ACLS Principles Flashcard 2
Rationale
B. Rationale: The team must continue with high-quality CPR for pulseless electrical activity. Asystole is not a shockable rhythm, and thus the right side of the algorithm must be followed.
Question
A 55-year-old man with cardiac arrest in asystole is being resuscitated for about 15 minutes. Your team decides to perform the rhythm check and record the following:
You check the pulse and feel none. You record the following vital signs: HR = 0 bpm, BP = 0 mm Hg. What is your next course of action?
a. Defibrillate
b. Continue high-quality CPR for 2 minutes and administer 1mg epinephrine every 3 to 5 minutes
c. Stop CPR and optimize ventilation and oxygenation and treat hypotension
d. Start an infusion of dopamine 5–10 mcg/kg/min
Answer
b. Continue high-quality CPR for 2 minutes and administer 1mg epinephrine every 3 to 5 minutes
Rationale
C. Rationale: This is the pattern of asystole. A flat line that denotes no electrical signal from the heart can be due to causes other than cardiac arrest. When this pattern is seen, the provider must ensure that the ECG leads are connected in their proper places. Loose leads, lack of power to the ECG unit, or signal gain/loss can cause a flatline reading.
Question
A 59-year-old man is brought to the emergency department unconscious and not breathing. An ECG shows the following tracing. What is your interpretation of the ECG finding?
a. Ventricular fibrillation
b. Ventricular tachycardia
c. Asystole
d. Atrial fibrillation
Answer
c. Asystole
Rationale
C. Rationale: This case represents PEA converting to asystole. The patient’s condition has not improved despite resuscitative efforts. Asystole is not a shockable rhythm, and after performing the rhythm check, the right side of the cardiac arrest algorithm is followed. High-quality CPR must resume with epinephrine 1 mg IV boluses every 3–5 minutes.
Question
A 60-year-old man with stage IV lung cancer is being resuscitated in the emergency department. He is in cardiac arrest with pulseless electrical activity. After 2 minutes of high-quality CPR, the team performs a rhythm check and records the following ECG tracing:
The patient has no pulse and is not breathing. What is the next treatment of choice?
a. Amiodarone 300 mg IV injection
b. Defibrillation
c. Continue high-quality CPR for 2 minutes, giving epinephrine 1 mg IV every 3 to 5 minutes
d. Have the ED physician call the time of death, as CPR is futile
Answer
c. Continue high-quality CPR for 2 minutes, giving epinephrine 1 mg IV every 3 to 5 minutes
Rationale
D. Rationale: CPR must be started once it is established that the patient has no pulse and no spontaneous breathing. (ACLS Case: Cardiac Arrest algorithm)
Question
A 65-year-old man complains of chest pain and soon becomes unresponsive. EMS has been called and is in transit. No pulse or spontaneous breathing is detected. What is the next correct step?
a. Give rescue breaths
b. Clear the path for EMS personnel in case they arrive
c. Keep checking for return of spontaneous circulation every 2 minutes
d. Begin CPR
Answer
d. Begin CPR
Rationale
A. Rationale: Even though the rhythm looks like sinus bradycardia, the fact that there is no pulse means that the patient is in cardiac arrest secondary to pulseless electrical activity. This must be recognized right away, as high-quality CPR should be initiated immediately.
Question
A 65-year-old man is brought to the emergency department allegedly due to a heart attack. The patient is unconscious with no pulse and not breathing spontaneously. The following ECG tracing was recorded:
What is the interpretation of this ECG finding?
a. Pulseless electrical activity
b. Sinus bradycardia
c. Idioventricular rhythm
d. First-degree AV block
Answer
a. Pulseless electrical activity
Rationale
D. Rationale: CPR must be started once it is established that the patient has no pulse and no spontaneous breathing.
Question
A 65-year-old man reports having chest pain and soon becomes unresponsive. EMS is called and in transit. No pulse or spontaneous breathing is detected. What is the next correct step?
a. Give rescue breaths.
b. Clear the path for EMS personnel in case they arrive.
c. Keep checking for return of spontaneous circulation every 2 minutes.
d. Begin CPR.
Answer
d. Begin CPR.
Rationale
B. Rationale: While performing continuous chest compressions, a provider delivers one asynchronous breath every 6 seconds during CPR with an advanced airway such as an endotracheal tube. (Systematic Approach in ACLS; BLS assessment)
Question
A cardiac arrest patient has been successfully intubated. During CPR with an advanced airway, the provider must deliver 1 breath every:
a. 3 seconds
b. 6 seconds
c. 7 seconds
d. 10 seconds
Answer
b. 6 seconds
Rationale
B. Rationale: The healthcare provider must recognize the rhythms of cardiac arrest. Asystole is a non-shockable rhythm. The right side of the ACLS algorithm should be followed to perform high-quality CPR for 2 minutes and administer epinephrine IV every 3 to 5 minutes.
Question
A cardiac arrest patient is brought by EMS to your emergency department for further management. He sustained electrical shock injuries after being hit by lightning in the fields where he farms apples. You record the following ECG tracing:
What is your interpretation of this ECG finding?
a. Ventricular tachycardia
b. Asystole
c. Pulseless electrical activity
d. Ventricular fibrillation
Answer
b. Asystole
Rationale
C. Rationale: The ECG tracing represents ventricular fibrillation. The definitive treatment for shockable rhythms is the successful termination of the arrhythmia and conversion to sinus rhythm. Hence, these patients must receive early defibrillation, or this rhythm will convert to asystole.
Question
A cardiac arrest patient’s rhythm strip shows the following ECG tracing.
What is the definitive treatment for this patient?
a. Epinephrine
b. Chest compressions
c. Extracorporeal CPR
d. Defibrillation
Answer
c. Extracorporeal CPR
Rationale
B. Rationale: Asystole is a cardiac arrest rhythm in which the heart does not exhibit any electrical activity. However, this can also indicate that the cardiac monitor or ECG machine is defective. If a cardiac arrest patient presents with this rhythm, first check to see if the leads are properly connected and the machine is functioning properly.
Question
A critically ill patient shows the following ECG tracing:
What is the first course of action in this case?
a. Immediate CPR beginning with chest compressions
b. Ensure the ECG leads are properly connected
c. Early defibrillation
d. Endotracheal intubation
Answer
b. Ensure the ECG leads are properly connected