ACLS Principles Flashcard 4
Rationale
A. Rationale: According to the World Health Organization in 2019, ischemic heart disease is the number one cause of death worldwide, followed by stroke.
Question
According to the World Health Organization in 2019, the second most common cause of death worldwide is:
a. Stroke
b. Vehicular accidents
c. Pneumonia
d. Ischemic heart disease
Answer
a. Stroke
Rationale
B. Rationale: IV/IO access has priority over advanced airway placement unless bag-mask ventilation is ineffective.
Question
Advance airway has priority over IV access in the pulseless arrest algorithm.
a. True
b. False
Answer
b. False
Rationale
A. Rationale: This rhythm strip is an example of an accelerated junctional rhythm. Notice the inverted P waves and a heart rate of about 100 bpm. However, any organized rhythm in the absence of a perfusing rhythm or pulse is diagnosed as pulseless electrical activity. This diagnosis will guide healthcare providers to perform advanced cardiac life support measures.
Question
After 10 minutes of high-quality CPR and two doses of epinephrine, you perform a rhythm check and find the following tracing:
You check for a pulse but do not feel it, and the patient is not breathing. What is your interpretation of the ECG tracing?
a. Pulseless electrical activity
b. Sinus rhythm
c. Second-degree AV block
d. Junctional rhythm
Answer
a. Pulseless electrical activity
Rationale
D. Rationale: Amiodarone is the antiarrhythmic of choice for persistent shockable cardiac arrest.
Question
After 7 minutes of resuscitating a cardiac arrest patient with pulseless ventricular tachycardia that is still unresponsive after the third defibrillation, what is the next treatment consideration?
a. Atropine 1 mg IV bolus injection
b. Adenosine 6 mg rapid IV injection
c. Magnesium sulfate 2 g IV over 20 minutes
d. Amiodarone 300 mg IV injection
Answer
d. Amiodarone 300 mg IV injection
Rationale
D. Rationale: The ECG tracing that was initially a pulseless electrical rhythm has converted into ventricular fibrillation. In this instance, the patient must be defibrillated immediately. After the shock is delivered, the team resumes 2 minutes of CPR, beginning with chest compression followed by a rhythm check afterward.
Question
After a dose of epinephrine is given and 2 minutes of CPR are performed on a patient with pulseless electrical activity, a rhythm check is performed showing the following tracing:
What is your next course of action?
a. Continue CPR beginning with chest compressions
b. Give another dose of epinephrine
c. Intubate the patient
d. Defibrillate
Answer
d. Defibrillate
Rationale
B. Rationale: After the AED announces that the shock has been delivered, CPR must be resumed as soon as possible for 2 full minutes before performing the next rhythm check.
Question
After an AED delivers a shock to a cardiac arrest patient, how many minutes must CPR be performed before the next rhythm check?
a. 1 minute
b. 2 minutes
c. 3 minutes
d. 5 minutes
Answer
b. 2 minutes
Rationale
B. Rationale: After the AED announces that the shock has been delivered, CPR must be resumed as soon as possible and continued for 2 minutes before performing the next rhythm check. (ACLS Case: Cardiac Arrest: Algorithm)
Question
After an AED delivers a shock to the patient and CPR is resumed, the next rhythm check is performed after:
a. 1 minute
b. 2 minutes
c. 3 minutes
d. 5 minutes
Answer
b. 2 minutes
Rationale
B. Rationale: Successful defibrillation will initially cause a slow organized rhythm that may not create a pulse. Continuing chest compressions is necessary until the heart functions adequately. If defibrillation is unsuccessful, chest compressions must be resumed at once.
Question
After defibrillating a patient with cardiac arrest in ventricular fibrillation secondary to myocardial infarction, what is the next most important step?
a. Stop and check for the rhythm, pulse, and spontaneous breathing
b. Provide high-quality CPR
c. Give another shock if the patient is unresponsive
d. Intubate the patient
Answer
b. Provide high-quality CPR
Rationale
D. Rationale: After a shock has been delivered, high-quality CPR must be continued for 2 minutes, as shown cardiac arrest algorithm. Rhythm or pulse checks are not done unless the patient has shown signs of life or advanced monitoring has indicated signs of return of spontaneous circulation.
Question
After delivering a shock of 120 J to convert ventricular fibrillation, there is no change in the patient’s condition. What is the next most important step?
a. Rhythm check
b. Deliver another shock at 150 J
c. Give epinephrine 1 mg IV bolus
d. Continue high-quality CPR for 2 minutes
Answer
d. Continue high-quality CPR for 2 minutes
Rationale
C. Rationale: This is asystole, a nonshockable rhythm. The next course of action is to perform high-quality CPR for 2 more minutes and administer a bolus of epinephrine 1 mg IV every 3 to 5 minutes.
Question
After delivering a shock to a patient with ventricular fibrillation and immediately performing high-quality CPR for 2 minutes, your team leader checks the ECG tracing and records the following:
What is your next course of action?
a. Defibrillate again
b. Synchronized cardioversion
c. Amiodarone 300 mg IV push
d. Continue high-quality CPR
Answer
c. Amiodarone 300 mg IV push