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1. a. start fibrinolyt- You are caring for a patient with a suspected stroke whose
ic therapy ASAP symptoms started 2 hours ago. The CT was normal with
no sign of hemorrhage. The patient does not have any
contraindications to fibrinolytic therapy. Which treatment is
best?
a. start fibrinolytic therapy ASAP
b. hold fibrinolytic therapy for 24 hours
c. order an echo before fibrinolytic administration
d. wait for MRI result

2. 90 mins For STEMI pt, maximum goal time for ED door-to-bal-

loon-inflation time for PCI?
a. 150 mins
b. 180 mins
c. 120 mins
d. 90 mins

3. 160-325 mg Which is the recommended oral dose of ASA for a pt w/

suspected ACS?
a. 81 mg
b. 325-650 mg
c. 160-325 mg
d. 40 mg

4. 100-120/min chest compressions during for adult rate

5. decreased car- effect of excessive ventilation

diac output a. decresed cardiac output
b. decreased intrathoracic pressure
c. increased perfusion pressure
d. increased venous return

6. 32-36C temperature to achieve targeted temperature manage-

ment after cardiac arrest

7. a. chest com- 3 mins into cardiac arrest resuscitation attempt, one mem-
pression may not ber of your team inserts an endotracheal tube while an-
be effective other performs chest compressions. Capnography shows
a persistent waveform & a PETCO2 of 8mmHg. What is

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the significance of the finding?
a. chest compression may not be effective
b. The endotrachael tube is in the esophagus
c. the team is ventilating the patient too often
d. the patient meets the criteria for termination of efforts

8. monitor the pa- Your patient is in cardiac arrest and has been intubated.
tient's PETCO2 to assess CPR quality, you should

9. continous wave- In addition to clinical assessment, which is the most reli-

form capnogra- able method to confirm & monitor correct placement of an
phy endotracheal tube?

10. answer has to do A 45M had coronary artery stents placed 2 days ago.
with acute coro- Today he is in severe distress and reporting "crushing"
nary syndrome chest discomfort. He is pale, diphoretic, and cool to the
touch. His radial pulse is very weak, blood pressure is
64/40, respiratory is 28 bpm/min and O2 set is 89% on
room air.

11. a. chest com- A 45M had coronary artery stents placed 2 days ago. To-
pression day he is in severe distress and reporting "crushing" chest
discomfort. He is pale, diphoretic, and cool to the touch.
His radial pulse is very weak, blood pressure is 64/40,
respiratory is 28 bpm/min and O2 set is 89% on room air.
When applied, the cardiac monitor initially showed ventric-
ular tachycardia, which then quickly changed to ventricular
fibrillation. What do we do?
a. chest compression
b. vasoactive meds
c. vascular access
d. advanced airway

12. epi 1 mg A 45M had coronary artery stents placed 2 days ago.
Today he is in severe distress and reporting "crushing"
chest discomfort. He is pale, diphoretic, and cool to the
touch. His radial pulse is very weak, blood pressure is
64/40, respiratory is 28 bpm/min and O2 set is 89% on
room air. Despite 2 defib attempt, the patient remains in
V-fib. Which drug & dose should be given?
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a. lidocaine 1 mg/kg
b. amiodarone 300mg
c. epi 1mg
d. atropine 1 mg

13. c. amiodarone A 45M had coronary artery stents placed 2 days ago.
300mg Today he is in severe distress and reporting "crushing"
chest discomfort. He is pale, diphoretic, and cool to the
touch. His radial pulse is very weak, blood pressure is
64/40, respiratory is 28 bpm/min and O2 set is 89% on
room air. despite the drug provided above & continuous
CPR, the patient remains in v-fib. which drug should be
given next?
a. atropine 1mg
b. mag sulfate 1g
c. amiodarone 300mg
d. epi 1 mg

14. initiate target- A 45M had coronary artery stents placed 2 days ago.
ed temperature Today he is in severe distress and reporting "crushing"
management chest discomfort. He is pale, diphoretic, and cool to the
(the guideline touch. His radial pulse is very weak, blood pressure is
no longer has 64/40, respiratory is 28 bpm/min and O2 set is 89% on
post-arrest opti- room air. The patient has returned of spontaneous circu-
mal glucose lev- lation (ROSC) & is not able to follow commands. Which
el) immediate post-cardiac arrest care intervention do you
choose for the patient?
a. extubate
b. check glucose
c. give epi
d. initiate targeted temp. management

15. performed syn- A 45M has coronary artery stents placed 2 days ago.
chronized car- Today, he is in severe distress & crushing chest discomfort.
dioversion he is pale, diaphoretic, & cool to the touch. His radial pulse
is very weak. Blood pressure is 64/40 mm Hg, respiratory
rate is 28 bpm & O2 is 89%. cardiac monitor initially
showed ventricular tachycardia, which quickly changed to
v-fib. what would you have done first if the patient had not

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gone into v-fib?
a. give atropine 1mg
b. establish IV
c. do a 12 lead
d. performed synchronized cardioversion

16. at least 24 hours During post-cardiac arrest, which is recommended du-

ration of targeted temp. management after reaching the
correct temperature range?
a. at least 24 hours
b. 0-8 hour
c. at least 36 hours
d. at least 48 hours

