EMED – ACLS EXAM QUESTIONS &
CORRECT ANSWERS
ACLS Conditions - CORRECT ANSWER (A) Cardiac arrest
1. VF***
2. Pulseless VT***
3. PEA
4. Asystole
(B) Tachydysrhythmias
1. Narrow complex
2. Wide complex
(C) Bradydysrhythmias
1. P wave present
2. P wave absent
Approach to Cardiac Arrest - Universal ACLS Algorithm - CORRECT ANSWER 1.
Assess responsiveness - call for help, AED, bring to ED resus
2. Primary survey (ABC)
3. CPR - continuous until ROSC/dead
4. Defibrillator
5. Secondary survey (ABC)
6. Drugs
7. Reassess patient after 1-2min of CPR
ACLS Primary Survey - CORRECT ANSWER (A) Airway - Clear the airway
1. Head tilt, chin lift, jaw thrust
- To prevent airway obstruction from tongue
(If cannot exclude cervical trauma, use jaw thrust/ tongue-jaw lift manoeuvre + in-line
cervical immobilisation)
2. Inspect airway for foreign body/blood/vomitus
3. Remove using finger sweep
4. Use oropharyngeal suction device to remove secretions/vomitus
5. +/- Airway adjuncts eg. oro/nasopharyngeal airway
(B) Breathing - Look, listen, feel for breathing
1. Look for chest rise & fall
2. Listen for breath sounds
3. Feel with cheek for breathing
,Note: Gasping/agonal respirations are NOT considered as normal breathing
(C) Circulation
1. Check for carotid pulse while checking for breathing - DO NOT take > 10s for both!
2. If no breathing + no pulse = CARDIAC ARREST
=> BEGIN CPR IMMEDIATELY
ACLS
1. CPR
2. Defibrillator - CORRECT ANSWER (A) CPR - continuous until ROSC/dead
1. Chest compressions
a) Rate: 100-120/min
b) Depth: > 5cm
c) Complete chest recoil between compressions
d) Minimal interruptions to chest compressions
2. Ventilations - do until patient is intubated => BVM +/- reservoir bag +/- valve
(21%/95%/100% O2)
a) 400-600ml/breath
b) 1 second/breath
c) Visible chest rise
3. 30 chest compressions : 2 ventilations - perform until definitive airway has been
secured
=>
Uninterrupted CPR
(B) Defibrillator
Analyse for shockable/ non-shockable rhythm
(Pads @ upper R, lower L)
1. Shockable - detected by AED
a) VF
b) Pulseless VT
2. Non-shockable
a) Pulseless electrical activity (PEA)
b) Asystole
(A) If shockable rhythm present
1. AED immediately =>
2. Secondary ABCD survey
(B) If non-shockable rhythm present
1. Secondary ABCD survey
, ACLS Secondary survey - CORRECT ANSWER (A) Airway - Advanced airway device
1. ETT
2. LMA
(B) Breathing
Once airway device is confirmed to be in place => no need to synchronise
compressions with ventilation
= Asynchronus compression & ventilation
1. Uninterrupted chest compressions @ 100-120 bpm
2. Continuous ventilation @ 8-10 ventilations/min
3. Confirm effective oxygenation & ventilation
Note: Avoid hyperventilating patient
(C) Circulation
1. IV access - IV NS 500ml over 4h
(D) Drugs
1. ALL cardiac arrest
a) IV Adrenaline 1mg Q3-5min*****
(10ml of 1 : 10 000)
2. Persistent VF
a) IV Amiodarone 300mg
b) IV Lignocaine 1.0-1.5mg/kg
3. Torsades des pointes
a) IV Mg sulfate 1-2mg
4. HyperK/TCA OD
a) IV Sodium bicarbonate
=> Continuous CPR for 30-60s after drug administration for drug to circulate to heart
ACLS: Reassessment of Patient after CPR - CORRECT ANSWER Reassess patient
after 1-2min of CPR
1. Check pulse
a) Pulse present = Return of Spontaneous Circulation (ROSC)
=> Post-resus care
b) Pulse absent => Continue CPR
CORRECT ANSWERS
ACLS Conditions - CORRECT ANSWER (A) Cardiac arrest
1. VF***
2. Pulseless VT***
3. PEA
4. Asystole
(B) Tachydysrhythmias
1. Narrow complex
2. Wide complex
(C) Bradydysrhythmias
1. P wave present
2. P wave absent
Approach to Cardiac Arrest - Universal ACLS Algorithm - CORRECT ANSWER 1.
