ADVANCED LIFE SUPPORT 2025 QUESTIONS AND
ANSWERS EXPERT VERIFIED ALREADY GRADED A+.
⫸If organised electrical rhythm is noted at a rhythm check, what should be done?Ans:Seek
evidence of ROSC => check signs of life, check central pulse, check end-tidal CO2
⫸If amiodarone is not available, what other drug can be given?Ans:Lidocaine, 1mg/ kg IV
⫸What should you consider in refractory VF/ pVT?Ans:Consider changing defib pad position
(e.g. anterior-posterior)
Consider amiodarone 150mg IV after the fifth shock
⫸For cardiac arrest in PEA/ asystole, when should you give adrenaline?Ans:Give adrenaline
1mg IV as soon as intravascular access achieved
⫸How often should you change the individual performing chest compressions?Ans:Every 2
minutes if possible
⫸What is the normal range of pCO2 in arterial blood?Ans:5.3kPa (range 4.7-6.0kPa)
⫸At what point of breathing is CO2 concentration/ partial pressure at its highest?Ans:End of
expiration (end-tidal)
⫸What does end-tidal CO2 reflect?Ans:Cardiac output, pulmonary blood flow and ventilation
minute volume
⫸During CPR, what is the expected end-tidal CO2 during ongoing arrest, and during
ROSC?Ans:<1.33kPa during cardiac arrest
4.8kPa (4.3-5.5kPa) during ROSC
⫸How do you measure waveform capnography during CPR?Ans:Capnographers - a connector
(T piece) is placed in the breathing system, usually on the end of a tracheal tube or SGA. This
has a small port on the side to which is attached a fine bore sampling tube and a continuous gas
sample is aspirated and analysed using absorption of infrared light.
,⫸Explain the capnography waveformAns:A-B = End of inspiration. CO2 measured from air.
B-C = Start of expiration. Initial minimal CO2 coming from anatomical dead space followed by
rapid rise in CO2.
C-D= Alveolar plateau reached. Represents gas from alveoli taking part in gas exchange.
D = End of expiration. Maximal CO2 concentration/ end-tidal CO2. Typically 4.8kPa.
D-E = Start of inspiration. Air containing no CO2 is mixed with small amount of residual expired
gas in breathing circuit.
⫸If there are signs of waking, purposeful movement, arterial blood pressure waveform or sharp
rise in end-tidal CO2, what should be done?Ans:Consider stopping chest compressions for a
rhythm check and pulse check
⫸When administering resuscitation drugs, what should be done following this
administration?Ans:Flush with at least 20mL sterile saline
Elevation of extremity for 10-20 seconds
⫸What are the 3 main insertion sites for IO access?Ans:Proximal humerus, proximal tibia and
distal tibia
⫸What are contraindications to IO access?Ans:Trauma, infection or prosthesis at target site,
recent IO access (last 48 hours), failure to identify anatomical landmarks
⫸What should you always suspect in a drowning incident?Ans:Hypothermia
⫸What are some of the causes of PEA?Ans:Hypovolaemia due to severe haemorrhage or
tension pneumothorax
⫸In cases of massive pulmonary embolism in which fibrinolytic therapy has been given, how
long should CPR be continued for prior to decision of termination?Ans:Consider CPR for at least
60-90 minutes
⫸How do you manage tension pneumothorax?Ans:Rapid decompression by open/ clamshell
thoracostomy OR needle thoracocentesis (inserting large-bore 14/16G needle into the 2nd
intercostal space in the midclavicular line)
Chest drain insertion
, ⫸How do you diagnose cardiac tamponade during CPR? How is this managed?Ans:Focused
cardiac ultrasound
Resuscitative thoracotomy
⫸In which situations are automated mechanical chest compression devices
appropriate?Ans:CPR in a moving ambulance
Prolonged CPR (e.g. hypothermic arrest)
CPR during procedures (e.g. coronary angiography or preparation for ECPR)
⫸At what point should the resuscitation team leader consider stopping CPR?Ans:Based on
individual/ patient circumstances
Asystole >20 minutes in absence of reversible causes
⫸If CPR is unsuccessful in achieving ROSC and a decision is made to discontinue CPR, how long
should you wait following this to diagnose death?Ans:5 minutes minimum
⫸If there is return of cardiac or respiratory activity during the 5 minute observation following
discontinuation of CPR, what should be done?Ans:Observe for a further 5 minutes from the next
cardiorespiratory arrest
⫸What can cause laryngeal obstruction?Ans:Oedema from burns, inflammation or anaphylaxis
⫸In partial airway obstruction, what are the common noises heard and what do they each
correlate to?Ans:Inspiratory stridor - Obstruction at laryngeal level or above
Expiratory wheeze - Obstruction at lower airways
Gurgling - Presence of liquid or semisolid foreign material in upper airways
Snoring - Pharynx is partially occluded by tongue or palate
⫸In what situation may you observe paradoxical chest and abdominal
movements?Ans:Complete airway obstruction
⫸What should you attempt if a patient with a tracheostomy develops airway
obstruction?Ans:Remove the inner tube of the tracheostomy
Pass a suction catheter + perform tracheal suctioning
ANSWERS EXPERT VERIFIED ALREADY GRADED A+.
