You also note all PR intervals have a uniform length but random QRS complexes are dropped. What type of atrioventricular block is most likely present? 2nd degree AV block- Type II EKG: you note presence of more P waves than QRS complexes. You also note the absence of a relationship between P waves and QRS complexes. What type of atrioventricular block is most likely present? 3rd degree Av block Symptomatic bradycardia is defined by a heart rate less than 50/min Which is indicate a symptomatic bradycardia? Altered mental status, chest pain What is the first-line treatment for unstable bradycardia? Atropine What is the recommended first dose of IV atropine for the management of bradycardia? 1mg IV What is a complication of IV atropine when administered in doses of less than 0.5mg? Further showing of heart rate Which sxs indicate a symptomatic bradycardia? Altered mental status, SOB, pulmonary edema Which sxs indicate a symptomatic bradycardia? SOB, hypotension What is the recommended infusion rate for epinephrine in the management of symptomatic bradycardia unresponsive to atropine? 2 to 10 mg per minute What is the recommended infusion rate for dopamine in the management of symptomatic bradycardia unresponsive to atropine? 5 to 20mcg/kg per minute Which sxs indicate a symptomatic bradycardia? Hypotension, SOB, altered mental status What therapy is a recommended alternative to vasopressor infusion in the management of unstable bradycardia unresponsive to atropine? Transcutaneous pacing What is the initial impulse setting for transcutaneous pacemaker use in the management of unstable bradycardia? 60 to 80 /min How much of a safety margin (energy above the dose at which consistent capture is observed) should you allow when the transcutaneous pacemaker? 2mA You are treating a patient with a heart rate of 186/min. which symptom (if present) suggests an unstable tachycardia? Hypotension Symptoms of instability are not usually caused by heart rates less than --- unless ventricular function is impaired. 150/min What is the symptom of unstable tachycardia? Hypotension What is the first line treatment of unstable tachycardia? Cardioversion The width of the QRS in a patient presenting with tachycardia is 0.16 seconds. Each QRS complex has a visible P wave. How would you classify this tachycardia? Wide QRS complex tachycardia The width of the QRS in a patient presenting with tachycardia is 0.10 seconds. There are no clearly discernable P waves. How would you classify this tachycardia? Narrow-complex tachycardia What is the upper heart rate limit for a patient with sinus tachycardia? 130/min What is the lower heart rate limit for a patient with sinus tachycardia? 100/min What is the recommended initial therapy for a patient with stable narrow-complex tachycardia, after establishing an IV and acquiring a 12-lead EKG? Vagal maneuvers What procedure used in the management of stable narrow-complex tachycardia forces a patient to strain a closed glottis? Valsalva maneuver What is the recommended initial dose of adenosine for the management of supraventricular tachycardia unresponsive to vagal maneuvers? 6mg IV What is the follow up dose of adenosine for the management of supraventricular tachycardia unresponsive to the first adenosine dose? 12mg IV If the patient is conscious, establish IV access prior to synchronized cardioversion and administer sedation Generally speaking, electrical cardioversion is not recommended as the initial therapy for patients unless the heart rate is above 150/min You are preparing to provide electrical cardioversion. You are monitoring the patient's EKG and have applied the defibrillation pads to the patient's bare chest. You have delivered sufficient sedation and have turned the defibrillator on. What is the next step you should perform? Activate the sync control button Which is contraindicated to the use of procainamide infusion in the management of stable wide-complex tachycardia? Prolonged QT interval What is the recommended first dose of amiodarone for the management of stable wide-complex tachycardia? 150mg IV In addition to CPR with minimal interruptions in chest compressions what is the most critical intervention during the first minutes of arrest for a patient in ventricular fibrillation? Defibrillation During the management of a patient in cardiac arrest, you have initiated CPR, attached the manual defibrillator, delivered the first shock, and immediately resumed high quality CPR, beginning with chest compressions. What is your next intervention? Establish IV or IO access What is the recommended first dose of amiodarone for the management of stable wide-complex tachycardia? 150 mg IV When is the recommended point to administer the first dose of epinephrine for a patient in a shockable rhythm? Between the second and third shocks What is the recommended dose for epinephrine during a resuscitation effort? 1mg IV every 3 to 5 minutes What is the recommended first IV/ IO dose of amiodarone for patients in cardiac arrest with VF/PVT that is unresponsive to defibrillation? 300mg What is the recommended first IV/IO dose of lidocaine for patients in cardiac arrest with VF/PVT that is unresponsive to defibrillation? 1 to 1.5mg/kg What term best describes an organized rhythm without a pulse? PEA PEA can present as which of the following organized rhythms? Bundle brunch blocks, Atrial fibrillation or flutter, Sinus rhythm When is the recommended point to administer epinephrine to a patient with a systole? As soon as IV/IO access is available In addition to hypoxia, what is the most common underlying, potentially reversible cause of pulseless electrical activity? Hypovolemia