ACLS

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1. Which type of atrioventricular (AV) block best de- Second degree

scribes this rhythm? type II

2. Your patient is in cardiac arrest and has been intubat- Monitor the pa-
ed. To assess CPR quality, which should you do? tient's PetCO2

3. Which facility is the most appropriate EMS destination Coronary reperfu-

for a patient with sudden cardiac arrest who achieved sion-capable med-
return a spontaneous circulation in the field? ical center

4. Which of the following signs is a likely indicator of Cyanosis

cardiac arrest in an unresponsive patient?

5. Which type of atrioventricular (AV) block best de- Second de-

scribes this rhythm? gree atrioventricu-
lar (AV) block type
I

6. To properly ventilate a patient with a perfusing rhythm, Once every 5 to 6

how often do you squeeze the bag? seconds

7. In addition to clinical assessment, which is the most Continuous wave-

reliable method to confirm and monitor correct place- form capnography
ment of an endotracheal (ET) tube?

8. You are caring for a patient with a suspected stroke Start fibrinolytic
whose symptoms started 2 hours ago. The CT scan therapy as soon as
was normal, with no signs of hemorrhage. The patient possible
does not have any contraindications to fibrinolytic
therapy. Which treatment approach is best for this
patient?

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9. Which best describes this rhythm? Third-degree atri-
oventricular block

10. What is the recommended range from which a temper- 32 degrees celsius
ature should be selected and maintained constantly to 36 degrees cel-
to achieve targeted management after cardiac arrest? sius

11. Which is the recommended first intravenous (IV) dose 300mg

of amiodarone for a patient with refractory ventricular
fibrillation?

12. Which is the primary purpose of a medical emergency Improving patient

team or rapid response team? outcomes by iden-
tifying and treating
early clinical dete-
rioration

13. Which is the recommended next step after a defibril- Resume CPR,
lation attempt? starting with chest
compressions

14. EMS providers are treating a patient with suspected Alert the hospital
stroke. According to the Adult Suspected Stroke Al-
gorithm, which critical action performed by the EMS
team will expedite this patient's care on arrival and
reduce the time to treatment?

15. A responder is caring for a patient with a history of Unstable

congestive heart failure (CHF). The patient is experi- supraventricular
encing shortness of breath, a blood pressure (BP) of tachycardia (SVT)
68/50 mmHg, and a heart rate of 190/min. The patient's
lead II ECG is displayed here. Which best character-
izes this patient's rhythm?

16.
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Your rescue team arrives to find a 59-year-old man Check the pa-
lying on the kitchen floor. You determine that he is un- tient's breathing
responsive. Which is the next step in your assessment and pulse
and management of this patient?

17. Which best describes the length of time it should 5 to 10 seconds

take to perform a pulse check during the BLS Assess-
ment?

18. You instruct a team member to give 0.5 mg atropine "I'll draw up 0.5 mg
IV. Which response is an example of closed-loop com- of atropine."
munication?

19. What is an effect of excessive ventilation? Decreased car-

diac output

20. If a team member is about to make a mistake during a Address the team
resuscitation attempt, which best describes the action member immedi-
that the team leader or other team members should ately
take?

21. Which best describes this rhythm? Monomorphic ven-

tricular tachycar-
dia

22. For STEMI patients, which best describes the recom- 90 minutes
mended maximum goal time for emergency depart-
ment door-to-balloon inflation time for percutaneous
coronary intervention?

23. Which is the maximum interval you should allow for 10 seconds
an interruption in chest compressions?

24. Which is one way to minimize interruptions in chest Continue CPR

compressions during CPR? while the defibrilla-
tor charges

25. Clearly delegate

tasks
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Which best describes an action taken by the team
leader to avoid inefficiencies during a resuscitation
attempt?

