Advanced Cardiac Life Support (ACLS) Exam 2022/2023 with complete solution

Advanced Cardiac Life Support (ACLS) Exam 2022/2023 with complete solution ACLS Exam 2022/2023 with complete solution Which class of medications commonly given to patients with acute coronary syndromes may be adversely affected by morphine administration A. Phosphodiesterase inhibitors B. Oral antiplatelet medications C. Beta blockers D. Calcium channel blockers - ANSWER Oral antiplatelet medications What is a benefit of morphine when given for the management of acute coronary syndromes? A. Central nervous system analgesia B. Increases systemic vascular resistance C. Increases left ventricular preload D. Vasoconstriction - ANSWER A. Central nervous system analgesia You obtain a 12-lead ECG in a patient with retrosternal chest pain. Which ECG finding is suggestive of high-risk non-ST segment elevation acute coronary syndromes A. ST depressions less than 0.5mm B. Dynamic T-wave inversion C. ST-segment elevation D. New bundle branch block - ANSWER B. Dynamic T-wave inversion Upon reviewing a patient's 12 lead ECG, you note ST-segment elevation of 2mm in leads II,III, and aVF How would you classify the electrocardiographic findings A. Normal B. STEMI C. Non-STEMI D. Non-diagnostic - ANSWER b. STEMI What happens when teams rapidly assess and intervene when patients have abnormal vital signs - ANSWER The number of in hospital cardiac arrests decreases What is the goal for first medical contact-to-ballon inflation time for a patient receiving PCI - ANSWER 90 minutes What is the longest acceptable emergency department door-to-needle time when fibrinolysis is the intended reperfusion strategy - ANSWER 30 minutes What is the time goal for how quickly you should complete a fibronolytic checklist once the patient arrives in the emergency department - ANSWER 10 minutes What is the recommended time window after symptom onset for early fibronolytic therapy or direct catheter-based reperfusion for patients with STEMI and no contraindication - ANSWER Within 12 hours a 49 yo says that he has had chest discomfort and excessive sweating for the past 25 minutes. Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of MI, what will your first actions include? - ANSWER Provide prehospital notification to the receiving hospital Administer aspirin if considering prehospital fibrinolysis, use the fibrinolytic checklist assess ABC Obtain EKG consider oxygen, nitroglycerin, and morphine if needed His initial vital signs are HR 120/min BP 135/88 RR 23 O2 87% When considering oxygen saturation, what is your course of actions? - ANSWER Start oxygen at 4L What additional questions help you determine next steps - ANSWER When did the symptoms start Do you take any medication Do you have any allergies Your patient continues to say that he has chest discomfort What treatment can you repeat as long as it is not contraindicated by vital signs - ANSWER Nitroglycerin sublingual every 3-5min What is your interpretation of the patient's EKG tracing STEMI in V2-6 - ANSWER Anterior STEMI With the possible diagnosis of STEMI, what is the most probable treatment - ANSWER Admission for PCI/fibrinolysis After you give report to the hospital, staff advise you to proceed to the cath lab for PCI What is the goal for PCI when treating this patient - ANSWER First medical contact to balloon inflation time of 90 minutes Which action is part of the secondary assessment of a conscious patient - ANSWER Formulate a differential diagnosis What is the most common type of stroke - ANSWER Ischemic stroke What is the recommended time window after symptom onset for early fibrinolytic therapy or direct catheter based reperfusion for patients with STEMI and no contraindications - ANSWER 12 hours What validated, abbreviated out of hospital neurologic evaluation tool contains 3 components: facial droop, arm drift, and abormal speech test - ANSWER Cincinnati Prehospital Stroke scale What is the estimated probability of the CPSS with 1 abnormal finding when scored by prehospital providers - ANSWER 72% Which is a stroke severity tool that helps EMS differentiate large vessel occlusion stroke from non-large vessel occlusion stroke - ANSWER Los Angeles Motor Scale What is the primary advantage of using a stroke severity tool? - ANSWER It helps ID large vessel occlusion stroke During CPR, CCF should be at least ______% and ideally greater than _____% - ANSWER 60/80 