https://www.youtube.com/watch?

v=ZQI6In4xco8

Slide 1 –
Course Description and Goal
The Advanced Cardiovascular Life Support (ACLS) Provider Course is designed for healthcare
providers who either direct or participate in the management of cardiopulmonary arrest or other
cardiovascular emergencies. Through didactic instruction and active participation in simulated
cases, students will enhance their skills in the recognition and intervention of cardiopulmonary
arrest, immediate post–cardiac arrest, acute dysrhythmia, stroke, and acute coronary syndromes
(ACS). The goal of this course is to improve outcomes for adult patients of cardiopulmonary
arrest and other cardiovascular emergencies through early recognition and interventions by high-
performance teams.
Course Objectives
After successfully completing this course, you should be able to
 Define systems of care
 Apply the Basic Life Support (BLS) Assessment, Primary Assessment, and Secondary
Assessment sequences for systematic evaluation of adult patients
 Discuss how using rapid response teams (RRTs) or medical emergency teams (METs)
may improve patient outcomes
 Discuss early recognition and management of ACS, including appropriate disposition
 Discuss early recognition and management of stroke, including appropriate disposition
 Recognize bradycardia and tachycardia that may result in cardiac arrest or complicate
resuscitation outcome
 Perform early management of bradycardia and tachycardia that may result in cardiac
arrest or complicate resuscitation outcome
 Model effective communication as a member or leader of a high-performance team
 Recognize the impact of team dynamics on overall team performance
 Recognize respiratory arrest
 Perform early management of respiratory arrest
 Recognize cardiac arrest
 Perform prompt, high-quality BLS, which includes prioritizing early chest compressions
and integrating early automated external defibrillator (AED) use
 Perform early management of cardiac arrest until termination of resuscitation or transfer
of care, including immediate post–cardiac arrest care
 Evaluate resuscitative efforts during cardiac arrest by continually assessing
cardiopulmonary resuscitation (CPR) quality, monitoring the patient’s physiologic
response, and delivering real-time feedback to the team
Slide 2 –
BLS Skills
Strong BLS skills form the foundation of ACLS, so you must pass the high-quality BLS Testing
Station to complete this course. Make sure that you are proficient in BLS skills before attending
the class.
ECG Rhythm Interpretation for Core ACLS Rhythms
The basic cardiac arrest and periarrest algorithms require students to recognize these ECG
rhythms:
 Sinus rhythm
  Atrial fibrillation and flutter
 Sinus bradycardia
 Sinus tachycardia
 Supraventricular tachycardia
 Atrioventricular blocks
 Asystole
 Pulseless electrical activity (PEA)
 Ventricular tachycardias (VTs)
 Ventricular fibrillation (VF)
The ACLS Precourse Self-Assessment contains an ECG rhythm identification section. Use your
self-assessment score and feedback to help you identify your areas of strength and weakness
before attending the class. You must be able to identify and interpret rhythms during course
practice sessions and the final Megacode evaluation station.
Basic ACLS Drug and Pharmacology Knowledge
You must know the drugs and doses used in the ACLS algorithms. You will also need to know
when to use which drug based on the clinical situation.
The ACLS Precourse Self-Assessment contains pharmacology questions. Use your self-
assessment score and feedback to help you identify areas of strength and weakness before
attending the class.

Slide 3 –
ACLS Student Resources

The ACLS Student Resources (accessed via eLearning.heart.org) contain mandatory

precourse preparation and supplementary materials.
 Precourse Self-Assessment (passing score 70% or greater)
 Precourse work (complete interactive video lessons)
Use the following website resources to supplement basic concepts in the ACLS Course. Some
information is supplementary; other areas provide additional information for interested students
or advanced providers.
 Precourse Preparation Checklist (used to ensure that students are ready to attend the
class).
 ACLS Supplementary Material
o –Basic Airway Management
o –Advanced Airway Management
o –ACLS Core Rhythms
o –Defibrillation
o –Access for Medications
o –Acute Coronary Syndromes
o –Human, Ethical, and Legal Dimensions of ECC and ACLS
 Optional Videos
o –Intraosseous Access
o –Coping With DeathN

YOU WILL NEED TO COMPLETE THE ACLS PRECOURSE SELF-ASSESSMENT WITH A PASSING SCORE OF 70% OR GREATER
Slide 4 –
Before class, read the ACLS Provider Manual, complete the mandatory precourse work in ACLS
Student Resources (accessed via eLearning.heart.org), identify any gaps in your knowledge,
and remediate those gaps by studying the applicable content in the ACLS Provider Manual or
other supplementary resources, including the ACLS Student Resources. You must pass the
Precourse Self-Assessment with a minimum score of 70%. You may retake the self-assessment
as often as needed to pass. Print your certificate of completion and score report and bring
them with you to the course.
https://quizlet.com/426981662/acls-pretest-flash-cards/#

