Acls Certification Test Study Guide 2010

Front 1

What rhythm most commonly follows a cardiac arrest in adults?

Back 1

VF (V-FIB)
.
Because pulseless VT (V-Tach) often rapidly deteriorates to VF (V-Fib)

Front 2

Adult patients with ROSC (return of spontaneous circulation), therapeutic hypothermia is recommended. What is the goal body temp and lenth of time of the cooling?

Back 2

32-34 C (89.6-93.2F) for 12 to 24 hrs

Front 3

IF during CPR (cardiopulmonary resusciation), the waveform capnography is < 10 mmHg. What would you consider?

Back 3

The quality of CPR in inadequate; attempt to improve it

Front 4

If PETCO2 abruptly increases to a normal value of 35-40 mmHg, what would you consider?

Back 4

ROSC
(return of spontaneous circulation)

Front 5

Synchronized cardioversion is the treatment of choice for what condition?

Back 5

1. unstable SVT
2. uunstable AFIB
3. unstable A-Fludder
4. unstable regular monomorphic tachycardia w/ a pulse

Front 6

While perfomring synchronized cardioversion, your pt suddenly develops V-FIB, what do you do??

Back 6

Immediately attempt to defibulate the patient.

Most defibs will revert back to unsynchronized mode after a synchronized cardioversion due to this)

Front 7

What four initial drugs should be considered for suspected MI?

Back 7

1. Morphine Sulfate
2. Oxygen
3. Nitroglycern
4. ASA (asprin)
"MONA"

Front 8

How long should you check for a pulse?

Back 8

5 seconds but no longer than 10 seconds

Front 9

If chest compressions must be interrupted, how long is the recommended limit?

Back 9

10 seconds or less

Front 10

What is the first step in any emergency before ABCD's?

Back 10

ABCD'S is the ACLS survey....
BLS survey comes first

Front 11

For a patient in respiratory arrest with a pulse, how often do you give a breath?

Back 11

1 ventilation every 5-6 seconds (10-12 bpm)

Front 12

For a patient in respiratory arrest with a pulse, how often do you recheck the pulse?

Back 12

every 2 minutes

Front 13

What harm can be caused by hyperventilation?

Back 13

increase of intrathoracic pressure
decrease venous return to the heart
diminishes cardiac output
Can also cause gastric inflation and pre-dispose pt to vomiting and aspiration of gastric contents.

Front 14

With a suspected neck injury, how would you open the airway?

Back 14

Jaw thrust WITHOUT head extension

Front 15

If the jaw thrust in a suspected neck injury pt was not effective, how would you open the airway with a suspected neck injury?

Back 15

head tilt chin lift as ventilation is priority

Front 16

Why is an OPA (oropharyngeal airway) NOT used on a conscious victim?

Back 16

Conscious victims have a cough an gag reflex - OPA can stimulate vomiting and laryngospasm.

Front 17

How do you measure for proper sizing of the OPA (oropharyngeal airway)?

Back 17

Place on side of face, when tip of OPA is at the corner of the mouth, the flange is at the angle of the mandible.
Properly sized OPA results in proper alignment with the glottic opening.

Front 18

What could happen if the OPA (oropharyngeal airway) is too large?

Back 18

May obstruct the larynx or could cause trauma to the laryngeal structures.

Front 19

What could happen if the OPA (oropharyngeal airway) is too small or incorrectly placed?

Back 19

It could push the base of the tongue posteriorly and obstruct the airway.

Front 20

When would you use an NPA (nasopharyngeal airway)?

Back 20

It can be used in consciouse or semi-conscious patients. Or used when OPA is technically difficult or dangerous as with pt with gag reflex, trismus, massive trauma around mouth, or wiring of the jaw.

Front 21

How do you correctly size the NPA (nasopharyngeal airway)?

Back 21

Outer circumference of the NPA should compare with the INNER aperture of the nares. Lenght of the NPA should be the same as the distance from the tip of the nose to the earlobe.

Front 22

What do you check immediately after insertion of an OPA or NPA?