What is an advantage of EMS alerting the receiving facility of the impending arrival of a patient with suspected acute ischemic stroke - ANSWER The hospital can perform more efficient evaluation and management What is the time goal for neurologic assessment by the stroke team or designee and noncontrast computed tomography or MRI performed after hospital arrival - ANSWER 20 minutes What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindication after hospital arrival - ANSWER 45 minutes What is the door-to-needle time goal for 85% or more of acute ischemic stroke patients treated with IV thrombolytics - ANSWER 60 minutes What is the door-to-device time goal for direct arriving patients with acute ischemic stroke treated with endovascular therapy - ANSWER 90 minutes Evidence suggests that there is a higher likelihood of good to excellent functional outcome when alteplase is given to adults with an acute ischemic stroke within what time frame - ANSWER 3 hours What is the maximum time from last known normal when endovascular therapy can be performed - ANSWER 24 hours What is the max time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment - ANSWER 6 hours ID the SBP threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke - ANSWER 185mmHg What is the DBP threshold for withholding fibrinolytic to otherwise eligible patients with acute ischemic stroke - ANSWER 110mmHg Which action is not part of the acute stroke pathway - ANSWER Seizure prophylaxis What BG should trigger the administration of IV or subQ insulin for a patient with acute ischemic stroke - ANSWER 180 A 74 yo man was brought to the hospital by his wife. She states that her husband started having sudden left arm weakness and left sided paralysis during lunch. He has a past medical history or poorly controlled hypertension HR 92 RR 14 BP 130/86 SPO2 97% Afib on monitor What additional assessment and stabilization activities should be completed? - ANSWER Establish time of symptom onset (last known normal) perform validated prehospital stroke screen and stroke severity tool provide prehospital notification to the receiving hospital initiate stroke protocol check glucose What needs to be completed for this patient within 20 min after hospital arrival - ANSWER neurologic assessment what are some of the general questions you need to ask - ANSWER when did the symptoms start do you have any allergies do you take any medications what other symptoms do you have within 45 minutes, the neuroimaging interpretation of the CT scan of the brain suggests an acute ischemic infarction. There is no signs of hemorrhage or mass lesions Is this patient a potential candidate for fibrinolytic therapy? - ANSWER Yes What actions should the hospital staff take to determine whether the patient is a candidate for fibrinolytic therapy - ANSWER Repeat neurologic exam You find that the patient's neurologic function is rapidly improving. Is this patient still a candidate for fibrinolytic therapy? - ANSWER No Because the patient is no longer a candidate for fibrinolyic therapy, what are your next steps for him? - ANSWER Support ABC Begin stroke pathway Admit to ICU What tidal volume typically maintains normal oxygenation and elimination of carbon dioxide - ANSWER 6-8mL/kg an 18yo is reporting difficulty breathing and is displaying increased respiratory effort b/l wheeze RR 28 O2 91% PETCO2 44mmHg - ANSWER Respiratory distress a 59yo is reporting difficulty breathing nasal flaring, intercostal retractions, and use of accessory muscles RR 28 O2 92% PETCO2 36mmHg - ANSWER Respiratory distress 75yo patient difficulty breathing emphysema drowsy b/l wheeze, difficult to appreciate RR 38 O2 85% PETCO2 49mmHg - ANSWER Respiratory failure What is the term for the rise in arterial carbon dioxide levels typically associated with respiratory failure - ANSWER hypercapnia How much tidal volume must you provide with a bag mask device to produce visible chest rise for an adult patient in respiratory arrest - ANSWER 6-7mL/kg What device on a resuscitation bag mask device may prevent sufficient tidal volume in patients with poor lung compliance - ANSWER pressure relief valve patients with perfusing rhythms should receive ventilation once every _____ seconds - ANSWER 6 What is the most effective way to deliver bag mask ventilation - ANSWER 2 person technique how long should the second rescuer squeeze the bag mask device when providing 2 rescuer ventilation - ANSWER 1 second When performing the jaw thrust maneuver on patients with suspected cervical spine injury where should you place your fingers - ANSWER just under the angle of the lower jaw When you use a bag mask device you should deliver 500- _______mL tidal volume - ANSWER 600 in which of the following patients can nasopharangeal airways be used - ANSWER unconscious, semi, conscious Select the first step in the use of an oropharyngeal airway - ANSWER Clear the mouth and pharynx What is a potential complication of inserting an oropharyngeal airway - ANSWER Pushing the base of the tongue back The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patient's nose to the - ANSWER earlobe What is a potential complication using a nasopharyngeal airway that is too long - ANSWER entering the esophagus What is the most serious potential complication of nasopharyngeal aiway insertion into a patient with facial trauma - ANSWER Misplacement into the cranial cavity What is the max length of suction catheter that should be inserted into the patient's oropharynx beyond the tongue - ANSWER tip of nose to earlobe What is the most reliable method of confirming and monitoring correct placement of an ET tube - ANSWER Quantitative waveform capnography What is the recommended ventilation rate for an adult in cardiac arrest with an advanced airway device in place - ANSWER Once every 6 seconds EMS brings a 54 year old patient to the ED who had been experiencing severe SOB and difficulty breathing. The patient loses consciousness on arrival What initial actions should be taken - ANSWER Assess ABC Call for help Check for responsiveness the patient is unresponsive and not breathing but has a strong pulse What should your initial actions include - ANSWER Open the patient's airway via a head tilt chin lift or jaw thrust Initiate ventilation with a bag mask device attached to supplemental oxygen Patient's HR 84 BP 124/73 SPO2 66% Cyanotic around the mouth and extremities what is the recommended rate for rescue breaths - ANSWER 1 breath every 6 seconds What is the single most reliable method of confirming and monitoring correct placement of the ET tube - ANSWER Quantitative waveform capnography Which S/S indicate symptomatic bradycardia - ANSWER Chest pain SOB Altered MS Pulmonary edema Hypotension PR intervals uniform but random QRS dropped - ANSWER Second degree type II more p waves than QRS. absence of relationship between the P wave and QRS - ANSWER 3rd degree Definition of bradycardia - ANSWER HR <50 First line of treatment for unstable bradycardia - ANSWER Atropine 1mg every 3-5 min for max dose of 3mg What is the max time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment - ANSWER 6 hours What is a complication of IV atropine when administered in doses of less than 0.5mg - ANSWER Further slowing of HR What is the recommended infusion rate for epi in management of symptomatic bradycardia unresponsive to atropine - ANSWER 2-10mcg/min What is the recommended infusion rate for dopamine in the management of symptomatic bradycardia unresponsive to atropine - ANSWER 5-20mcg/kg/min What therapy is recommended alternative to vasopressor infusion in the management of unstable bradycardia unresponsive to atropine - ANSWER Transcutaneous pacing What is your initial impulse setting for transcutaneous pacemaker use in the management of unstable bradycardia - ANSWER 60-80 How much of a safety margin should you allow when using the transcutaneous pacemaker - ANSWER 2mA 75yo male present to the ED. He fainted 45 min ago HR 30 BP 66/43 RR 20 O2 89% Alert and responsive What should your next steps be to assess and treat this patient - ANSWER Establish IV Obtain 12 lead Maintain airway and administer O2 as needed You determine patient has poor perfusion. What is your next step - ANSWER Atropine 1mg Patient does not respond to atropine HR 34 BP 66/43 RR 18 O2 91% Responsive, but dizzy. What option do you have - ANSWER Initiate transcutaneous pacing administer epi 2-10mcg/min adminster dopa 5-20 mvg/kg/min Patient does not respond to treatments HR 40 BP 66/43 RR 18 O2 91% - ANSWER Seek expert consultation prepare for TV pacing You are treating a patient with a HR 186/min. Which symptom if present suggests an unstable tachycardia - ANSWER Hypotension Symptoms of instability are not usually caused by HR less than ______bpm unless ventricular function is impaired - ANSWER 150/min What is the first