17. c. improving pa- which is the primary purpose of medical emergency team
tient outcomes or rapid response team?
by identifying a. provide diagnostic consultation to emergency depart-
& treating early ment patients
clinical deteriora- b. provide online consultation to EMS personnel
tion c. improving patient outcomes by identifying & treating
early clinical deterioration
d. improving care for patients admitted to critical care units

18. performing syn- A patient is respiratory distress, 70/50, presents with lead
chronized car- 2 ECG shown. appropriate treatment?
dioversion a. defibrillation
b. perform synchronized cardioversion
c. administering adenosine 6mg IV pust
d. perform vagal maneuvers

19. non-contrast CT which of these tests should be performed for a patient w/

scan of the head suspected stroke w/in 25 mins of hospital arrival?
a. coagulation studies
b. cardiac enzymes
c. noncontrast CT scan of the head
d. 12 lead ECG

20. d. agnoal gasps Which of the following signs are likely indicator of cardiac
arrest in an unresponsive patient?
a. slow, weak pulse rate
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b. cyanosis
c. irregular, weak pulse
d. agonal gasps

21. I have an order a patient is being resuscitated in a very noisy environment.

to give 500mg of A team member thinks he heard an order of 500mg of
amiodarone IV. Is amiodarone IV. which is the best response from the team
this correct? member?

22. resume CPR, Which is the recommended next step after a defibrillation
starting with attempt?
chest compres-
sion

23. unstable A responder is caring for a patient with a history of con-

supraventicular gestive heart failure. The patient is experiencing shortness
tachycardia of breath, 68/50 mmHg, heart rate 190/min. The patient's
lead 2 ECG is shown. Which best characterizes this pa-
tient's rhythm?

24. continue CPR which is one way to minimize interruptions in chest com-
while the defibril- pressions during CPR?
lator charges

25. tachycardia A 68F lightheadedness, nausea, chest discomfort. Your

wide com- assessment finds her awake & responsive but ill-appear-
plex (monopha- ing, pale, and grossly diaphoretic. Her radial pulse is weak,
sic) tachycardia thready & fast. Your are unable to get a BP. She has no
obvious dependent edema, & her neck veins are flat. Her
lung sounds are equal w/ moderate rales present bilater-
ally. The cardiac monitor shows rhythm seen here. Based
on the patient's initial assessment, what adult ACLS algo-
rithm should you follow?

26. synchronized A 68F lightheadedness, nausea, chest discomfort. Your

cardioversiion assessment finds her awake & responsive but ill-appear-
ing, pale, and grossly diaphoretic. Her radial pulse is weak,
thready & fast. Your are unable to get a BP. She has
no obvious dependent edema, & her neck veins are flat.
Her lung sounds are equal w/ moderate rales present
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bilaterally. The cardiac monitor shows rhythm seen here.
After your initial assessment, which intervention should be
preformed?

27. perform defibril- A 68F lightheadedness, nausea, chest discomfort. Your

lation assessment finds her awake & responsive but ill-appear-
ing, pale, and grossly diaphoretic. Her radial pulse is weak,
thready & fast. Your are unable to get a BP. She has
no obvious dependent edema, & her neck veins are flat.
Her lung sounds are equal w/ moderate rales present
bilaterally. The cardiac monitor shows rhythm seen here.
If the patient became apnic & pulseless but the rhythm
remained the same, which would take the highest priority?

28. monomorphic Which best describes the rhythm?

ventricular
tachycardia

29. 12mg A patient in stable narrow-complex tachycardia with a

peripheral IV in place is refractory to the 1st dose of
adenosine. Which dose would you administer next?

30. I'll draw up 0.5mg You instruct a team member to give 0.5mg atropine IV.
of atropine Which response is an example of closed-loop communi-
cation?

31. defibrillation A patient has a witnessed loss of consciousness. The lead

2 ECG is shown. appropriate treatment?

32. Give epi 1mg IV You have completed 2 mins of CPR. The ECG monitor
shows the lead 2 rhythm, and the patient has no pulse. An-
other member of your team resumes chest compression,
and an IV is in place. Which do you do next?

33. once every 5-6 to properly ventilate a patient w/ perfusing rhythm, how
seconds often do you squeeze the bag?

34. 300mg Which is the recommended 1st IV dose of amiodarone for

a patient w/ refractory ventricular fibrillation?
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35. 5-10 seconds Which best describes the length of time it should take to
perform a pulse check during BLS assessment?

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

37. 10 seconds Which is the maximum interval you should allow for an
interruption in chest compression?

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

39. coronary Which facility is the most appropriate EMS destination for
reperfusion-capa- a patient w/ a sudden cardiac arrest who achieved return
ble medical of spontaneous circulation in the field?
center

40. measure from the which is an acceptable method of selecting an appropri-

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

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

42. 90 mmHg What is the minimum systolic blood pressure one should
attempt to achieve w/ fluid administration or vasoactive
agents in a hypotensive post-cardiac arrest patient who
achieves return of spontaneous circulation?

43. obtaining a 12 You are evaluating a 58M w/ chest discomfort, BP 92/50,

lead heart rate 92/min, his non-labored respiratory rate is 14
bpm, and his pulse oximetry reading is 97%. Which as-
sessment step is most important now?

44.
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about every 2 As a team leader, when do you tell the chest compressors
minutes to switch?

45. apply oxygen The patient's pulse ox shows a reading of 84% on room
(I think I put Bag air. Which initial action do you take?
valve mask for
this and I got it
wrong)

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