ACLS Principles Flashcard 17
Rationale
C. Rationale: Agonal gasps are not normal breathing and occur in the first few minutes after cardiac arrest. It looks like a person is drawing air inward very quickly with the mouth open, and the jaw, neck, and head may move while they are gasping. This occurs at a very slow rate, and there might be some time before the next gasp. The gasp may have a sound like moaning or snorting. Agonal gasps are a sign of cardiac arrest.
Question
You were called to respond to an office worker who began choking while eating. He’s been trying to relieve the obstruction for quite a while, but he is now unresponsive. You notice that his face is blue, and he appears to gulp air. You assess that he is displaying agonal gasps. Which of the following is true regarding agonal gasps?
a. Agonal gasps are normal breathing patterns
b. Agonal gasps occur at a very fast rate
c. Agonal gasps are signs of cardiac arrest
d. None of the above
Answer
c. Agonal gasps are signs of cardiac arrest
Rationale
C. Rationale: The only drug of choice for cardiac arrest in asystole is epinephrine.
Question
Your ACLS team is currently reviving a 29-year-old drowned patient in asystole. You are assigned as the medication administrator by your team leader. What is the drug of choice to convert asystole to a return of spontaneous circulation?
a. Amiodarone
b. Vasopressin
c. Epinephrine
d. Dobutamine
Answer
c. Epinephrine
Rationale
A. Rationale: Asystole, when not responsive to cardiopulmonary resuscitation and vasopressors, is due to extensive myocardial ischemia with necrosis secondary to a prolonged period of inadequate coronary perfusion.
Question
You and your team have been resuscitating a patient in cardiac arrest with asystole for more than 30 minutes. Despite providing high-quality CPR and administering epinephrine, the patient’s condition has not improved. What is the pathophysiology of the persistent asystole?
a. Extensive myocardial ischemia and necrosis from a prolonged period of inadequate coronary perfusion
b. Aberrant impulses secondary to myocardial scar tissue from a previous myocardial infarction
c. A high degree of atrioventricular block
d. Formation of an asynchronous impulse to the infranodal conducting system
Answer
a. Extensive myocardial ischemia and necrosis from a prolonged period of inadequate coronary perfusion
Rationale
D. Rationale: Biphasic defibrillators are defined to effectively terminate ventricular fibrillation by applying a variety of waveforms. Therefore, the initial dose depends on the manufacturer’s setting. If you are unaware of the manufacturer’s recommended first dose, the highest energy dose should be applied. There is no time to read the user’s manual because chest compressions should be interrupted as short a time as possible.
Question
Your emergency response team is currently resuscitating a 65-year-old man in cardiac arrest secondary to ventricular fibrillation. You are the assigned defibrillator. The patient is attached to a new biphasic defibrillator that you are not familiar with. Your team leader orders you to deliver a shock; what energy setting will you use for the patient?
a. Attach a biphasic defibrillator that you are familiar with
b. Refer to the user’s manual on the recommended dose
c. Apply the lowest dose possible
d. Apply the highest energy dose possible
Answer
d. Apply the highest energy dose possible
Rationale
B. Rationale: This is a case in which ventricular fibrillation converted into pulseless electrical activity. Even though you assess that the ventricular fibrillation has converted into sinus rhythm, the patient remains pulseless. Thus, you must follow the asystole/PEA arm of the AHA cardiac arrest algorithm, continuing high-quality CPR and giving epinephrine every 3–5 minutes.
Question
Your emergency response team is resuscitating a 35-year-old patient in cardiac arrest secondary to sudden cardiac death. After delivering the first defibrillation of 120 J with a biphasic defibrillator, you notice the following rhythm:
You then check for the pulse and feel none. There is no spontaneous breathing. What is your next course of action?
a. Deliver another shock at 150 J.
b. Continue high-quality CPR for 2 minutes and give IV epinephrine every 3 to 5 minutes.
c. Give synchronized cardioversion.
d. Maintain good ventilation and oxygenation and give vasopressors to sustain normal blood pressure; transfer the patient to the ICU.
Answer
b. Continue high-quality CPR for 2 minutes and give IV epinephrine every 3 to 5 minutes.
Rationale
B. Rationale: You must check the rhythm to guide your next course of action on the cardiac arrest algorithm. For example, if the rhythm has converted to ventricular fibrillation or pulseless ventricular tachycardia, immediate defibrillation must be given. You must also check for return of spontaneous circulation. This is done every 2 minutes of high-quality CPR and assessed for < 10 seconds.
Question
Your team has been resuscitating a patient in cardiac arrest with pulseless electrical activity. How will you determine if there is any progress in your management?
a. Check for pulse or spontaneous breathing every 3 to 5 minutes
b. Rhythm check every 2 minutes
c. Monitor end-tidal carbon dioxide every minute and target 40 mm Hg
d. Check if there is an increase in blood oxygen saturation every 2 minutes
Answer
b. Rhythm check every 2 minutes
Rationale
D. Rationale: This is a case where pulseless electrical activity has converted to ventricular fibrillation, a shockable cardiac arrest rhythm. The AHA cardiac arrest guidelines recommend defibrillation as soon as possible.
Question
Your team is resuscitating a 45-year-old man with gunshot wounds who is in cardiac arrest with pulseless electrical activity. At your next rhythm check, you record the following ECG:
The patient is not breathing, and he has no pulse. What is your next course of action?
a. Request expert help to assess the gunshot wound.
b. Perform a precordial thump right away.
c. Continue high-quality CPR with rhythm checks every 2 minutes and administer 1 mg epinephrine every 3 to 5 minutes.
d. Continue high-quality CPR while the defibrillator is charging. Once completed, deliver a shock.
Answer
d. Continue high-quality CPR while the defibrillator is charging. Once completed, deliver a shock.
Rationale
A. Rationale: The asystole has converted to ventricular fibrillation! It is a shockable rhythm, and there must be no delay in delivering a shock. If the defibrillator is still charging, high-quality CPR must be resumed while waiting for it to fully charge.
Question
Your team is resuscitating a cardiac arrest patient in asystole. After 10 minutes of high-quality CPR and the administration of epinephrine, you observe the following ECG tracing:
What is your next course of action?
a. Immediately defibrillate
b. Resume high-quality CPR with pulse checks every 2 minutes
c. Give an IV bolus of epinephrine 1 mg
d. Perform synchronized cardioversion
Answer
a. Immediately defibrillate
Rationale
D. Rationale: The algorithm states that rhythm and pulse checks must be performed after 2 minutes of high-quality CPR.
Question
Your team is resuscitating a patient with cardiac arrest that was previously in ventricular fibrillation and converted to asystole. When is the most appropriate time to check the rhythm while performing high-quality CPR?
a. Every 3 to 5 minutes
b. After defibrillating the patient
c. After the administration of epinephrine
d. After 2 minutes of high-quality CPR
Answer
d. After 2 minutes of high-quality CPR
Rationale
D. Rationale: In this case, obtaining IV or IO access takes priority over placing an advanced airway. An exception would be when bag-mask ventilation is inadequate, or hypoxia is the cause of cardiac arrest.
Question
Your team is resuscitating an adult patient in asystole secondary to a myocardial infarction. While performing high-quality CPR, what is your next priority for the patient?
a. Rhythm and pulse check
b. Defibrillation
c. Placement of advanced airway
d. Obtaining access for medications
Answer
d. Obtaining access for medications