Slide 5 –
Cardiac arrest can happen anywhere—on the street, at home, or in a hospital emergency
department (ED), in-patient bed, or intensive care unit (ICU). Elements in the system of care and
order of actions in the Chain of Survival differ based on the situation. Care will depend on
whether the victim has the arrest outside the hospital or inside the hospital. Care also depends on
whether the victim is an adult, child, or infant.
Chain of Survival Elements
Although there are slight differences in the Chains of Survival based on the age of the victim and
location of the cardiac arrest, each includes the following elements:
 Prevention and preparedness, including responder training, early recognition of cardiac
arrest, and rapid response
 Activation of the emergency response system, either outside of or within the hospital
 High-quality CPR, including early defibrillation of VF and pVT
 Advanced resuscitation interventions, including medications, advanced airway
interventions, and extracorporeal CPR
 Post–cardiac arrest care, including critical care interventions and targeted temperature
management
 Recovery, including effective support for physical, cognitive, emotional, and family
needs
Regardless of where an arrest occurs, the care following resuscitation converges in the hospital,
generally in an ED or ICU. This post‒cardiac arrest care is depicted as the final link in both
chains, symbolized by a hospital bed with a monitor and thermometer, which represent critical
care interventions, advanced monitoring, and targeted temperature management. Patients who
achieve ROSC after cardiac arrest in any setting have complex pathophysiologic processes called
the post–cardiac arrest syndrome. This syndrome plays a significant role in patient mortality and
includes
 Postarrest brain injury
 Postarrest myocardial dysfunction
 Systemic ischemia and reperfusion response
 Persistent acute and chronic pathology that may have precipitated the cardiac arrest 5
Healthcare systems should implement a comprehensive, structured, consistent, multidisciplinary
system of care for treating post–cardiac arrest patients. Programs should address ventilation and
hemodynamic optimization, targeted temperature management (TTM), immediate coronary
reperfusion with percutaneous coronary intervention (PCI) for eligible patients, neurologic care
and prognostication, and other structured interventions. Individual hospitals that frequently treat
cardiac arrest patients show an increased likelihood of patient survival when these interventions
are provided.
As noted above, the structure and process elements before the convergence of the 2 chains vary
significantly. Patients with OHCA depend on elements within the community for support. Lay
rescuers must recognize the patient’s arrest, call for help, and initiate CPR and early
defibrillation (public-access defibrillation [PAD]) until a team of professionally trained
emergency medical services (EMS) providers assumes responsibility and transports the patient to
an ED and/or cardiac catheterization lab, followed by admission to an ICU for post‒cardiac
arrest care. Ideally, all victims of OHCA receive bystander CPR and defibrillation; if not, CPR
and defibrillation won’t occur until EMS personnel arrive, making the victim’s chance of
survival much lower. It is vital to measure and improve dispatch-aided CPR rates.
In contrast, patients with IHCA depend on a system of appropriate early recognition and
prevention of cardiac arrest, which is represented by a magnifying glass in the first link. When
cardiac arrest occurs, prompt activation of the emergency response system with a response to the
cardiac arrest that provides high-quality CPR, early defibrillation, and advanced cardiovascular
life support should result in the smooth interaction of a multidisciplinary team of professional
providers, including physicians, nurses, respiratory therapists, and others. The last link is
recovery and includes considerations for the postarrest needs of the patient and family. The chain
metaphor endures: in any resuscitation, the chain is no stronger than its weakest link.
The classic resuscitation Chain of Survival concept linked the community to EMS and EMS to
hospitals, with hospital care as the destination.6 But patients with a cardiac emergency may enter
the system of care at any point (Figure 3), including on the street; at home; or in the hospital’s
ED, inpatient bed, ICU, operating suite, catheterization suite, or imaging department. The system
of care must be able to manage cardiac emergencies wherever they occur.

The third link in the Chain of Survival is High quality CPR

Slide 6 – Megacode example

https://www.youtube.com/watch?
time_continue=1&v=XAXu_zsBAAI&embeds_referring_euri=https%3A%2F
%2Fcpr.talentlms.com%2F&source_ve_path=MjM4NTE&feature=emb_title

slide 7 – ACLS Systems of Care

https://www.youtube.com/watch?v=ZErUwbAx3Qs

Slide 8 – ACLS Science of Resuscitation

https://www.youtube.com/watch?v=4X16Ea4l-tM
HIGH QUALITY CPR INCLUDES A COMPRESSION RATE OR 100-120 CPM.
COMPRESSING TO A DEPTH OR AT LEAST 2" FOR AN ADULT
ALLOWING COMPLETE RECOIL AND GIVING A FULL BAG OF AIR WITH THE BAG
MADK DEVICE?
TRUE or FALSE

Slide 9 – ACLS Systematic Approach

https://www.youtube.com/watch?v=XG2QZKpXPVI
Slide 10 – ACLS CPR Coach
https://www.youtube.com/watch?v=8T2dTV5e-G4

Slide 11 – ACLS High Quality BLS Part 1

https://www.youtube.com/watch?
time_continue=196&v=blYvzGBwIu0&embeds_referring_euri=https%3A%2F
%2Fcpr.talentlms.com%2F&source_ve_path=MTM5MTE3LDIzODUx&feature=emb_title

Slide 12 – ACLS High Quality BLS Part 2

https://www.youtube.com/watch?v=ofuI1AO2f40

slide 13 – ACLS Airway Management

https://www.youtube.com/watch?v=zlnc5wVIfY4&embeds_referring_euri=https%3A%2F
%2Fcpr.talentlms.com%2F&source_ve_path=MTc4NDI0

slide 14 – ACLS Recognition

https://www.youtube.com/watch?v=Vf-XZdRRvhk

YOU CAN RECOGNIZE A VICTIM OF POSSIBLE CARDIAC ARREST BY LACK OF BREATHING ALONE
FALSE or TRUE

Slide 15 – Advance Cardiac Support

https://www.youtube.com/watch?v=QRcloJp6r7Q&embeds_referring_euri=https%3A%2F
%2Fcpr.talentlms.com%2F&source_ve_path=MTc4NDI0

Slide 16 – Advance Cardiac Support Part 2

https://www.youtube.com/watch?v=9LefHqsOh7w

slide 17 – Advance Cardiac Support Part 3

https://www.youtube.com/watch?v=XCcTxTRQdwg

Slide 18 – Advance Cardiac Support Part 4

https://www.youtube.com/watch?v=40ltFhXmYjc

Stroke
https://m.blog.naver.com/dbsgpwls416/221853393354
Slide 19 – Stroke Part 1
https://www.youtube.com/watch?v=kaDicOVpiww

Slide 20 – Stroke Part 2

https://www.youtube.com/watch?v=r56OWg7-fd8&embeds_referring_euri=https%3A%2F
%2Fcpr.talentlms.com%2F&source_ve_path=MTc4NDI0
10:32
Slide 21 – Stroke Part 3
https://www.youtube.com/watch?v=KAQMoUZUVMk