Back 22

Check spontaneous respirations....if respirations are absent or inadequate, start positive pressure ventilations at once with an appropriate device.
If not available use mouth to mouth w/barrier device for ventilation.

Front 23

If routine use of circoid pressure indicated?

Back 23

No, may impede with ventilation and interfere with placement of supraglottic airway or intubation.

Front 24

How often are breaths given when an advanced airway is in place?

Back 24

1 breath every 6-8 seconds (8-10 bpm) without regard to compressions.
If NO compressions, 1 breath every 5-6 seconds (10-12 bpm)

Front 25

When suctioning with ETT (endotracheal tube), how long would you apply suction?

Back 25

no longer than 10 seconds

Front 26

If you were not sure if the patient has a pulse, would you begin compressions?

Back 26

YES

Front 27

How does defibrallation affect the viable heart in V-tach or V-Fib?

Back 27

Stuns and briefly terminates all electrical activity including VT and VF, when viable, the hearts normal pacemakers may eventually resume electrical activity.

Front 28

Prior to shocking, is it important to be sure oxygen is NOT flowing across the victim's chest?

Back 28

YES!! COULD CAUSE EXPLOSION

Front 29

Waveform capnography monitor ETT placement but can it also monitor CPR quality?

Back 29

YES, PETCO<10 mmHg suggests poor quality of CPR, if arterial relaxation is <20 mmHg attempt to improve chest compressions, if ScvO2 is <30% try to improve

Front 30

Why is CPR needed immediately following defibrillation?

Back 30

Immediately after successful defib, any spontaneous rhythm is typically slow and does not create pulses or adequate perfusion.

Front 31

What should you do if the AED does not function properly?

Back 31

NEVER delay chest compressions to troubleshoot AED
Resume compressions and ventilations
Check all connections between the AED and the patient.

Front 32

What would you do when applying the AED pads on a hairy chest?

Back 32

Press down firmly on the pads; If the AED continues to promp you to check pads/electrodes quickly pull off the pades as this will revove much of the hair. If still too much hair, shave with razor in the AED carrying case if available and put new set of AED pads on pt.

Front 33

What would you do if your victum is in water and you needed to defibrillate him?

Back 33

DO NOT USE IN WATER - pull pt out of water
If water on patient's chest, wipe off
Lying on snow or ice or in a small puddle - ok to use AED

Front 34

What would you do if your victim needed a shock but was lying in the snow?

Back 34

USE THE AED

Front 35

Could you utilize an AED if the victium has an implanted defib/pacemaker?

Back 35

YES - place the pads on either side of device (not directly on top) & follow normal steps. Occasionally the analysis & shock cycles of implanted defib & AEDs will conflict- if you notice pt's muscles contracting like with shock AED/defib shocking, wait 30-60 sec for internal defib to finish cycle before delivering shock via AED

Front 36

Is it acceptable to place pads over medication patches?

Back 36

NO - may block transfer of energy or cause burns on skin
Remove medication patches and wipe skin.

Front 37

What is done IMMEDIATELY post-shock?

Back 37

Restart of compressions

Front 38

How long should compressions be held for rhythm checks?

Back 38

Less than 10 seconds.

Front 39

What vasopressor and dose willyou give your patient in VF?

Back 39

Epinephrine 1 mg q 3-5 min
OR
Vasopressor 40 units

Front 40

If IV access is not available what is the next best-preferred route for medication adminstration?

Back 40

IO (intraosseous or directly into the bone marrow)

Front 41

At what SBP would you consider treatment for hypotension?

Back 41

<90 SBP

Front 42

What is recommended IV fluid bolus and amount to treat hypotension?

Back 42

1-2 L NS or LR

Front 43

What is the second does of amiodarone in VF?

Back 43

150 mg (first is 300mg)

Front 44

During a code, are drug administrations and advances airway a primary importance?

Back 44

NO - compressions are priority!

Front 45

What is the energy level for biphasic cardioversion of unstable A-FIB?

Back 45

200j

Front 46

What is the energy level for biphasic cardioversion of unstable monorphic VT?