26. Which is an acceptable method of selecting an appro- Measure from the

priately sized oropharyngeal airway? corner of the
mouth to the angle
of the mandible

27. 27. You are evaluating a 58-year-old man with chest Obtaining a
discomfort, his blood pressure is 92/50 mmHg, his 12-lead ECG
heart rate is 92/min, his nonlabored respiratory rat is
14 breaths/min, and his pulse oximetry reading is 97%.
Which assessment step is most important?

28. A patient in respiratory distress and with a blood Performing syn-

pressure of 70/50 mmHg presents with the lead II ECG chronized car-
rhythm shown here. Which is the appropriate treat- dioversion
ment?

29. During post-cardiac arrest care, which is the recom- At least 24 hours
mended duration of targeted temperature manage-
ment after reaching the correct temperature range?

30. Three minutes into a cardiac arrest resuscitation at- Chest compres-
tempt, one member of your team inserts an endotra- sions may not be
cheal (ET) tube while another performs chest com- effective
pressions. Capnography shows a persistent wave-
form and a PetCO2 of 8mmHg. Which is the signifi-
cance of this finding?

31. Which is the recommended oral dose of aspirin for a 160 to 325 mg
patient with a suspected acute coronary syndrome?

32. A team member is unable to perform an assigned task Ask for a new task
because it is beyond the team member's scope of or role
practice. Which action should the team member take?

33.

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As the team leader, when do you tell the chest com- About every 2 min-
pressors to switch? utes

34. You are performing chest compressions during an 100 to 120 per
adult resuscitation attempt. Which rate should you minute
use to perform the compressions?

35. A patient is being resuscitated in a very noisy envi- "I have an order
ronment. A team member thinks he heard an order for to give 500 mg of
500 mg of amiodarone IV. Which is the best response amiodarone IV. Is
from the team member? this correct?"

36. A patient in stable narrow-complex tachycardia with a 12mg

peripheral IV in place is refractory to the first dose of
adenosine. Which dose would you administer next?

37. A patient has a witness loss of consciousness. The Defibrillation

lead II ECG reveals this rhythm. Which is the appro-
priate treatment?

38. Which of these tests should be performed for a patient Noncontract CT

with suspected stroke within 25 minutes of hospital scan of the head
arrival?

39. What is the minimum systolic blood pressure one 90mmHg

should attempt to achieve with fluid administration
or vasoactive agents in a hypotensive post-cardiac
arrest patient who achieves return of spontaneous
circulation?

40. You have completed 2 minutes of CPR. The ECG mon- Give epinephrine
itor displays the lead II rhythm shown here, and the 1 mg IV
patient has no pulse. Another member of your team
resumes chest compressions, and an IV is in place.
Which do you do next?

41. A 45-year-old man had coronary artery stents placed Acute coronary
2 days ago. Today, he is in severe distress and is syndrome
reporting "crushing" chest discomfort. He is pale, di-
aphoretic, and cool to the touch. His radial pulse is
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very weak, blood pressure is 64/40 mmHg, respiratory
rate is 28 breaths/min, and oxygen saturation is 89%
on room air. When applied, the cardiac monitor initially
showed ventricular tachycardia, which then quickly
changed to ventricular fibrillation.

Based on this patient's initial presentation, which con-

dition do you suspect led to the cardiac arrest?

42. A 45-year-old man had coronary artery stents placed Chest compres-
2 days ago. Today, he is in severe distress and is sion
reporting "crushing" chest discomfort. He is pale, di-
aphoretic, and cool to the touch. His radial pulse is
very weak, blood pressure is 64/40 mmHg, respiratory
rate is 28 breaths/min, and oxygen saturation is 89%
on room air. When applied, the cardiac monitor initially
showed ventricular tachycardia, which then quickly
changed to ventricular fibrillation.

In addition to defibrillation, which intervention should

be performed immediately?

