- Which type of atrioventricular block best describes this rhythm?
C) Second-degree type II - Your patient is in cardiac arrest and has been intubated. To assess CPR quality, which should you do?
A) Monitor the patient’s PETCO2 - Which facility is the most appropriate EMS destination for a patient with sudden cardiac who achieved return of spontaneous circulation in the field?
D) Coronary reperfusion-capable medical center - Which of the following signs is a likely indicator of cardiac arrest in an unresponsive patient?
C) Agonal gasps - Which type of atrioventricular block best describes this rhythm?
B) Second-degree atrioventricular block type I - To properly ventilate a patient with a perfusing rhythm, how often do you squeeze the bag?
B) Once every 5 to 6 seconds. - In addition to clinical assessment, which is the most reliable method to confirm and monitor correct placement of an endotracheal tube?
C) Continuous waveform capnography - You are caring for a patient with a suspected stroke whose symptoms started 2 hours ago. The CT scan was normal, with no signs of hemorrhage. The patient does not have any contraindications to fibrinolytic therapy. Which treatment is the best for this patient?
B) Start fibrinolytic therapy as soon as possible. - Which best describes this rhythm?
D) Third-degree atrioventricular block. - What is the recommended range from which a temperature should be selected and maintained constantly to achieve targeted temperature management after cardiac arrest?
C) 32 to 36 Degrees Celsius - Which is the recommended first intravenous dose of amiodarone for a patient with refractory ventricular fibrillation?
D) 300 mg - What is the primary of a medical emergency team or rapid response team?
B) Improving patient outcomes by identifying and treating early clinical deterioration. - What is the recommended next step after a defibrillation attempt?
D) Resume CPR, starting with chest compressions - EMS providers are treating a patient with suspected stroke. According to the Adult Suspected Stroke Algorithm, which critical action performed by the EMS team will expedite this patient’s care on arrival and reduce the time to treatment?
A) Alert the hospital. - A responder is caring for a patient with a history of congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mmHg, and a heart rate of 190/min. The patient’s lead II ECG is displayed here. Which best characterizes this patient’s rhythm?
D) Unstable supraventricular tachycardia - Your rescue team arrives to find a 59-year-old man lying on the kitchen floor. You determine that he is unresponsive. Which is the next step in your assessment and management of this patient?
B) Check the patient’s breathing and pulse. - Which best describes the length of time it should take to perform a pulse check during the BLS assessment?
B) 5 to 10 seconds - You instruct a team member to give 1 mg Atropine IV. Which is the best example of closed-loop communication?
C) I’ll draw up 1 mg of Atropine. - What is an effect of excessive ventilation?
A) Decreased cardiac output. - If a team member is about to make a mistake during a resuscitation attempt, which best describes the action that the team leader or other team members should take?
C) Address the team members immediately. - Which best describes this rhythm?
A) Monomorphic ventricular tachycardia. - For STEMI patient, which best describes the recommended maximum goal time for emergency department door-to-balloon inflation time for percutaneous coronary intervention?
D) 90 minutes. - Which is the maximum interval you should allow for an interruption in chest compressions?
A) 10 seconds. - Which is the one way to minimize interruptions in chest compressions during CPR?
D) Continue CPR while the defibrillator charges. - Which best describes an action taken by the team leader to avoid insufficiencies during a resuscitation attempt?
C) Clearly delegate tasks. - Which is an acceptable method of selecting an appropriately sized oropharyngeal airway?
A) Measure the corner of the mouth to the angle of the mandible. - You are evaluating a 58-year-old man with chest discomfort. His blood pressure is 92/50 mm Hg, his heart rate is 92/min, his nonlabored respiratory rate is 14 breaths/min, and his pulse oximetry reading is 97%. Which assessment step is most important now?
C) Obtaining a 12-lead ECG. - A patient in respiratory distress and with a blood pressure of 70/50 mmHg presents with the lead IIECG rhythm shown here. Which is the appropriate treatment?
B) Performing synchronized cardioversion. - During post-cardiac arrest care, which is the recommended duration of targeted temperature management after reaching the correct temperature range?
B) At least 24 hours. - Three minutes into a cardiac resuscitation attempt, one member of your team inserts an endotracheal tube while another performs chest compressions. Capnography shows a persistent waveform and a PETCO2 of 8 mmHg. Which is the significance of this finding?
A) Chest compressions may not be effective. - Which is the recommended oral dose of aspirin for a patient with a suspected acute coronary syndrome?
C) 160 to 325 mg. - A team member is unable to perform an assigned task because it is beyond the team member’s scope of practice. Which action should the team member take?
A) Ask for a new task or role. - As the team leader, when do you tell the chest compressors to switch?
B) About every 2 minutes. - You are performing chest compressions during an adult resuscitation attempt. Which rate should you use to perform the compressions?
