ACLS Exam Version C
EXAM QUESTIONS WITH
SOLUTIONS
1. What should be done if a patient is in ventricular fibrillation (VF) or pulseless
ventricular tachycardia (VT)?
● Solution 1: Defibrillation
Apply a defibrillator and deliver a shock. Use 120-200 J for biphasic defibrillators or 360
J for monophasic defibrillators. This is the primary treatment to restore a normal heart
rhythm.
● Solution 2: Continue CPR
While preparing for defibrillation, continue high-quality chest compressions at a rate of
100-120 compressions per minute and a depth of 2-2.4 inches (5-6 cm). After
defibrillation, resume CPR immediately.
● Solution 3: Medication
Administer antiarrhythmic medications such as amiodarone (300 mg IV push, followed
by 150 mg if needed) or lidocaine (1-1.5 mg/kg IV push, with a repeat dose if
necessary). These medications can help stabilize the heart's rhythm after defibrillation.
2. How should you manage symptomatic bradycardia?
● Solution 1: Atropine
Administer 1 mg of atropine IV every 3-5 minutes, up to a total dose of 3 mg. Atropine
helps increase the heart rate by blocking vagal effects on the heart.
● Solution 2: Transcutaneous Pacing
If atropine is ineffective, apply transcutaneous pacing. This involves placing electrode
pads on the patient’s chest and delivering electrical impulses to stimulate heartbeats.
● Solution 3: Dopamine or Epinephrine Infusion
Start a dopamine infusion (2-20 mcg/kg/min) or an epinephrine infusion (2-10 mcg/min) if
atropine and pacing are not effective. These medications help increase heart rate and
improve cardiac output.
3. What steps should you take if a patient is in asystole or pulseless electrical activity
(PEA)?
, ● Solution 1: CPR
Immediately start high-quality chest compressions. Ensure compressions are performed
at the correct depth and rate, and allow full chest recoil between compressions.
● Solution 2: Epinephrine
Administer 1 mg of epinephrine IV every 3-5 minutes. Epinephrine helps improve blood
flow to the heart and brain during resuscitation efforts.
● Solution 3: Identify and Treat Reversible Causes
Assess and treat potential reversible causes of the cardiac arrest (the 4 Hs and 4 Ts):
hypovolemia, hypoxia, hydrogen ion (acidosis), hyperkalemia/hypokalemia; tension
pneumothorax, cardiac tamponade, toxins, and thrombosis (pulmonary or coronary).
4. What is the recommended management for a patient with symptomatic tachycardia?
● Solution 1: Vagal Maneuvers
In cases of stable narrow-complex tachycardia, encourage the patient to perform vagal
maneuvers, such as the Valsalva maneuver, which can sometimes restore a normal
heart rhythm.
● Solution 2: Medications
Administer antiarrhythmic drugs such as adenosine (6 mg IV push, followed by 12 mg if
needed) for supraventricular tachycardia (SVT). For wider complex tachycardia, consider
medications like amiodarone or procainamide based on the specific rhythm.
● Solution 3: Cardioversion
For unstable patients with tachycardia, immediate synchronized cardioversion may be
necessary. Start with a lower dose (50-100 J) and increase if needed.
5. How should you handle post-cardiac arrest care?
● Solution 1: Optimize Hemodynamics
Ensure adequate blood pressure and heart rate. Use intravenous fluids, vasopressors
(like norepinephrine), and inotropes if necessary to maintain hemodynamic stability.
● Solution 2: Temperature Management
Consider targeted temperature management (cooling the patient to 32-36°C) to improve
neurological outcomes if the patient remains comatose after return of spontaneous
circulation (ROSC).
● Solution 3: Identify and Treat Causes
Continue to investigate and treat any underlying causes or complications. This may
include performing imaging studies, addressing electrolyte imbalances, and providing
supportive care.
6. What are the immediate steps for managing a patient in cardiac arrest?
● Solution 1: Start CPR
Begin high-quality chest compressions immediately. Ensure compressions are at the
correct depth (2-2.4 inches) and rate (100-120 per minute), with minimal interruptions.
● Solution 2: Defibrillation
If the rhythm is shockable (VF or pulseless VT), apply a defibrillator and deliver a shock.
Follow up with CPR and consider drug administration.
● Solution 3: Airway Management
Secure the airway using appropriate methods (bag-mask ventilation, advanced airway)
and ensure proper ventilation if the airway is secured.