43. A 45-year-old man had coronary artery stents placed Epinephrine 1 mg

2 days ago. Today, he is in severe distress and is
reporting "crushing" chest discomfort. He is pale, di-
aphoretic, and cool to the touch. His radial pulse is
very weak, blood pressure is 64/40 mmHg, respiratory
rate is 28 breaths/min, and oxygen saturation is 89%
on room air. When applied, the cardiac monitor initially
showed ventricular tachycardia, which then quickly
changed to ventricular fibrillation.

Despite 2 defibrillation attempts, the patient remains

in ventricular fibrillation (V-Fib). Which drug and dose
should you administer first to this patient?

44. A 45-year-old man had coronary artery stents placed Amiodarone 300
2 days ago. Today, he is in severe distress and is mg
reporting "crushing" chest discomfort. He is pale, di-

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aphoretic, and cool to the touch. His radial pulse is
very weak, blood pressure is 64/40 mmHg, respiratory
rate is 28 breaths/min, and oxygen saturation is 89%
on room air. When applied, the cardiac monitor initially
showed ventricular tachycardia, which then quickly
changed to ventricular fibrillation.

Despite the drug provide above and continued CPR,

the patient remains in ventricular fibrillation (V-Fib).
Which other drug should be administered next?

45. A 45-year-old man had coronary artery stents placed Initiate targeted
2 days ago. Today, he is in severe distress and is temperature man-
reporting "crushing" chest discomfort. He is pale, di- agement
aphoretic, and cool to the touch. His radial pulse is
very weak, blood pressure is 64/40 mmHg, respiratory
rate is 28 breaths/min, and oxygen saturation is 89%
on room air. When applied, the cardiac monitor initially
showed ventricular tachycardia, which then quickly
changed to ventricular fibrillation.

The patient has return of spontaneous circulation and

is not able to follow commands. Which immediate
post-cardiac arrest care intervention do you chose for
this patient?

46. A 45-year-old man had coronary artery stents placed Obtained a

2 days ago. Today, he is in severe distress and is 12-lead ECG
reporting "crushing" chest discomfort. He is pale, di-
aphoretic, and cool to the touch. His radial pulse is
very weak, blood pressure is 64/40 mmHg, respiratory
rate is 28 breaths/min, and oxygen saturation is 89%
on room air. When applied, the cardiac monitor initially
showed ventricular tachycardia, which then quickly
changed to ventricular fibrillation.

Which would you have done first if the patient had not
gone into ventricular fibrillation (V-Fib)?

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47. A 68-year-old woman presents with light-headedness, Tachycardia
nausea, and chest discomfort. Your assessment finds
her awake and responsive but ill-appearing, pale, and
goodly disphorttie. Her radial is weak, thread, 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
the rhythm seen here.

Based on this patient's initial assessment, which adult

ACLS algorithm should you follow?

48. A 68-year-old woman presents with light-headedness, Apply oxygen

nausea, and chest discomfort. Your assessment finds
her awake and responsive but ill-appearing, pale, and
goodly disphorttie. Her radial is weak, thread, 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
the rhythm seen here.

The patient's pulse oximeter shows a reading of 84%

on room air. Which initial action do you take?

49. A 68-year-old woman presents with light-headedness, Synchronized car-

nausea, and chest discomfort. Your assessment finds dioversion
her awake and responsive but ill-appearing, pale, and
goodly disphorttie. Her radial is weak, thread, 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
the rhythm seen here.

After your initial assessment of this patient, which

intervention should be performed next?

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50. A 68-year-old woman presents with light-headedness, Perform defibrilla-
nausea, and chest discomfort. Your assessment finds tion
her awake and responsive but ill-appearing, pale, and
goodly disphorttie. Her radial is weak, thread, 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
the rhythm seen here.

If the patient became apneic and pulseless but the

rhythm remained the same, which would take the
highest priority?

51. H's Hypovolemia, Hy-

poxia, Hypo-
glycemia, Hy-
pokalemia, Hyper-
kalemia

52. T's Tension pneu-

mo, Tamponade,
Thrombosis pulm,
Thrombosis cardia

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