C) 100 to 120/min. - A patient is being resuscitated in a very noisy environment. A team member thinks he heard an order for 500 mg of amiodarone IV. Which is the best response?
D) I have an order to give 500 mg of amiodarone IV. - A patient in stable narrow-complex tachycardia with a peripheral IV in place is refractory to the first dose of adenosine. Which dose would you administer next?
B) 12 mg. - A patient has a witnessed loss of consciousness. The lead II ECG reveals this rhythm. Which is the appropriate treatment?
C) Defibrillation - Which of these tests should be performed for a patient with suspected stroke within 25 minutes of hospital arrival?
D) Noncontrast CT scan of the head. - What is the minimum systolic blood pressure one should attempt to achieve with fluid administration or vasoactive agents in a hypotensive post-cardiac arrest patient who achieves return of spontaneous circulation?
D) 90 mm Hg. - You have completed 2 minutes of CPR. The ECG monitor displays the lead II rhythm shown here, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. What do you do next?
C) Give epinephrine 1 mg IV. - Based on this patient’s initial presentation, which condition do you suspect led to the cardiac arrest?
A) Acute Coronary Syndrome. - In addition to defibrillation, which intervention should be performed immediately?
C) Chest Compressions. - Despite 2 Defibrillation attempts, the patient remains in ventricular fibrillation. Which drug and dose should you administer first to this patient?
A) Epinephrine 1 mg. - Despite the drug provided above and continued CPR, the patient remains in ventricular fibrillation. Which other drug should be administered next?
D) Amiodarone 300 mg. - The patient has return of spontaneous circulation and is not able to follow commands. Which immediate post-cardiac arrest care intervention do you choose for this patient?
A) Initiate targeted temperature management. - Which would you have done first if the patient had not gone into ventricular fibrillation?
D) Performed synchronized cardioversion. - Based on this patient’s initial assessment, which adult ACLS algorithm should you follow?
B) Tachycardia. - The patient’s pulse oximeter shows a reading of 84% on room air. Which initial action do you take?
C) Apply oxygen. - After your initial assessment of this patient, which intervention should be performed next?
A) Synchronized cardioversion. - If the patient became apneic and pulseless but the rhythm remained the same, which would take the highest priority?
D) Perform defibrillation.
Chest compressions for an adult are performed:
a. at a rate between 60-80 compressions
b. at a rate of at least 80 compressions per minute
c. at a rate between 80-100 compressions per minute
d. at a rate between 100-120 compressions per minute
d. at a rate between 100-120 compressions per minute
The ratio of compressions to breaths in adults is:
a. 15:1
b. 10:2
c. 20:2
d. 30:2
d. 30:2
*No matter how many rescuers are available (in adults), the correct ratio is 30 to 2.
An adult patient in respiratory arrest with a pulse is ventilated via bag valve mask:
a. 8-10 times per minute
b. 10-12 times per minute
c. 12-14 times per minute
d. 14-16 times per minute
b. 10-12 times per minute
*When there is no advanced airway in place, ventilations should be given 10 to 12 times per minute. This translates to one ventilation every 5 to 6 seconds.
Hypotension following cardiac arrest is NOT treated with:
a. IV calcium infusion
b. IV dopamine infusion
c. IV epinephrine infusion
d. IV ringer’s lactate or IV normal saline
a. IV calcium infusion
*Fluid resuscitation and/or “pressors” like epinephrine and dopamine are used to maintain blood pressure after cardiac arrest. Hypocalcemia, if present, can be treated separately but this is not a standard treatment for hypotension.
The leader in team resuscitation must:
a. be able to perform all the skills if needed
b. be certified as a leader
c. be a physician
d. undergo leadership training
a. be able to perform all the skills if needed
*There is no special training required to be a team leader other than the ability to perform all facets of the resuscitation, if needed. While the team leader is often a physician, this is not essential as long as a team member is capable of prescribing ACLS medications.
Recommended ED door to balloon inflation time for a STEMI patient is:
a. no longer than 15 minutes
b. no longer than 30 minutes
c. no longer than 60 minutes
d. no longer than 90 minutes
d. no longer than 90 minutes
*Programs should be set up to have STEMI patients diagnosed, evaluated, and treated within 90 minutes of arriving to the emergency department
The effectiveness of CPR can be estimated by:
a. arterial diastolic blood pressure
b. quantitative waveform capnography
c. central venous oxygen saturation
d. all of the above
d. all of the above
*All of these measures can inform providers about the quality of CPR. The quantitative waveform capnography goal is at least 10 mm Hg during CPR. Arterial diastolic blood pressure should be at least 20 mm Hg during CPR. Central venous oxygen saturation as measured by a Swan-Ganz catheter or equivalent should be at least 30%.