line treatment for unstable tachycardia - ANSWER Cardioversion The width of the QRS in a patient presenting with tachycardia is .16 seconds. Each QRS complex has a visible p wave. how would you classify this tachycardia - ANSWER wide complex tachycardia The width of the QRS in a patient presenting with tachycardia is .10 second. There are no clearly discernable P waves How would you classify this tachycardia - ANSWER Narrow complex tachycardia What is the upper HR limit for a patient with stach? - ANSWER 130/min What is the lower HR limit for a patient with stach - ANSWER 100 What is the recommended initial therapy for a patient with stable narrow complex tachycardia, after establishing an IV and acquiring a 12 lead EKG - ANSWER Vagal maneuvers What procedure used in the management of stable narrow complex tachycardia forces a patient to strain against a closed glottis? - ANSWER valsalva maneuver What is the recommended initial dose of adenosine for the mgmt of SVT unresponsive to vagal maneuvers? - ANSWER 6mg/ 12mg follow up if a patient is conscious, establish IV access prior to synchronized cardioversion and administer - ANSWER sedation electrical cardioversion is not recommended as the initial therapy for patients unless the HR is above - ANSWER 150 You are preparing to provide electrical cardioversion you are monitoring the patient's EKG and have applied defib pads, sedation, and defib on. What is the next step - ANSWER Activate the sync control button Which is a contraindication to the use of procainamide infusion in the mgmt of stable wide complex tachycardia - ANSWER Prolonged QT interval What is the recommended first dose of amio for mgmt of stable wide complex tachycardia - ANSWER 150mg A 72yo male has been suffering from progressive dizziness and bouts of palpitations after exercising last night. His symptoms reappeared and worsened this morning The patient is conscious and alert, HR 180 weak radial pulse BP 110/78 O2 96% What are the most appropriate initial interventions - ANSWER In addition to CPR with minimal interruptions in chest compressions, what is the most critical intervention during the first few minutes of arrest for a patient in vfib - ANSWER defibrillation during the management of a patient in cardiac arrest, you have initiated CPR, attached the defibrillator, delivered first shock, and resumed CPR. What is your next intervention - ANSWER establish IV/ IO When is the recommended point to administer the first dose of epi for a patient in a shockable rhythm - ANSWER between second and third shocks What is the recommended first dose of amio for patient with VF/pVT that is unresponsive to defibrillation - ANSWER 300mg what is the recommended first IV dose of lido for patients in cardiac arrest with VF/pVT that is unresponsive to defibrillation - ANSWER 1-1.5mg/kg PEA can present as which of the following organized rhythm - ANSWER afib sr bbb when is the recommended point to administer epi to a patient with asystole - ANSWER as soon as IV access available in addition to hypoxia, what is the most common underlying, potentially reversible causes of PEA - ANSWER hypovolemia which therapy is not supported by evidence for use in patients with cardiac arrest secondary to hypothermia - ANSWER antiarrhythmics which alteration to the standard ACLS algorithm is appropriate for patients whose cardiac arrest is caused by hypothermia - ANSWER medications spaced at longer intervals a patient with suspected opioid poisoning is not breathing normally but has a pulse. What is your next step - ANSWER provide rescue breathing and give naloxone How can rescuers administer naloxone - ANSWER intranasally IV IM what roles does ECPR fill in the management of cardiac arrest - ANSWER Provides vital organ support while treating reversible causes serve as a bridge for LVAD how will the current generation of continuous flow left ventricular assist devices complicate the BLS assessment - ANSWER the devices will not produce a pulse you are assessing an unresponsive patient known to have LVAD. Patient is not breathing, skin pale and cook and cap refill inadequate how do ou assess whether the LVAD is functioning - ANSWER listen for device hum patient with VAD is not breathing, has signs of inadequate perfusion, and is unconscious. VAD is functioning. After intubation, PETCO 12. What is next step - ANSWER perform external chest compressions CPR position for 3rd trimester patient - ANSWER supine with manual left lateral uterine displacement what alterations are recommended for resuscitation to 3rd trimester gravid patients in cardiac arrest - ANSWER no dosing alterations recommended when should resuscitation TL activate protocol for perimortem CS delivery - ANSWER as soon as cardiac arrest ID in pregnant patient how quickly should TL consider perimortem CS delivery after beginning efforts if ROSC has not been achieved - ANSWER 5 min When adjusting ventilation rates, which PETCO2 value lies within the recommended range for a patient who achieves ROSC - ANSWER 40mmHg What is the purpose of obtaining an EKG early during post cardiac arrest care phase - ANSWER to detect STEMI or LBBB EKG reveales STEMI Which step has highest priority - ANSWER Coronary angiography what is an advantage of primary percutaneous coronary intervention in a cath lab for patients with cardiac arrest secondary to coronary artery occlusion once they achieve ROSC - ANSWER Restores blood flow in an infarction related artery During post cardiac care phase why is it important to assess the patient's ability to follow commands - ANSWER to determine need for TTM what is an advantage of placing a post cardiac arrest patient in ccu after coronary reperfusion intervention - ANSWER experts can perform timely neurologic evaluation which factor can confound neuroprognostication during the post cardiac arrest phase - ANSWER TTM How long should you wait to determine the neurologic prognosis of a patient treated with TTM after normothermia - ANSWER 72 hours A BLS team is bringing a 70yo woman who suddenly collapsed while on her morning jog. CPR in progress - ANSWER Based on patient's condition, what is your next action (pt in vfib) - ANSWER shock immediately, establish IV/IO Pt converted to vtach. What actions need to be completed next - ANSWER shock resume cpr administer epi 1mg consider advanced airway pt in vfib/ vtach. shock is delievered and CPR resumed. next intervention - ANSWER amio 300mg You are attempting to resuscitate a 70yo female who suffered sudden cardiac arrest. she has a palpable pulse HR 65 o2 94% etco 38mmhg bp 82/55 what are your highest priorities - ANSWER ventilating patient with 10 breaths/minute maintain paco2 between 35-40 maintain o2 92-98% in addition to managing the airway and respiratory parameters, which step is also prioritized during the initial stabilization phase - ANSWER treat hypotension Math the treatment for hypotension - ANSWER Epi: 2-10mcg/min norepi: 0.1-0.5mcg/kg/min dopamine: 5-20mcg/kg/min normal saline: 1-2L the patient's ventilation and bP have responded to treatment what other lab or diagnostic tests would be appropriate to consider at this time for reversible causes - ANSWER temp 12 lead ekg troponin During transport (STEMI EKG) what will ED physician most likely do when you arrive - ANSWER transfer to cath lab which of the following are immediately available as feedback from CPR performance monitors - ANSWER Compression rate, depth, recoil Normal PetCO2 range - ANSWER 35-45mmHg what is the main determinant of ETCO2 measurement during CPR - ANSWER Blood delivery to lungs what is the only CPR monitor typically available for measuring a physiologic end point outside of a hospital setting - ANSWER ETCO2 what invasive CPR performance measure reflects changes in cardiac output due to chest compressions, if oxygen consumption, arterial o2 sat, and hgb remain constant - ANSWER central venous oxygen saturation a 49yo arrives with chest discomfort, palpitations for past several hours, cold sweaty and weak initial steps - ANSWER ABC monitor rhythm and vital signs IV access 12 lead EKG first line drug for symptomatic bradycardia - ANSWER atropine pacing steps - ANSWER attach electrodes sedative/ analgesic turn pacer on set demand rate set current appropriate demand rate - ANSWER 60-80 Unable to palpate pulse that matches capture. do you have mechanical capture - ANSWER no Pt went into - ANSWER vfib, 1mg epi pt has ROSC. post cardiac arrest care algorithm - ANSWER ventilate patient with 10 breaths/ min, 92-98% sat, paco2 35-45 which component of effective high performance team is represented by the use of real time feedback devices - ANSWER quality initial assessment reveals conscious patient patient's airway is patent and advanced airway is not indicated which action in the primary assessment should you perform next - ANSWER administer oxygen as needed