Slide 22 – Stroke Part 4

https://www.youtube.com/watch?v=ZIgFMasw6fQ&embeds_referring_euri=https%3A%2F
%2Fcpr.talentlms.com%2F&source_ve_path=MTc4NDI0

Slide 23 – Cardiac Arrest Algorithms

https://www.youtube.com/watch?v=7B7dIYDLy_M&embeds_referring_euri=https%3A%2F
%2Fcpr.talentlms.com%2F&source_ve_path=MTc4NDI0

Slide 24 – Tachycardia Arrythmias

https://www.youtube.com/watch?v=iSUs_6kuRaI

Slide 25 – Bradycardia Algorithms

https://www.youtube.com/watch?v=N8Sg-rVGR70

Slide 26 – Post Cardiac Arrest

https://www.youtube.com/watch?v=TQ54cOmFBIQ

Slide 27 – IO Access
https://www.youtube.com/watch?v=OvzI8QUR0fg&embeds_referring_euri=https%3A%2F
%2Fcpr.talentlms.com%2F&source_ve_path=MTc4NDI0

Slide 28 – Coping With Death Part 1

https://www.youtube.com/watch?v=_ys89Cf5koE
Slide 29 – Coping With Death Part 2
https://www.youtube.com/watch?v=YiNd558dcdc

Slide 30 - Conclusion
YOU HAVE COMPLETED THE VIDEO PORTION OF THE ACLS COURSE.
NOW YOU NEED TO COMPLETE THE ACLS ONLINE EXAM. YOU WILL
RECEIVE A CERTIFICATE FOR COMPLETING THIS PORTION OF THE
COURSE. REMEMBER TO TAKE A PICTURE OF THE CERTIFICATE FROM
THIS COURSE. YOU WILL NEED TO TURN IT INTO THE INSTRUCTOR
WHEN YOU TAKE THE SKILLS PORTION OF THE COURSE.

NEXT YOU WILL NEED TO TAKE THE ACLS ONLINE EXAM. YOU WILL
RECIEVE AN EMAIL WITH A LINK TO TAKE THE AHA ONLINE EXAM.
PLEASE REMEMBER TO TAKE A PICTURE OF THE CERTIFICATE FROM
THE EXAM AS WELL. YOU WILL NEED TO TURN THAT CERTIFICATE IN AS
WELL.

TAKE YOUR TIME WITH THE EXAM. YOU WILL BE ABLE TO TAKE IT AS
MANY TIMES AS NECESSARY BUT YOU MUST SCORE AT LEAST 70%. THE
AHA WILL ASSIST YOU WITH THE EXAM BY ASKING YOU THE QUESTIONS
THAT YOU MISS SEVERAL TIMES AFTER GIVING YOU THE ANSWERS.

ONCE YOU HAVE COMPLETED THE ONLINE EXAM YOU WILL NEED TO
COMPLETE THE SKILLS CHECK OFF BY GOING TO
AMERICANCPRCONNECTION.COM AND GOING TO TRACEY'S ZOOM
SESSIONS. THE TIMES FOR THE CLASSES ARE ON THAT PAGE. DURING
THE ZOOM SESSION WE WILL GO THRU MEGA CODES USING A
SIMULATED HEART MONITOR. FOLLOWING THE SKILLS SESSION, YOU
WILL RECEIVE YOUR AHA ACLS CERTIFCATION CARD THE SAME DAY.

SEE YOU SOON IN CLASS AND HAPPY LEARNING.

THANK YOU FOR CHOOSING AMERICAN CPR CONNECTION.

1. WHICH OF THESE TESTS SHOULD BE PERFORMED FOR A PATIENT WITH
SUSPECTED STROKE AS SOON AS POSSIBLE BUT NO MORE THAN 20
MINUTES AFTER HOSPITAL ARRIVAL?
a. 12 LEAD ECG
b. CARDIAC ENZYMES
c. COAGULATION STUDIES
d. NONCONTRAST CT SCAN OF THE HEAD
2. WHICH IS AN ACCEPTABLE METHOD OF SELECTING AN APPROPRIATELY
SIZED OROPHARYNGEAL AIRWAY?
a. MEASURE FROM THE CORNER OF THE MOUTH TO THE ANGLE OF
THE MANDIBLE
b. MEASURE FROM THE THYROID CARTLAGE TO THE BOTTOM OF THE
EARLOBE
c. ESTIMATE BY USING THE FORMULA WEIGHT (KB) 8+2
d. ESTIMATE BY USING THE SIZE OF THE PATIENT'S FINGER
3. 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
APPROACH IS BEST FOR THE PATIENT?
a. HOLD FIBRINOLYTIC THEAPY FOR 24 HOURS
b. GIVE FIBRINOLYTIC THERAPY AS SOON AS POSSIBLE AND
CONSIDER ENDOVASCULAR THERAPY
c. ORDER AN ECHOCARDIOGRAM BEFORE FIBRINOLYTIC
ADMINISTRATION
d. WAIT FOR RESULTS OF THE MRI
4. WHICH IS THE RECOMMENDED NEXT STEP AFTER A DEFIBRILLATION
ATTEMPT?
a. CHECK THE ECG FOR EVIDENCE OF A RHYTHM
b. OPEN THE PATIENT'S AIRWAY
c. DETERMINE IF A CAROTID PULSE IS PRESENT
d. RESUME CPR, STARTING WITH CHEST COMPRESSIONS.
5. WHICH OF THE FOLLOWING SIGNS IS A LIKELY INDICATOR OF
CARDIAC ARREST IN AN UNRESPONSIVE PATIENT?

a. SLOW, WEAK, PULSE RATE?