Narrow-complex supra ventricular tachycardia is best treated with:
a. adenosine
b. amiodarone
c. atropine
d. epinephrine
a. adenosine
*The main drug treatment for narrow QRS complex SVT is adenosine. The other drugs are used in ACLS under different circumstances.
Pulseless electrical activity is treated with:
a. epinephrine
b. magnesium
c. atropine
d. unsynchronized cardioversion
a. epinephrine
*Epinephrine is the standard treatment for PEA. Unsynchronized cardioversion is not recommended because PEA is not considered a “shockable” rhythm.
The correct sequence for basic life support is:
a. ABC-airway, breathing, circulation
b. ACB-airway, compressions, breathing
c. BCA-breathing, compressions, airway
d. CAB-compressions, airway, breathing
d. CAB-compressions, airway, breathing
Which of the following is the correct initial dose of adenosine for treatment of supra ventricular tachycardia:
a. 1mg IV
b. 6mg IV
c. 12mg IV
d. 100mg IV
b. 6mg IV
*The first dosage of adenosine is 6 mg IV. If 6 mg fails to achieve an effect, the subsequent dosage is 12 mg IV.
At what heart rate does tachycardia usually become symptomatic?
a. 100 bpm
b. 60 bpm
c. 150 bpm
d. 50 bpm
c. 150 bpm
*
While it depends on the patient, a useful rule of thumb is tachycardia starts to become symptomatic at 150 bpm. The textbook definition of tachycardia is a heart rate >100 bpm.
Pulse checks should be done for at least 10 seconds
True
False
False
*They should be done for no less than 5 seconds and no more than 10 seconds.
The initial recommended dosage of atropine for symptomatic bradycardia is 0.5 mg IV.
True
False
True
*Dosages less than 0.5 mg may cause a paradoxical slowing of the heart rate.
During cardiopulmonary resuscitation, deliver oxygen at:
a. 2 liters per minute via nasal cannula
b. titrated to keep oxygen saturation greater than or equal to 85%
c. titrated to keep oxygen saturation greater than or equal to 94%
d. 100%
d. 100%
*CPR is performed during cardiac arrest and 100% oxygen should be administered during cardiac arrest.
The goal for initiation of fibrinolytic therapy in appropriate stroke patients is:
a. within 4 hrs of ED arrival
b. within 6 hrs of ED arrival
c. within 3 hrs of ED arrival
d. within 1 hr of ED arrival
d. within 1 hr of ED arrival
*All diagnostic testing and checklists should be performed so that a fibrinolytic drug can be infused within 1 hour of arriving to the emergency department. The window from symptom onset is different (3 hours in most, 4.5 hours in some).
The most common reversible causes of PEA are called the “H’s and T’s” and include all of the following except:
a. hypovolemia
b. hypoxia
c. hypocalcemia
d. tamponade
c. hypocalcemia
An EMT discovers STEMI on a 12-lead EKG in the ambulance. The best option is to:
a. take the patient to the hospital capable of providing open-heart surgery, regardless of fibrinolysis or PCI capability
b. take the patient to a hospital capable of providing fibrinolysis only (not PCI), 5 minutes away
c. Provide fibrinolysis in the ambulance then take the patient to a hospital capable of proving PCI, 15 minutes away
d. take the patient to the hospital of providing PCI, 15 minutes away
d. take the patient to the hospital of providing PCI, 15 minutes away
*PCI is the preferred treatment for STEMI. So much so, patients should be preferentially taken to hospitals that offer the procedure, even if it takes a slightly longer time. During travel time, the accepting hospital should activate the cardiac catheterization team.
Which of the following signs is NOT part of the Cincinnati Prehospital Stroke Scale?
a. facial droop
b. arm drift
c. abnormality
d. confusion/disorientation
d. confusion/disorientation
*The Cincinnati Prehospital Stroke Scale can be remembered by the acronym FAST: Facial droop, Arm drift, Speech abnormality (slurring, usually), and Time. Time is not a symptom.
A child is gasping for breath but has a pulse rate of 100 per minute. The rescuers should:
a. start CPR beginning with compressions
b. give 1 breath every 5-6 seconds
c. give 1 breath every 3-5 seconds
d. do nothing; the child is not in distress
c. give 1 breath every 3-5 seconds
*This child needs rescue breathing, not chest compressions. The correct rate for pediatric rescue breathing is 1 ventilation every 3 to 5 seconds. This equates to 12-20 breaths per minute.
A child is not breathing but has a pulse rate of 50 per minute. The rescuers should:
a. start CPR beginning with compressions
b. give 1 breath every 5-6 seconds
c. give 1 breath every 3-5 seconds
d. do nothing; the child is not in distress
a. start CPR beginning with compressions
*A pulse rate <60 bpm is consistent with cardiac arrest in children. Therefore, CPR is required, starting with chest compressions.