ACLS Exam Questions & Answer Latest Updated

Targeted temperature management - adults. - ANSWER32 - 36 C (89.6 - 95.2F). Titrate inspired O2 to... - ANSWERthe lowest level required to achieve arterial O2 sat 94% + to avoid complications associated with O2 toxicity. Mean arterial pressure goal - ANSWER65 mm Hg or greater A team leader should be able to explain why it is essential to... - ANSWERpush hard and fast in center of chest. ensure complete chest recoil. minimize interruptions in compressions. avoid excessive ventilation. A team member should be... - ANSWERclear about role assignments. prepared to fill their responsibilities. well practiced in resuscitation. knowledgeable about algorithms. committed to success. Resuscitation triangle (3) - ANSWERCompressor: assessed pt, 5 cycles chest compressions, alternates with AED person every 5 cycles or 2 min. AED/Defibrillator Monitor: brings and operates AED, places monitor where it can be seen by team leader, alternates with compressor every 5 cycles or 2 min. Airway: Opens airway, provides bag-mask ventilation, inserts airway adjuncts as appropriate. Leadership roles (3) - ANSWERTeam leader: every team needs one. assigns roles to team members, makes treatment decisions, provides feedback, assumes responsibility for roles not assigned. Meds: Initiates IV/IO access, administers meds. Time recorder: records time of interventions & medications and announces when next are due, records frequency and duration of interruptions in compressions, communicates to the team leader. Should you start CPR when you are unsure about a pulse? - ANSWERYes, unnecessary compressions are less harmful than failing to provide compressions when needed. Agonal gasps - ANSWERA sign of cardiac arrest! May be present in first minutes. Looks like pt is drawing in air quickly. Occur at a slow rate. May be forceful or weak. Time passes between gasps. Snort, snore, groan. BLS assessment - ANSWERCheck responsiveness. Shout for help. Get AED/send someone. Look for breathing - chest 5-10 sec. Check pulse at same time. 5-10 sec. No pulse in 10 sec, start chest compressions. If pulse, rescue breathing 1 breath q 5-6 sec. Check pulse q 2 minutes. Defibrillation: check for shockable rhythm, shock, follow with compressions. Minimize interruptions - ANSWERNo longer than 10 sec! Avoid... prolonged rhythm analysis. frequent/inappropriate pulse checks. taking too long to give breaths. unnecessary moving the pt. Coronary Perfusion Pressure (CPP) - ANSWERAortic relaxation (diastolic) - right atrial relaxation (diastolic) pressure. Correlates with both myocardial blood flow and return of spontaneous circulation. ROSC does not occur unless it is 15 mm Hg or + If < 20 improve chest compressions and vasopressor therapy. Quality compressions - ANSWERcompress 2 in (5 cm). Rate 100-120 BPM. Allow complete recoil. single rescuer CPR - ANSWERCardiac arrest: Call for help, get AED, return to pt, start CPR. Hypoxia (drowning): give 2 mins CPR before activating emergency response system. Primary Assessment - ANSWERAssess before action!!! Airway, Breathing, Circulation, Disability (Alert, Voice, Painful, Unresponsive), Exposure (remove clothing to examine). Secondary Assessment - ANSWERFocused medical history and physical exam. SAMPLE Signs and sx. Allergies. Medications (including last dose taken). Past medical hx. Last meal consumed. Events. H&Ts - ANSWERCommon reversible causes of cardiac arrest. Hypovolemia, hypoxia, hydrogen ion (acidosis), Hypo/hyperkalemia, hypothermia. Tension pneumo, tamponade (cardiac), toxins, thrombosis (coronary or pulmonary). 