b. CYANOSIS?
c. AGONAL GASPS
d. IRREGULAR, WEAK PULSE RATE
6. 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 RRESPIRATORY RATE IS 14
BREATHS PER MINUTE, AND HIS PULSE OXIMETRY READING IS 97%.
WHICH ASSESSMENT STEP IS MOST IMPORTANT NOW?
a. EVALUATING THE PETCO2 READING
b. REQUESTING A CHEST X-RAY
c. OBTAINING A 12-LEAD ECG
d. REQUESTING LABORATORY TESTING
7. DURING POST-CARDIAC ARREST CARE, WHICH IS THE
RECOMMENDED DURATION OF TARGETED TEMPERATURE
MANAGEMENT AFTER REACHING THE CORRECT TEMPERATURE
RANGE?
a. AT LEAST 8 HOURS
b. AT LEAST 24 HOURS
c. AT LEAST 36 HOURS
d. AT LEAST 48 HOURS
8. YOUR RESCUE TEAM ARRIVES TO FIND A 59-YEAR-OLD MAN LYING
ON THE KITCHEN FLOOR. YOU DEETERMINE THAT HE IS
UNRESPONSIVE. WHICH IS THE NEXT STEP IN YOUR ASSESSMENT
AND MANAGEMENT OF THIS PATIENT?
a. APPLY THE AED
b. CHECK THE PATIENT'S BREATHING AND PULSE
c. OPEN THE PATIENT'S AIRWAY
d. CHECK FOR A MEDICAL ALERT BRACELET
9. USE THIS SCENARIO TO ANSWER THE NEXT 6 QUESTIONS
 A 45-YEAR-OLD MAN HAD CORONARY ARTERY STENTS PLACE 2 DAYS
AGO. TODAY, HE IS IN SEVERE DISTRESS AND IS REPORTING
"CRUSHING' CHEST DISCOMFORT. HE IS PALE, DIAPHORETIC, AND
COOL TO THE TOUCH. HIS RADIAL PULSE IS VERY WEAK., BLOOD
PRESSURE IS 64/40mm Hg, RESPIRATORY RATE IS 28 BREATHS PER
MINUTE, AND OXYGEN SATURATION IS 89% ON ROOM AIR. WHEN
APPLIED, THE CARDIAC MONITOR INITIALLY SHOWED VENTRICULAR
TACHYCARDIA WHICH THEN QUICKLY CHANGED TO VENTRICULAR
FIBRILLATION.

ON THE BASIS OF THE PATIENT'S INITIAL PRESENTATION, WHICH

CONDITION DO YOU SUSPECT LED TO THE CARDIAC ARREST?

a.ACUTE CORONARY SYNDROME

b.ACUTE HEART FAILURE
c.ACUTE ISCHEMIC STROKE
d.SUPRAVENTRICULAR TACHYCARDIA WITH ISCHEMIC CHEST
PAIN
10. IN ADDITION TO DEFIBRILLATION, WHICH INTERVENTION
SHOULD BE PERFORMED IMMEDIATELY?
a. ADVANCED AIRWAY INSERTION
b. VASOACTIVE MEDICATION ADMINISTRATION
c. CHEST COMPRESSIONS
d. VASCULAR ACCESS

11. Where should the CPR COACH stand?

a. Next to the Team Leader
b. Across from the Compressor and next to the feedback
display
12. AED STANDS FOR....?
a. AUTOMATED EXTRA DEFIBRILLATOR
b. AUTOMAIC EXTERNAL DEFIBRILLATOR
13. IN THE CARDIAC ARREST ALGORITHM, WHEN SHOULD 1 MG
OF EPINEPHRINE BE ADMINISTERED?
a. AFTER THE FIRST SHOCK
 b. AFTER THE SECOND SHOCK
14. FOR UNSTABLE TACHYCARDIA, IMMEDIATE _______________IS
INDICATED
a. ADENOSINE
b. SYNCHRONIZED CARDIOVERSION
15. BRADYCARDIA IS A HEARTRATE LESS THAN
_______________BPM?
a. 50
b. 60

16. DESPITE 2 DEFIBRILLATION ATTEMPTS, THE PATIENT REMAINS

IN VENTRICULAR FIBRILLATION. WHICH DRUG AND DOSE SHOULD
YOU ADMINISTEER FIRST TO THIS PATIENT?
a. EPINEPHRINE 1 MG
b. AMIODARONE 300 MG
c. LIDOCAINE 1 MG/KG
d. ATROPINE 1 MG
17. BRADYCARDIA IS A HEARTRATE LESS THAN
_______________BPM?
a. 50
b. 60
18. DESPITE THE DRUG PROVIDED ABOVE AND CONTINUED CPR,
THE PATIENT REMAINS IN VENTRICULAR FIBRILLATION. WHICH
OTHER DRUG SHOULD BE ADMINISTERED NEXT?
a. EPINEPHRINE 1 MG
b. ATROPINE 1 MG
c. MAGNESIUM SULFATE 1 G
d. LIDOCAINE 1 TO 1.5 MG/KG

