ACLS Principles Flashcard 1

B. Rationale: Chest compression rate must be between 100 and 120/min. These chest compression rates have been associated with improved survival.

C. Rationale: This woman has persistent ventricular fibrillation after a witnessed arrest. She was given prompt standard therapy with CPR, defibrillation, and epinephrine. In this case, amiodarone is the standard of care following VF refractory to standard management. It has a 40% success rate in nonarrest cases of VT. It has less side effects than other anti-arrhythmic medications. While epinephrine can be tried again, it is appropriate to try another medication since it has failed multiple times already in this patient. It is inappropriate to terminate resuscitation efforts in this patient until all options have been exhausted. Lidocaine is an alternative to amiodarone, but is is considered inferior.

D. Rationale: Atropine is the treatment of choice in symptomatic bradycardia, as it works at the nodal level to oppose vagal stimulation of the node. However, 2nd-degree (Mobitz II) AV block (as in this case) or 3rd-degree AV block are initiated below the node and are unlikely to respond to atropine. Instead, these patients should be managed with beta-adrenergic medications (e.g., epinephrine, dopamine) or transcutaneous pacing as a temporizing measure until transvenous pacing can be accomplished. Dobutamine is generally not recommended in bradycardia due to the high risk of hypotension. Defibrillation is not warranted in this alert patient with a pulse. Note that a new Mobitz type II AV block may be related to ACS with blockage in the left anterior descending artery. Evaluation for ACS with this patient’s classic symptoms is warranted.

A. Rationale: Even though the rhythm looks like sinus bradycardia, the fact that there is no pulse means the patient is in cardiac arrest secondary to pulseless electrical activity. Rescuers must recognize this as soon as possible so that high-quality CPR may be provided immediately.

B. Rationale: While performing continuous chest compressions, a provider delivers 1 asynchronous breath every 6 seconds during CPR with an advanced airway such as an endotracheal tube.

C. Rationale: This is a paroxysmal supraventricular tachycardia, likely an AV nodal re-entrant tachycardia. The characteristic finding seen on this ECG is a narrow and regular tachyarrhythmia. The presence of unstable symptoms, such as hypotension and chest pain, is an indication for synchronized cardioversion. A precordial thump may be performed, but only if a defibrillator is not available. In this case, the patient is already connected to a defibrillator.

B. Rationale: In this scenario, the patient has symptomatic bradycardia. The first choice of medication to be given in this case is atropine.

B. Rationale: In patients with cardiac arrest, regardless of etiology, the first step is CPR, beginning with chest compressions and defibrillation if a shockable rhythm is found. This does not change, even in the case of toxic ingestion. In a patient with clinically symptomatic opiate toxicity, naloxone IV is a good treatment strategy. Advanced airway management is indicated for respiratory distress or arrest that is not responsive to naloxone. Flumazenil is used in cases of benzodiazepine toxicity, not opiate ingestion.

A. Rationale: An oxygen saturation of greater than or equal to 94% is in the normal range and will not require any intervention.

B. Rationale: One of the important measures to successful advanced cardiac life support is the shortest time to defibrillation. When a shockable rhythm is diagnosed, then defibrillation should not be delayed.