2 most common causes of PEA - ANSWERHypoxia and hypovolemia. PEA hypovolemia - ANSWERrapid, narrow-complex tachycardia (sinus tachy). Increased diastolic, decreased systolic pressure. BP drops. Narrow QRS. Common causes: occult internal hemorrhage, severe dehydration. Consider volume infusion. acute coronary syndrome - ANSWERsudden symptoms of insufficient blood supply to the heart indicating unstable angina or acute myocardial infarction Tx for PE - ANSWERFibrinolytics. Tx for cardiac tamponade - ANSWERpericardiocentesis. tx for Tension pneumo - ANSWERneedle aspiration and chest tube placement. Drug overdose/toxic exposure - ANSWERmay lead to peripheral vascular dilation and/or myocardial dysfunction with hypotension. Tx: prolonged basic CPR, etracorporeal CPR, intra-aortic balloon pumping, renal dialysis, IV lipid emulsion, digoxin, glucagon, bicarbonate, transcutaneous pacing, correction of electrolyte imbalances. Normal respiratory rate. Normal tidal volume. - ANSWER12-16/min. 8-10 ml/kg. ***<6 = assisted ventilation with BVM or advanced airway with 100% O2. Respiratory Distress - ANSWERabnormal respiratory rate or effort. Sx: nasal flaring, retractions, use of accessory muscles, hypoventilation, bradypnea, stridor, wheezing, grunting, tachycardia, cyanosis, changes in LOC, agitation, use of abdominal muscles. Mild respiratory distress sx - ANSWERmild tachypnea and mild increase in respiratory effort with changes in airway sounds. Severe respiratory distress sx - ANSWERtachypnea, increased respiratory effort, deterioration in skin color, changes in mental status. Can be indicitive of respiratory failure. Respiratory Failure - ANSWERinadequate oxygenation, ventilation or both. Often the end stage of respiratory distress. Confirm dx with objective measures (pulseOx, ABGs). Sx of respiratory failure - ANSWERmarked tachypnea, bradypnea, apnea (late), increased/decreased/no effort, poor/absent distal air movement, tachycardia (early), bradycardia (late), cyanosis, stupor, coma (late). Causes of respiratory failure - ANSWERupper or lower airway obstruction. Lung tissue disease. Disordered control of breathing. Rise in arterial CO2 (hypercapnia). Drop in blood O2. Respiratory arrest - ANSWERthe cessation of breathing. Caused by drowning or head injury. Tx: tidal volume 500-600ml (visable chest rise). ***Pts with airway obstruction or poor lung compliance may require higher pressures. Complications of excessive ventilation - ANSWERgastric inflation. regurgitation. aspiration. Intrathoracic pressure increase --> decreased venous return to heart --> low cardiac output. cerebral vasoconstriction --> decreased blood to brain. The most common cause of upper airway obstruction in an unconscious pt - ANSWERloss of tone in the throat muscles --> tongue occluding airway. Basic airway opening - ANSWERhead tilt-chin lift. neck injury: jaw thrust maneuver. (may do HTCL if this is not effective). Oropharyngeal airway (OPA) - ANSWERused in unconscious patients who have obstruction risk from tongue. ***check for gag/cough reflex*** J shaped device. Holds tongue away from the posterior wall of pharynx. also used when suctioning intubated pts to prevent them from biting and occluding the ET tube. Too large or too small causes airway obstruction. OPA insertion - ANSWERclear mouth/pharynx with suctioning. select proper size: flange is at corner of mouth, tip at mandible. Insert so it curves upward toward the hard palate. Insert at 90 or 180 degrees and turn. Nasopharyngeal Airway (NPA) - ANSWERUsed in pts who need a basic airway management adjunct. Soft rubber/plastic uncuffed tube that allows airflow between nares and pharynx. May be used in conscious, semi-conscious or unconscious pts. Indicated when OPA is technically difficult or dangerous (gag reflex, trismus, massive mouth trauma, wired jaws), neurologically impaired pts with poor pharyngeal tone/coordination. NPA Insertion - ANSWERSelect proper size: tip of nose to earlobe. (some providers use diameter of pt's smallest finger as a guide). Lubricate airway. Insert. If resistance: slightly rotate or attempt placement in other nares. ***Caution with facial trauma: risk of misplacement into the cranial cavity through a fractured cribriform plate. OPA and NPA precautions - ANSWERAlways check for spontaneous respirations immediately after insertion. Absent respirations: PPV. if no adjuncts available start mouth-to-mask barrier ventilation.