19. THE PATIENT HAS RETURN OF SPONTANEOUS CIRCULATION

AND IS NOT ABLE TO FOLLOW COMMANDS. WHICH POST-CARDIAC
ARREST CARE INTERVENTION DO YOU CHOOSE FOR THIS PATIENT?
a. INITIATE TARGETED TEMPERATURE MANAGEMENT
b. CHECK THE GLUCOSE LEVEL
c. ADMINSTER EPINEPHRINE
 d. EXTUBATE
20. WHICH WOULD YOU HAVE DONE FIRST IF THE PATIENT HAD
NOT GONE INTO VENTRICULAR FIBRILLATION?
a. ESTABLISHED IV ACCESS
b. OBTAINED A 12 LEAD ECG
c. GIVEN ATROPINE 1 MG
d. PERFORMED SYNCHRONIZED CARDIOVERSION
21. HOW CAN YOU INCREASE CHEST COMPRESSION FRACTION
DURING A CODE?
a. CHARGE THE DEFIBRILLATOR 15 SECONDS BEFORE RHYTHM
CHECK
b. INTERCHANGE THE VENTILATOR AND COMPRESSOR
DURING A RHYTHM CHECK
c. ADMINSTER EPINEPHRINE DURING THE 2 -MINUTE CYCLE
d. INITIATE INTRAVENOUS OR INTRAOSSEOUS ACCESS DURING
THE 2-MINUTE CYCLE
22. 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
b. ASSIGN IT TO ANOTHER TEAM MEMBER
c. DO IT ANYWAY
d. SEEK EXPERT ADVICE
23. A 68-YEAR-OLD WOMAN PRESENTS WITH LIGHT-HEADEDNESS,
NAUSEA, AND CHEST DISCOMFORT. YOUR ASSESSMENT FINDS HER
AWAKE AND RESPONSIVE BUT APPEARING ILL, PALE AND GROSSLY
DIAPHORETIC. HER RADIAL PULSE IS WEAK, THREADY AND FAST.
YOU ARE UNABLE TO OBTAIN A BLOOD PRESSURE. SHE HAS NO
OBVIOUS DEPENDENT EDEMA, AND HER NECK VEINS ARE FLAT. HER
LUNG SOUNDS ARE EQUAL, WITH MODERATE RALES PRESENT
BILATERALLY. THE CARDIAC MONITOR SHOWS AN ADULT
TACHYCARDIA WITH A PULSE.

ON THE BASIS OF THIS PATIENT'S INITIAL ASSESSMENT , WHICH

ACLS ALFORITHM SHOULD YOU FOLLOW?
 a. ACUTE COONARY SYNDROMES
b. ADULT TACHYCARDIA WITH A PULSE
c. ADULT SUSPECTED STROKE
d. ADULT CARDIAC ARREST
24. HE PATIENT'S PULSE OXIMETER SHOWS A READING OF 84%
ON ROOM AIR. WHICH INITIAL ACTION DO YOU TAKE?
a. PERFORM BAG-MASK VENTILATION
b. INTUBATE THE PATIENT
c. GIVE OXYGEN
d. CHECK THE PULSE OXIMETER PROBE
25. AFTER YOUR INITIAL ASSESSMENT OF THIS PATIENT, WHICH
INTERVENTION SHOULD BE PERFORMED NEXT?
a. SYNCHRONIZED CARDIOVERSION
b. ADMINISTRATION OF AMIODARONE 150MG IM
c. IMMEDIATE DEFIBRILLATION
d. ENDOTRACHEAL INTUBATION

26. IF THE PATIENT BECAME APNEIC AND PULSELESS BUT THE

RHYTHM REMAINED THE SAME , WHICH WOULD TAKE THE HIGHEST
PRIORITY?

a. ADMINISTER AMIODARONE 300 MG

b. ADMINISTER ATROPINE 0.5 MG
c. INSERT AN ADVANCED AIRWAY
d. PERFORM DEFIBRILLATION
27. YOU INSTRUCT A TEAM MEMBER TO GIVE 1 MG OF ATROPINE
IV. WHICH RESPONSE IS AN EXAMPLE OF CLOSED-LOOP
COMMUNICATION?
a. I'LL GIVE IT IN A FEW MINUTES
b. OK
c. I'LL DRAW UP 1MG OF ATROPINE
d. ARE YO SURE THAT IS WHAT YO WANT GIVEN?
28. WHICH BEST DESCRIBES AN ACTION TAKEN BY THE TEAM
LEADER TO AVOID INEFFICIENCIES DURING A RESUSCITATION
ATTEMPT?

a. ASSIGN MOST TASKS TO THE MORE EXPERIENDED TEAM

MEMBERS
b. PERFORM THE MOST COMPLICATED TASKS
c. CLEARLY DELEGTE TASKS
d. ASSIGN THE SAME TASKS TO MORE THAN ONE TEAM MEMBER
29. WHAT IS AN EFFECT OF EXCESSIVE VENTILATION?
a. DECREASED CARDIAC OUTPUT
b. DECREASED INTRATHORACIC PRESSURE
c. INCREASED PERFUSION PRESSURES
d. INCREASED VENOUS RETURN

30. WHICH BEST DESCRIBES THE LENGTH OF TIME IT SHOULD

TAKE TO PERFORM A PULSE CHECK DURING THE BLS ASSESSMENT?
a. 1 TO 4 SECONDS
b. 5 TO 10 SECONDS
c. 11 TO 15 SECONDS
d. 16 TO 20 SECONDS
31. WHICH IS THE RECOMMENDED FIRST INTRAVENOUSE DOSE OF
AMIODARONE FOR A PATIENT WITH REFRACTORY VENTRICULAR
FIBRILLATION?
a. 100 MG
b. 150 MG
c. 250 MG
d. 300 MG

32. WHICH FACILITY IS THE MOST APPROPRIATE EMS

DESTINATION FOR A PATIENT WITH SUDDEN CARDIAC ARREST WHO
ACHIEVED RETURN OF SPONTANEOUS CIRCULATION IN THE FIELD?

a. COMPREHENSIVE STROKE CARE UNIT

b. ACUTE REHABILITATION CARE UNIT
c. ACUTE LONG-TERM CARE UNIT
 d. CORONARY REPERFUSION-CAPABLE MEDICAL CENTER

33. IN ADDITION TO CLINICAL ASSESSMENT, WHICH IS THE MOST

RELIABLE METHOD TO CONFIRM AND MONITOR CORRECT
PLACEMENT OF A ENDOTRACHEAL TUBE?
a. CONTINUOUS WAVEFORM CAPNOGRAPHY
b. CHEST RADIOLOGY
c. HEMOGLOBIN LEVELS
d. ATRIEAL BLOOD GASES
34. YOUR PATIENT IS IN CARDIAC ARREST AND HAS BEEN
INTUBATED. TO ASSESS CPR QUALITY, WHICH SHOULD YOU DO?