⫸If organised electrical rhythm is noted at a rhythm check, what should be done?Ans:Seek
evidence of ROSC => check signs of life, check central pulse, check end-tidal CO2
⫸If amiodarone is not available, what other drug can be given?Ans:Lidocaine, 1mg/ kg IV
⫸What should you consider in refractory VF/ pVT?Ans:Consider changing defib pad position
(e.g. anterior-posterior)
Consider amiodarone 150mg IV after the fifth shock
⫸For cardiac arrest in PEA/ asystole, when should you give adrenaline?Ans:Give adrenaline
1mg IV as soon as intravascular access achieved
⫸How often should you change the individual performing chest compressions?Ans:Every 2
minutes if possible
⫸What is the normal range of pCO2 in arterial blood?Ans:5.3kPa (range 4.7-6.0kPa)
⫸At what point of breathing is CO2 concentration/ partial pressure at its highest?Ans:End of
expiration (end-tidal)
⫸What does end-tidal CO2 reflect?Ans:Cardiac output, pulmonary blood flow and ventilation
minute volume
⫸During CPR, what is the expected end-tidal CO2 during ongoing arrest, and during
ROSC?Ans:<1.33kPa during cardiac arrest
4.8kPa (4.3-5.5kPa) during ROSC
⫸How do you measure waveform capnography during CPR?Ans:Capnographers - a connector
(T piece) is placed in the breathing system, usually on the end of a tracheal tube or SGA. This
has a small port on the side to which is attached a fine bore sampling tube and a continuous gas
sample is aspirated and analysed using absorption of infrared light.
,⫸Explain the capnography waveformAns:A-B = End of inspiration. CO2 measured from air.
B-C = Start of expiration. Initial minimal CO2 coming from anatomical dead space followed by
rapid rise in CO2.
C-D= Alveolar plateau reached. Represents gas from alveoli taking part in gas exchange.
D = End of expiration. Maximal CO2 concentration/ end-tidal CO2. Typically 4.8kPa.
D-E = Start of inspiration. Air containing no CO2 is mixed with small amount of residual expired
gas in breathing circuit.
⫸If there are signs of waking, purposeful movement, arterial blood pressure waveform or sharp
rise in end-tidal CO2, what should be done?Ans:Consider stopping chest compressions for a
rhythm check and pulse check
⫸When administering resuscitation drugs, what should be done following this
administration?Ans:Flush with at least 20mL sterile saline
Elevation of extremity for 10-20 seconds
⫸What are the 3 main insertion sites for IO access?Ans:Proximal humerus, proximal tibia and
distal tibia
⫸What are contraindications to IO access?Ans:Trauma, infection or prosthesis at target site,
recent IO access (last 48 hours), failure to identify anatomical landmarks
⫸What should you always suspect in a drowning incident?Ans:Hypothermia
⫸What are some of the causes of PEA?Ans:Hypovolaemia due to severe haemorrhage or
tension pneumothorax
⫸In cases of massive pulmonary embolism in which fibrinolytic therapy has been given, how
long should CPR be continued for prior to decision of termination?Ans:Consider CPR for at least
60-90 minutes
⫸How do you manage tension pneumothorax?Ans:Rapid decompression by open/ clamshell
thoracostomy OR needle thoracocentesis (inserting large-bore 14/16G needle into the 2nd
intercostal space in the midclavicular line)
Chest drain insertion
, ⫸How do you diagnose cardiac tamponade during CPR? How is this managed?Ans:Focused
cardiac ultrasound
Resuscitative thoracotomy
⫸In which situations are automated mechanical chest compression devices
appropriate?Ans:CPR in a moving ambulance
Prolonged CPR (e.g. hypothermic arrest)
CPR during procedures (e.g. coronary angiography or preparation for ECPR)
⫸At what point should the resuscitation team leader consider stopping CPR?Ans:Based on
individual/ patient circumstances
Asystole >20 minutes in absence of reversible causes
⫸If CPR is unsuccessful in achieving ROSC and a decision is made to discontinue CPR, how long
should you wait following this to diagnose death?Ans:5 minutes minimum
⫸If there is return of cardiac or respiratory activity during the 5 minute observation following
discontinuation of CPR, what should be done?Ans:Observe for a further 5 minutes from the next
cardiorespiratory arrest
⫸What can cause laryngeal obstruction?Ans:Oedema from burns, inflammation or anaphylaxis
⫸In partial airway obstruction, what are the common noises heard and what do they each
correlate to?Ans:Inspiratory stridor - Obstruction at laryngeal level or above
Expiratory wheeze - Obstruction at lower airways
Gurgling - Presence of liquid or semisolid foreign material in upper airways
Snoring - Pharynx is partially occluded by tongue or palate
⫸In what situation may you observe paradoxical chest and abdominal
movements?Ans:Complete airway obstruction
⫸What should you attempt if a patient with a tracheostomy develops airway
obstruction?Ans:Remove the inner tube of the tracheostomy
Pass a suction catheter + perform tracheal suctioning