Back 46

100j

Front 47

What is the energy level for biphasic cardioversion of unstable SVT or A-flutter

Back 47

200j

Front 48

What is the energy level for biphasic cardioversion of unstable polymorphic VT (irregular form and rate)?

Back 48

Treat as VF with high-energy shock

Front 49

Why is the IO route considered over the ETT route for medication administration?

Back 49

Increased absorption via IO route - higher doses of medications and unknown absorption rates via ETT

Front 50

Can IO access be established in the elderly?

Back 50

YES - all age groups

Front 51

What drugs can be administered via the IO route?

Back 51

ANY ACLS drug or fluid that is administered IV can be done via IO

Front 52

When would you NOT consider therapeutic hypothermia after ROSC (return of spontaneous circulation)?

Back 52

NONE

Front 53

If necessary, what drugs can be given via the ETT route?

Back 53

Lidocaine, epinephrine, vasopressin

Front 54

How would you administer drugs via the ETT route?

Back 54

Dilute the dose in 5-10 mls sterile water or NS and inject the drug directly into the trachea
Dose is 2 - 2 1/2 x the IV dose

Front 55

What is the definistion of PEA? (pulseless electrical activity)

Back 55

Any organized rhythm without a pulse

Front 56

For PEA (pulseless electrical activity), what dose would you give?

Back 56

Epinephrine 1mg q3-5 min or vasopressin 40 units
Amiodarone 300 mg then 150 mg

Front 57

What is the maximum total dose of atropine?

Back 57

0.04 mg/kg or 3 mg total

Front 58

What would be two acceptable reasons to stop or withold CPR?

Back 58

pulse / rhythm check and to defib

Front 59

After giving a drug, how long do you provide CPR?

Back 59

2 minutes

Front 60

What are the 6 H's?

Back 60

hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia

Front 61

What are the 5 T's?

Back 61

tension pneumothorax, tamponade, toxins, thrombosis (cardiac or pulmonary)

Front 62

Would you give NTG to a patient with an inferior wall MI or with right ventricular infarction?

Back 62

NO - due to dependence on RV filling to maintain CO and BP
Other vasodilators (morphine) or volume-depleting drugs drugs (morphine) are contraindicated as well

Front 63

Is asystole truly a "rhythm"?

Back 63

YES

Front 64

Symptomatic bradycardia exists when what criteria are present?

Back 64

Hypotension, AMS change, signs of shock, eschemic chest discomfort, acute heart failure.

Front 65

What is the key critical concept to consider in treating bradycardia?

Back 65

Determination of adequate perfusion

Front 66

If atropine is ineffective for symptomatic bradycardia, what will you do next?

Back 66

Transcutaneous pacing, dopamine or epinephrine infusion.

Front 67

Is pacing recommended for asystole?

Back 67

no

Front 68

How would you treat stable regular tachycardia with wide complexes?

Back 68

Adenosine - if regular or monomorphic
anti-arrhythmic infusion
expert consultation

Front 69

How would you treat stable narrow QRS complex trachycardia,?

Back 69

IV access w/ 12 lead EKG, vagal maneuvers, BB or CCB, adnosine (if regular), expert consultation

Front 70

Whar are the key questions to ask when evaluating a patient with tachycardia?

Back 70

Unstable with s/sx a result of tachycardia - hypotension, AMS, signs of shock, ischemic chest discomfort, AHF

Front 71

Why is it important to synchronize cardoversion?

Back 71

Is in sync with the rhythm to defib in the peak of the R wave instead of shocking during the repolarization period which can percipitate VF

Front 72

Why is a CT scan critical to determine treatment for a stroke?

Back 72

To determine hemorrhagic VS ischemic stroke

Front 73

Why is it best to call EMS vs driving someone to the ER?

Back 73

delays access to treament and diagnosis

Front 74

What is the correct order for AED use?

Back 74

Power on AED
Attach electrode pads
analyze rhythem
if AED advises shock, be sure to clear the patient

Front 75

How many times will you shock a patient VF?

Back 75

Until perusing rhythm, ROSC, or deteriorates to asystole (unless hypothermia or drug overdose)