ADVANCED LIFE SUPPORT (ALS) ONLINE SESSION FINAL EXAM| 48 QUESTIONS AND ANSWERS.

A patient's ECG reveals a narrow QRS complex with a regular rhythm, indicating a narrow-complex supraventricular tachyarrhythmia. The patient is hemodynamically stable. Which intervention would be initiated first? Vagal maneuvers For a patient who is hemodynamically stable and experiencing a narrow-complex supraventricular tachyarrhythmia, vagal maneuvers are attempted first. If ineffective, adenosine is given. A patient's capnogram reveals the following waveform. Which segment would the healthcare provider interpret as reflecting the beginning of exhalation? A-B The A–B segment is the respiratory baseline that represents the beginning of exhalation. A patient experiencing an unstable bradyarrhythmia does not respond to atropine or transcutaneous pacing. Which intervention would the healthcare provider use next? Administration of an epinephrine infusion. Epinephrine or dopamine may be administered to patients with symptomatic bradycardia if atropine and transcutaneous pacing are not effective. A patient with a suspected stroke arrives at the emergency department at 7:10 p.m. The stroke team ensures that a neurologic assessment and brain computed tomography or magnetic resonance imaging is obtained by which time? 7:30 p.m. In accordance with National Institute of Neurological Disorders and Stroke guidelines, the stroke team, emergency physician or other expert must conduct a neurologic assessment and obtain computed tomography or magnetic resonance imaging within 20 minutes after the patient’s arrival in the emergency department. That would be 7:30 p.m. for this patient. A patient in the telemetry unit is stable. Cardiac monitoring indicates the patient has ventricular tachycardia with a pulse. Further assessment reveals that the corrected QT interval is greater than 0.46 seconds. Which treatment would be appropriate at this time? Synchronized cardioversion For a patient with ventricular tachycardia who is stable, has a pulse and has a corrected QT interval greater than 0.46 seconds, synchronized cardioversion is the recommended treatment. A resuscitation team is debriefing following a recent event. A patient experienced cardiac arrest, and advanced cardiac life support was initiated. The patient required the placement of an advanced airway to maintain airway patency. Which statement indicates that the team performed high-quality CPR? “We delivered 1 ventilation every 6 seconds and chest compressions at a rate of 100 to 120 compressions per minute.” When an advanced airway has been placed in a patient who is in cardiac arrest, compressions and ventilations are delivered continuously with no interruptions. One provider delivers 1 ventilation every 6 seconds, while the second provider performs compressions at a rate of 100 to 120 compressions per minute. A healthcare provider initiates ventilations to ensure adequate breathing and oxygenation. While ventilations are being performed, capnography is established to evaluate the adequacy of the ventilations. The healthcare provider determines that ventilations are adequate based on which end-tidal carbon dioxide (ETCO2) value? 35 to 45 mmHg End-tidal carbon dioxide values in the range of 35 to 45 mmHg confirm adequacy of ventilation. An ECG strip of a patient in the emergency department reveals the following rhythm. Which feature would the healthcare provider interpret as indicating atrial fibrillation? Absence of discrete P waves and presence of irregularly irregular QRS complexes. The two key features of atrial fibrillation on ECG are the absence of discrete P waves and the presence of irregularly irregular QRS complexes. A patient in cardiac arrest experiences return of spontaneous circulation. As part of post-cardiac arrest care, the patient is receiving mechanical ventilation. Which finding(s) would indicate the need for change in the ventilator settings to optimize the patient's ventilation and oxygenation? 1. ETCO2 50 mmHg 2. PaCO2 35 mmHg 3. SaO2 92% Mechanical ventilation should be started at a rate of 10 to 12 breaths per minute and adjusted as necessary to keep ETCO2 levels in the range of 35 to 40 mmHg and PaCO2 levels in the range of 40 to 45 mmHg. The minimum fraction of inspired oxygen necessary to maintain an SaO2 of at least 94% is used. The following capnogram is from a patient experiencing respiratory distress. At which point in the waveform would the patient's ETCO2 level be measured? D The ETCO2 value is measured at the end of exhalation (point D), which represents the peak level. Assessment of a patient reveals an ETCO2 level of 55 mmHg and an arterial oxygen saturation (SaO2) level of 88%. The provider would interpret these findings as indicative of which condition? Respiratory failure An SaO2 level of less than 90% (PaO2 of less than 50 mmHg) accompanied by ETCO2 values greater than 50 mmHg is indicative of respiratory failure. A patient presents to the emergency department with mild to moderate recurrent chest pain, without any nausea or vomiting. A 12-lead ECG is obtained and shows ST-segment depression with transient T-wave elevation indicative of NSTE-ACS. Cardiac enzyme levels are obtained and are not elevated. These findings suggest which condition? Unstable angina A patient who presents with ECG findings consistent with NSTE-ACS and does not have elevated cardiac serum markers is to be considered as having unstable angina. The resuscitation team suspects that hyperkalemia is the cause of cardiac arrest in a patient brought to the emergency department. Which finding on a 12-lead ECG would confirm this suspicion? Wide-complex ventricular rhythm or tall, pointed T waves. In hyperkalemia the patient’s 12-lead ECG rhythm strip will show wide-complex ventricular rhythm or tall, pointed T waves. A patient with an ischemic stroke arrives at the emergency department at 2 a.m. The patient's symptoms started about 12:30 