a.MONITOR THE PATIENT'S PETCO2

b.OBTAIN A CHEST X-RAY
c.CHECK THE PATIENT'S PULSE
d.OBTAIN A 12- LEAD ECG
35. THREE MINUTES INTO A CARDIAC ARREST 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 8mm Hg. WHAT IS THE SIGNIFICANCE OF THIS
FINDING?
a. THE ENDOTRACHEAL TUBE IS IN THE ESOPHAGUS
b. THE PATIENT MEETS THE CRITERIA FOR TERMINATION OF
EFFORTS
c. THE TEAM IS VENTILATIONG THE PATIENT TOO OFTEN
(HYPERVENTILATION)
d. CHEST COMPRESSIONS MAY NOT BE EFFECTIVE
36. 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?
a. REASSIGN THE TEAM TASKS
b. CONDUCT A DEBRIEFING AFTER THE RESUSCITATION ATTEMPT
c. REMOVE THE TEAM MEMBER FROM THE AREA
d. ADDRESS THE TEAM MEMBER IMMEDIATELY

37. 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 ADMINSTER NEXT.
a. 40 MG
b. 20 MG
c. 12 MG
d. 3 MG
38. WHICH IS THE PRIMARY PURPOSE OF A MEDICAL EMERGENCY
TEAM OR RAPID RESPONSE TEAM
a. PROVIDING DIAGNOSTIC CONSULTATION TO EMERGENCY
DEPARTMENT PATIENTS
b. PROVIDING ONLINE SONSULTATION TO EMS PERSONNEL IN
THE FIELD
c. IMPROVING PATIENT OUTCOMES BY IDENTIFICATION AND
TREATEMENT
d. IMPROVING CARE FOR PATIENTS ADMITTED TO CRITICAL CARE
UNITS
39. 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 FROM
THE TEAM MEMBER ?
a. I HAVE AN ORDER TO GIVE 500 MG OF AMIODARONE IV. IS
THAT CORRECT?
b. OK
c. AMIODARONE 500 MG IV HAS BEEN GIVEN
d. ARE YOU SURE
40. WHICH IS THE RECOMMENDED ORAL DOSE OF ASPRIN FOR A
PATIENT WITH A SUSPECTED ACUTE CORONARY SYNDROME?
a. 350 TO 650 MG
b. 162 TO 325 MG
c. 81 MG
d. 40 MG
41.WHAT IS THE MINIMUM SYSTOLIC BLOOD PRESUURE ONE SHOULD ATTEMPT
TO ACHIEVE WITH FLUID AMINISTRATION OF VASOACTIVE AGENTS IN A
HYPOTENSIVE POST-CARDIAC ARREST PATIENT WHO ACHIEVES RETURN OF
SPONTANEOUS CIRCULATION?
a. 90 mm Hg
b. 85 mm Hg
c. 80 mm Hg
d. 75mm Hg

42. WHAT SHOULD BE THE PRIMARY FOCUS OF THE CPR COACH

ON A RESUSCITATION TEAM?

a. TO ENSURE HIGH QUALITY CPR

b. TO CONVEY POSITIVE FEEDBACK
c. TO DOCUMENT CPR OUTCOMES
d. TO RESOLVE TEAM ARGUMENTS
43. A 68-YEAR-OLD WOMAN PRESENTS WITH LIGHT-HEADEDNESS,
NAUSEA, AND CHEST DISCOMFORT. YOUR ASSESSMENT FINDS HER
AWAKE AND RESPONSIVE BUT APPEARING ILL, PALE AND GROSSLY
DIAPHORETIC. HER RADIAL PULSE IS WEAK, THREADY AND FAST.
YOU ARE UNABLE TO OBTAIN A BLOOD PRESSURE. SHE HAS NO
OBVIOUS DEPENDENT EDEMA, AND HER NECK VEINS ARE FLAT. HER
LUNG SOUNDS ARE EQUAL, WITH MODERATE RALES PRESENT
 BILATERALLY. THE CARDIAC MONITOR SHOWS AN ADULT
TACHYCARDIA WITH A PULSE.

ON THE BASIS OF THIS PATIENT'S INITIAL ASSESSMENT , WHICH

ACLS ALFORITHM SHOULD YOU FOLLOW?

a. ACUTE COONARY SYNDROMES

b. ADULT CARDIAC ARREST
c. ADULT SUSPECTED STROKE
d. ADULT TACHYCARDIA WITH A PULSE
44. THE PATIENT'S PULSE OXIMETER SHOWS A READING OF 84%
ON ROOM AIR. WHICH INITIAL ACTION DO YOU TAKE?
a. GIVE OXYGEN
b. CHECK THE PULSE OXIMETER PROBE
c. INTUBATE THE PATIENT
d. PERFORM BAG-MASK VENTILATION
45. AFTER YOUR INITIAL ASSESSMENT OF THIS PATIENT, WHICH
INTERVENTION SHOULD BE PERFORMED NEXT?
a. ADMINISTRATION OF AMIODARONE 150MG IM
b. SYNCHRONIZED CARDIOVERSION
c. ENDOTRACHEAL INTUBATION
d. IMMEDIATE DEFIBRILLATION
46. IF THE PATIENT BECAME APNEIC AND PULSELESS BUT THE
RHYTHM REMAINED THE SAME , WHICH WOULD TAKE THE HIGHEST
PRIORITY?
a. PERFORM DEFIBRILLATION
b. ADMINISTER ATROPINE 0.5 MG
c. INSERT AN ADVANCED AIRWAY
d. ADMINISTER AMIODARONE 300 MG
47. YOU INSTRUCT A TEAM MEMBER TO GIVE 1 MG OF ATROPINE
IV. WHICH RESPONSE IS AN EXAMPLE OF CLOSED-LOOP
COMMUNICATION?
a. I'LL GIVE IT IN A FEW MINUTES
b. OK
c. I'LL DRAW UP 1MG OF ATROPINE
 d. ARE YO SURE THAT IS WHAT YO WANT GIVEN?