Assess responsiveness - call for help, AED, bring to ED resus
2. Primary survey (ABC)
3. CPR - continuous until ROSC/dead
4. Defibrillator
5. Secondary survey (ABC)
6. Drugs
7. Reassess patient after 1-2min of CPR
ACLS Primary Survey - CORRECT ANSWER (A) Airway - Clear the airway
1. Head tilt, chin lift, jaw thrust
- To prevent airway obstruction from tongue
(If cannot exclude cervical trauma, use jaw thrust/ tongue-jaw lift manoeuvre + in-line
cervical immobilisation)
2. Inspect airway for foreign body/blood/vomitus
3. Remove using finger sweep
4. Use oropharyngeal suction device to remove secretions/vomitus
5. +/- Airway adjuncts eg. oro/nasopharyngeal airway
(B) Breathing - Look, listen, feel for breathing
1. Look for chest rise & fall
2. Listen for breath sounds
3. Feel with cheek for breathing
,Note: Gasping/agonal respirations are NOT considered as normal breathing
(C) Circulation
1. Check for carotid pulse while checking for breathing - DO NOT take > 10s for both!
2. If no breathing + no pulse = CARDIAC ARREST
=> BEGIN CPR IMMEDIATELY
ACLS
1. CPR
2. Defibrillator - CORRECT ANSWER (A) CPR - continuous until ROSC/dead
1. Chest compressions
a) Rate: 100-120/min
b) Depth: > 5cm
c) Complete chest recoil between compressions
d) Minimal interruptions to chest compressions
2. Ventilations - do until patient is intubated => BVM +/- reservoir bag +/- valve
(21%/95%/100% O2)
a) 400-600ml/breath
b) 1 second/breath
c) Visible chest rise
3. 30 chest compressions : 2 ventilations - perform until definitive airway has been
secured
=>
Uninterrupted CPR
(B) Defibrillator
Analyse for shockable/ non-shockable rhythm
(Pads @ upper R, lower L)
1. Shockable - detected by AED
a) VF
b) Pulseless VT
2. Non-shockable
a) Pulseless electrical activity (PEA)
b) Asystole
(A) If shockable rhythm present
1. AED immediately =>
2. Secondary ABCD survey
(B) If non-shockable rhythm present
1. Secondary ABCD survey
, ACLS Secondary survey - CORRECT ANSWER (A) Airway - Advanced airway device
1. ETT
2. LMA
(B) Breathing
Once airway device is confirmed to be in place => no need to synchronise
compressions with ventilation
= Asynchronus compression & ventilation
1. Uninterrupted chest compressions @ 100-120 bpm
2. Continuous ventilation @ 8-10 ventilations/min
3. Confirm effective oxygenation & ventilation
Note: Avoid hyperventilating patient
(C) Circulation
1. IV access - IV NS 500ml over 4h
(D) Drugs
1. ALL cardiac arrest
a) IV Adrenaline 1mg Q3-5min*****
(10ml of 1 : 10 000)
2. Persistent VF
a) IV Amiodarone 300mg
b) IV Lignocaine 1.0-1.5mg/kg
3. Torsades des pointes
a) IV Mg sulfate 1-2mg
4. HyperK/TCA OD
a) IV Sodium bicarbonate
=> Continuous CPR for 30-60s after drug administration for drug to circulate to heart
ACLS: Reassessment of Patient after CPR - CORRECT ANSWER Reassess patient
after 1-2min of CPR
1. Check pulse
a) Pulse present = Return of Spontaneous Circulation (ROSC)
=> Post-resus care
b) Pulse absent => Continue CPR