a.m. After completing the necessary assessments, the healthcare team diagnoses an ischemic stroke, and the patient is determined to be a candidate for fibrinolytic therapy. To achieve the best outcomes, the team should initiate therapy for this patient no later than by which time? 3:00 a.m. For patients with ischemic stroke who meet the eligibility criteria, fibrinolytic therapy is the first-line treatment. Administration of IV recombinant tissue plasminogen activator within 3 hours of the onset of signs and symptoms is optimal (with a goal “door-to-needle” time of less than 1 hour). A patient is brought into the emergency department with a suspected opioid overdose. The patient is in cardiac arrest. Which action would be the team's priority? Initiating high-quality CPR Although no evidence supports any benefit to naloxone administration during cardiac arrest, administration of naloxone during both respiratory and cardiac arrest is recommended when opioid overdose is suspected. However, for a patient in cardiac arrest, high-quality CPR is prioritized over the administration of naloxone. A patient with dyspnea and a change in mental status arrives at the emergency department. The healthcare team completes the necessary assessments and begins to care for the patient, including initiating cardiac monitoring, pulse oximetry, supplemental oxygen and vascular access. The team reviews the patient's ECG rhythm strip, as shown in the following figure. Which agent would the team most likely administer? Atropine 0.5 mg every 4 to 5 minutes. The ECG strip is showing bradycardia. Atropine is an anticholinergic drug that increases sinoatrial node firing by counteracting vagus nerve action to increase the heart rate. It is the first-line therapy for symptomatic bradycardia. A 0.5-mg bolus is given intravenously every 3 to 5 minutes, up to a maximum dose of 3 mg. A 20-year-old man with respiratory depression is brought to the emergency department by his parents. The parents state that "[They] found him at home with various needles and syringes around him, but [they] have no idea what he took." Opioid overdose is suspected, and an initial dose of naloxone is administered at 10 p.m. The patient does not respond to this initial dose. The team would expect to administer a second dose after how many minutes? 4 minutes The dose of naloxone may be repeated after 4 minutes. Additional doses, increased in a stepwise fashion, are often necessary to reverse the respiratory depression. A 30-year-old patient has been brought to the emergency department in full cardiac arrest. The cardiac monitor shows the following rhythm. Interpretation of this rhythm would suggest which of the following as a possible precipitating factor? Electrocution The rhythm is ventricular fibrillation. Precipitating causes of ventricular fibrillation include electrocution, myocardial ischemia or infarction, shock, stimulant overdose and ventricular tachycardia. A patient with acute renal failure experiences cardiac arrest. Just before the cardiac arrest, the patient's ECG showed peaked T waves. What might be causing the patient's cardiac arrest? Hyperkalemia Suspect hyperkalemia in all patients with acute or chronic renal failure who exhibit a wide-complex ventricular rhythm or tall, peaked T waves on an ECG before cardiac arrest. A patient has experienced return of spontaneous circulation (ROSC) after cardiac arrest. The healthcare team is conducting a secondary assessment to determine the possible cause of the patient's cardiac arrest. Before the arrest, the patient exhibited jugular venous distension, cyanosis, apnea and hyperresonance on percussion. The patient was also difficult to ventilate during the response. The team would most likely suspect which condition as the cause? Tension pneumothorax Prearrest signs of tension pneumothorax in the advanced stage include jugular venous distension, cyanosis, apnea and hyperresonance on percussion. Difficulty ventilating the patient may also be a sign of tension pneumothorax. A patient is brought to the emergency department by their spouse. The spouse says, "I think it's a stroke." The stroke team initiates a rapid stroke assessment using the National Institutes of Health Stroke Scale. Which area(s) would the team include in this assessment? 1. Language deficits 2. Level of consciousnesses 3. Visual function The National Institutes of Health Stroke Scale evaluates level of consciousness, visual function, motor function, sensation and neglect, cerebellar function and language deficits and helps to determine both the location and the severity of the stroke. A patient's ECG reveals a tachyarrhythmia. The patient is hemodynamically stable and has a heart rate ranging from 120 to 135 beats per minute. Based on the findings of the secondary assessment, which statement(s) by the patient would the team interpret as a possible contributing cause? 1. “I’ve been so anxious lately because I just lost my job.” 2. “I’ve been vomiting for the past 2 days from a gastrointestinal bug.” 3. “I’ve had a terrible cold with a horrible cough the past week.” If the heart rate is between 100 and 150 beats per minute, the underlying cause is most likely a systemic one, such as anxiety, dehydration or infection. That condition is treated first. If the heart rate is 150 beats per minute or more, the tachycardia is likely caused by a cardiac condition, rather than a systemic one. A patient presents to the emergency department with suspected ACS. Electrocardiogram and cardiac biomarkers show the patient has ST-segment elevation myocardial infarction (STEMI). Physical examination reveals signs of left ventricular dysfunction. Which finding(s) would support this? 1. Pulmonary edema 2. Crackles 3. Hypotension Physical examination findings in patients with ACS may include signs of left ventricular dysfunction (e.g., hypotension, crackles, pulmonary edema) or cardiogenic shock (e.g., cool, clammy skin).