48. WHICH BEST DESCRIBES AN ACTION TAKEN BY THE TEAM

LEADER TO AVOID INEFFICIENCIES DURING A RESUSCITATION
ATTEMPT?

a. ASSIGN MOST TASKS TO THE MORE EXPERIENDED TEAM

MEMBERS
b. PERFORM THE MOST COMPLICATED TASKS
c. CLEARLY DELEGTE TASKS
d. ASSIGN THE SAME TASKS TO MORE THAN ONE TEAM MEMBER
49. WHAT IS AN EFFECT OF EXCESSIVE VENTILATION?
a. DECREASED CARDIAC OUTPUT
b. DECREASED INTRATHORACIC PRESSURE
c. INCREASED PERFUSION PRESSURES
d. INCREASED VENOUS RETURN

50. WHICH BEST DESCRIBES THE LENGTH OF TIME IT SHOULD

TAKE TO PERFORM A PULSE CHECK DURING THE BLS ASSESSMENT?
a. 1 TO 4 SECONDS
b. 5 TO 10 SECONDS
c. 11 TO 15 SECONDS
d. 16 TO 20 SECONDS
51. WHICH IS THE RECOMMENDED FIRST INTRAVENOUSE DOSE OF
AMIODARONE FOR A PATIENT WITH REFRACTORY VENTRICULAR
FIBRILLATION?
a. 100 MG
b. 150 MG
c. 250 MG
d. 300 MG

52. WHICH FACILITY IS THE MOST APPROPRIATE EMS

DESTINATION FOR A PATIENT WITH SUDDEN CARDIAC ARREST WHO
ACHIEVED RETURN OF SPONTANEOUS CIRCULATION IN THE FIELD?

a. COMPREHENSIVE STROKE CARE UNIT

 b. ACUTE REHABILITATION CARE UNIT
c. ACUTE LONG-TERM CARE UNIT
d. CORONARY REPERFUSION-CAPABLE MEDICAL CENTER
53.A PATIENT HAS A WITNESSED LOSS OF CONSCIOUSNESS. THE LEAD 11 ECG
REVEALS THIS RHYTHM. WHICH IS THE BEST APPROPRIATE TREATMENT?

a. SYNCHRONIZED CARDIOVERSION
b. DEFIBRILLATION
c. ADMINISTRATION OF ADENOSINE 6 MG IV PUSH
d. ADMINISTRATION OF SPINEPHRINE 1 MG IV PUSH
54.FOR STEMI PATIENTS, WHICH BEST DESCRIBES THE RECOMMENDED
MAXIMUM GOAL TIME FOR THE FIRST MEDICAL CONTACT-TO-BALLOON
INFLATION TIME FOR PERCUTANEOUS CORONARY INTERVENTION?
a. 150 MINUTES
b. 90 MINUTES
c. 180 MINUTES
d. 120 MINUTES
55. YOU ARE PERFORMING CHEST COMPRESSIONS DURING AN
ADULT RESUSCITATION ATTEMPT. WHICH RATE SHOULD YOU USE
TO PERFORM THE COMPRESSIONS?
a. 100 TO 120 /MIN
b. MORE THAN 120/MIN
c. LESS THA 80/MIN
d. 80 TO 90/MIN
56. WHICH IS THE MAXIMUM INTERVAL YOU SHOULD ALLOW FOR
INTERRUPTION IN CHEST COMPRESSIONS?
a. 25 SECONDS
b. 15 SECONDS
c. 10 SECONDS
d. 20 SECONDS
57. TO PROPERLY VENTILATE A PATIENT WITH A PERFUSING
RHYTHM, HOW OFTEN DO YOU SQUEEZE THE BAG?
a. ONCE EVERY 12 SECONDS
b. ONCE EVERY 6 SECONDS
c. ONCE EVERY 3 SECONDS
d. ONCE EVERY 10 SECONDS
58.EMS PROVIDERS ARE TREATING A PATIENT WITH SUSPECTED STROKE.
ACCORDING TO THE ADULT SUSPECTED STOKE ALGORITHM, WHICH
CRITICAL ACTION PERFORMED BY THE EMS TEAM WILL EXPEDITE THIS
PATIENT'S CARE ON ARRIVAL AND REDUCE THE TIME TO TREATMENT?
a.TREAT HYPERTENSION
b.PROVIDE PREHOSPITAL NOTIFICATION
c.ESTABLISH IV ACCESS
d.REVIEW THE PATIENT'S HISTORY
59. WHAT IS THE RECOMMENDED RANGE FOR WHICH A
TEMPERATURE SHOULD BE SELECTED AND MAINTAINED
CONSISTANTLY TO ACHIEVE TARGETED TEMPERATURE
MANAGEMENT AFTER CARDIAC ARREST?
a. 32 DEGREES C TO 36 DEGREES C
b. 35 DEGREES C TO 37 DEGREES C
c. 26 DEGREES C TO 28 DEGREES C
d. 29 DEGREES C TO 31 DEGREES C

60.

A RESONDER IS CARING FOR A PATIENT WITH A HISTORY OF

CONGESTIVE HEART FAILURE. THE PATIENT IS EXPERIENCING
SHORTNESS OF BREATH, A BLOOD PRESSUE OF 68/50mmHg, AND A
HEART RATE OF 190/MIN. THE PATIENT'S LEAD ll ECG IS DISPLAYED
HERE. WHICH BEST CHARACTERIZES THIS PATIENT'S RHYTHM?