EXAM QUESTIONS WITH
SOLUTIONS
1. What should be done if a patient is in ventricular fibrillation (VF) or pulseless
ventricular tachycardia (VT)?
● Solution 1: Defibrillation
Apply a defibrillator and deliver a shock. Use 120-200 J for biphasic defibrillators or 360
J for monophasic defibrillators. This is the primary treatment to restore a normal heart
rhythm.
● Solution 2: Continue CPR
While preparing for defibrillation, continue high-quality chest compressions at a rate of
100-120 compressions per minute and a depth of 2-2.4 inches (5-6 cm). After
defibrillation, resume CPR immediately.
● Solution 3: Medication
Administer antiarrhythmic medications such as amiodarone (300 mg IV push, followed
by 150 mg if needed) or lidocaine (1-1.5 mg/kg IV push, with a repeat dose if
necessary). These medications can help stabilize the heart's rhythm after defibrillation.
2. How should you manage symptomatic bradycardia?
● Solution 1: Atropine
Administer 1 mg of atropine IV every 3-5 minutes, up to a total dose of 3 mg. Atropine
helps increase the heart rate by blocking vagal effects on the heart.
● Solution 2: Transcutaneous Pacing
If atropine is ineffective, apply transcutaneous pacing. This involves placing electrode
pads on the patient’s chest and delivering electrical impulses to stimulate heartbeats.
● Solution 3: Dopamine or Epinephrine Infusion
Start a dopamine infusion (2-20 mcg/kg/min) or an epinephrine infusion (2-10 mcg/min) if
atropine and pacing are not effective. These medications help increase heart rate and
improve cardiac output.
3. What steps should you take if a patient is in asystole or pulseless electrical activity
(PEA)?
, ● Solution 1: CPR
Immediately start high-quality chest compressions. Ensure compressions are performed
at the correct depth and rate, and allow full chest recoil between compressions.
● Solution 2: Epinephrine
Administer 1 mg of epinephrine IV every 3-5 minutes. Epinephrine helps improve blood
flow to the heart and brain during resuscitation efforts.
● Solution 3: Identify and Treat Reversible Causes
Assess and treat potential reversible causes of the cardiac arrest (the 4 Hs and 4 Ts):
hypovolemia, hypoxia, hydrogen ion (acidosis), hyperkalemia/hypokalemia; tension
pneumothorax, cardiac tamponade, toxins, and thrombosis (pulmonary or coronary).
4. What is the recommended management for a patient with symptomatic tachycardia?
● Solution 1: Vagal Maneuvers
In cases of stable narrow-complex tachycardia, encourage the patient to perform vagal
maneuvers, such as the Valsalva maneuver, which can sometimes restore a normal
heart rhythm.
● Solution 2: Medications
Administer antiarrhythmic drugs such as adenosine (6 mg IV push, followed by 12 mg if
needed) for supraventricular tachycardia (SVT). For wider complex tachycardia, consider
medications like amiodarone or procainamide based on the specific rhythm.
● Solution 3: Cardioversion
For unstable patients with tachycardia, immediate synchronized cardioversion may be
necessary. Start with a lower dose (50-100 J) and increase if needed.
5. How should you handle post-cardiac arrest care?
● Solution 1: Optimize Hemodynamics
Ensure adequate blood pressure and heart rate. Use intravenous fluids, vasopressors
(like norepinephrine), and inotropes if necessary to maintain hemodynamic stability.
● Solution 2: Temperature Management
Consider targeted temperature management (cooling the patient to 32-36°C) to improve
neurological outcomes if the patient remains comatose after return of spontaneous
circulation (ROSC).
● Solution 3: Identify and Treat Causes
Continue to investigate and treat any underlying causes or complications. This may
include performing imaging studies, addressing electrolyte imbalances, and providing
supportive care.
6. What are the immediate steps for managing a patient in cardiac arrest?
● Solution 1: Start CPR
Begin high-quality chest compressions immediately. Ensure compressions are at the
correct depth (2-2.4 inches) and rate (100-120 per minute), with minimal interruptions.
● Solution 2: Defibrillation
If the rhythm is shockable (VF or pulseless VT), apply a defibrillator and deliver a shock.
Follow up with CPR and consider drug administration.
● Solution 3: Airway Management
Secure the airway using appropriate methods (bag-mask ventilation, advanced airway)
and ensure proper ventilation if the airway is secured.