a. UNSTABLE SUPRVENTRICULAR TACHYCARDIA

b. PERFUSING VENTRICULAR TACHYCARDIA
 c. SINUS TACHYCARDIA
d. STABLE SUPRAVENTRICULAR TACHYCARDIA
61. Where should the CPR COACH stand?
a. Next to the Team Leader
b. Across from the Compressor and next to the feedback
display
62. IN ADDITION TO DEFIBRILLATION, WHICH INTERVENTION
SHOULD BE PERFORMED IMMEDIATELY?
a. VASOACTIVE MEDICATION ADMINISTRATION
b. ADVANCED AIRWAY INSERTION
c. CHEST COMPRESSIONS
d. VASCULAR ACCESS
63. USE THIS SCENARIO TO ANSWER THE NEXT 6 QUESTIONS
A 45-YEAR-OLD MAN HAD CORONARY ARTERY STENTS PLACE 2 DAYS
AGO. TODAY, HE IS IN SEVERE DISTRESS AND IS REPORTING
"CRUSHING' CHEST DISCOMFORT. HE IS PALE, DIAPHORETIC, AND
COOL TO THE TOUCH. HIS RADIAL PULSE IS VERY WEAK., BLOOD
PRESSURE IS 64/40mm Hg, RESPIRATORY RATE IS 28 BREATHS PER
MINUTE, AND OXYGEN SATURATION IS 89% ON ROOM AIR. WHEN
APPLIED, THE CARDIAC MONITOR INITIALLY SHOWED VENTRICULAR
TACHYCARDIA WHICH THEN QUICKLY CHANGED TO VENTRICULAR
FIBRILLATION.
64. ON THE BASIS OF THE PATIENT'S INITIAL PRESENTATION, WHICH
a. ACUTE ISCHEMIC STROKE
b. SUPRAVENTRICULAR TACHYCARDIA WITH ISCHEMIC CHEST
PAIN
c. ACUTE CORONARY SYNDROME
d. ACUTE HEART FAILURE
65. DURING POST-CARDIAC ARREST CARE, WHICH IS THE
RECOMMENDED DURATION OF TARGETED TEMPERATURE
MANAGEMENT AFTER REACHING THE CORRECT TEMPERATURE
RANGE?
a. AT LEAST 8 HOURS
b. AT LEAST 48 HOURS
c. AT LEAST 36 HOURS
 d. AT LEAST 24 HOURS

66. 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 RRESPIRATORY RATE IS 14
BREATHS PER MINUTE, AND HIS PULSE OXIMETRY READING IS 97%.
WHICH ASSESSMENT STEP IS MOST IMPORTANT NOW?
a. EVALUATING THE PETCO2 READING
b. REQUESTING A CHEST X-RAY
c. OBTAINING A 12-LEAD ECG
d. REQUESTING LABORATORY TESTING
67. WHICH OF THE FOLLOWING SIGNS IS A LIKELY INDICATOR OF
CARDIAC ARREST IN AN UNRESPONSIVE PATIENT?

a. SLOW, WEAK, PULSE RATE?

b. CYANOSIS?
c. AGONAL GASPS
d. IRREGULAR, WEAK PULSE RATE
68. WHICH IS THE RECOMMENDED NEXT STEP AFTER A
DEFIBRILLATION ATTEMPT?
a. CHECK THE ECG FOR EVIDENCE OF A RHYTHM
b. OPEN THE PATIENT'S AIRWAY
c. DETERMINE IF A CAROTID PULSE IS PRESENT
d. RESUME CPR, STARTING WITH CHEST COMPRESSIONS.

69. 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 APPROACH IS BEST FOR THE PATIENT?
a. HOLD FIBRINOLYTIC THEAPY FOR 24 HOURS
b. GIVE FIBRINOLYTIC THERAPY AS SOON AS POSSIBLE AND
CONSIDER ENDOVASCULAR THERAPY
c. ORDER AN ECHOCARDIOGRAM BEFORE FIBRINOLYTIC
ADMINISTRATION
 d. WAIT FOR RESULTS OF THE MRI
70. WHICH IS AN ACCEPTABLE METHOD OF SELECTING AN
APPROPRIATELY SIZED OROPHARYNGEAL AIRWAY?
a. MEASURE FROM THE CORNER OF THE MOUTH TO THE
ANGLE OF THE MANDIBLE
b. MEASURE FROM THE THYROID CARTLAGE TO THE BOTTOM OF
THE EARLOBE
c. ESTIMATE BY USING THE FORMULA WEIGHT (KB) 8+2
d. ESTIMATE BY USING THE SIZE OF THE PATIENT'S FINGER
71. YOUR RESCUE TEAM ARRIVES TO FIND A 59-YEAR-OLD MAN
LYING ON THE KITCHEN FLOOR. YOU DEETERMINE THAT HE IS
UNRESPONSIVE. WHICH IS THE NEXT STEP IN YOUR ASSESSMENT
AND MANAGEMENT OF THIS PATIENT?

a. APPLY THE AED

b. CHECK THE PATIENT'S BREATHING AND PULSE

c. OPEN THE PATIENT'S AIRWAY

d. CHECK FOR A MEDICAL ALERT BRACELET

72. WHICH OF THESE TESTS SHOULD BE PERFORMED FOR A

PATIENT WITH SUSPECTED STROKE AS SOON AS POSSIBLE BUT NO
MORE THAN 20 MINUTES AFTER HOSPITAL ARRIVAL?
a. 12 LEAD ECG
b. CARDIAC ENZYMES
c. COAGULATION STUDIES
d. NONCONTRAST CT SCAN OF THE HEAD
73. BRADYCARDIA IS A HEARTRATE LESS THAN
_______________BPM?
a. 50
b. 60
74. FOR UNSTABLE TACHYCARDIA, IMMEDIATE _______________IS
INDICATED
a. ADENOSINE
 b. SYNCHRONIZED CARDIOVERSION
75. IN THE CARDIAC ARREST ALGORITHM, WHEN SHOULD 1 MG
OF EPINEPHRINE BE ADMINISTERED?

a. AFTER THE FIRST SHOCK

b. AFTER THE SECOND SHOCK

76. THE SECOND LINK IN THE STROKE CHAIN OF SURVIVAL IS

RAPID?
a. RAPID RECOGNITION
b. DISPATCH OF EMS
77. FOR ACLS, EMS MAY ADMINISTER OXYGEN, GIVE ASPRIN IF
THERE ARE NO CONTRAINDICATIONS AND OBTAIN A....?

a. 12 LEAD EKG
b. BLOOD SAMPLE
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.

90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
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102.
103.