ACLS Practice Quiz I

Hyperventilation during resuscitation can cause an increase in intrathoracic pressure and a decrease in cardiac output. When a person hyperventilates, they breathe rapidly and shallowly, leading to excessive elimination of carbon dioxide from the body. This causes a decrease in blood carbon dioxide levels, leading to vasoconstriction and a decrease in blood flow to vital organs, including the heart. Additionally, the increased intrathoracic pressure can impede venous return to the heart, further reducing cardiac output. Therefore, it is true that hyperventilation during resuscitation can cause an increase in intrathoracic pressure and a decrease in cardiac output.

The OPA sits in the posterior oropharynx, excites and gag reflex,
and if used in an conscious patient will likely lead to vomiting and aspiration.

The Cincinnati Prehospital Stroke Scale is a tool to detect stroke
in the prehospital setting. If any one of its three components are
positive, the pt has a 72% likelihood of having an acute CVA.
If all three are positive, there is an 85% likelihood of the patient
having an acute CVA.

Remember, Face/Arm/Speech. Balance is not tested.

This is SVT.
Notice that this is a narrow-complex, rapid, regular rhythm.
There are no discernible P-waves.

tPA should be given as treatment for an acute CVA when the
patient presents within 3 hours of the onset of symptoms,
and there are no contraindications. In some circumstances,
with input from neurology, the window may be pushed back
to 4.5 hours.
Outside of this 4.5 hour window, there is no literature to show
that the benefits outweigh the risks of treating a CVA with
tPA and it should not be done.

This is VVentricular Tachycardia (Torsades de Points).
Notice the sinusoidal nature of this rhythm. This is generated
as the axis of depolarization revolves around a point.
This rhythm needs to be recognized because treatment is
Magnesium Sulfate.

In an unstable patient in whom you are not sure if the Ventricular Tachycardia
is monomorphic or polymorphic, assume it is polymorphic and defibrillate.

This is first degree heart block.
Conduction has been slowed through the AV node so the
PR interval>0.2 seconds (one large box).

If a patient is in a puddle or in the snow, he does not need to
be moved. If he is submerged, he should be moved to drier ground.

In a monophasic defibrillator, the initial shock should be 360 J. This is because monophasic defibrillators deliver a single pulse of electrical current during each shock. The higher energy level of 360 J is necessary to effectively restore normal heart rhythm in cases of ventricular tachycardia (VT) or ventricular fibrillation (VF).

This is Third Degree Heart Block.
Notice the complete dissociation between the
P-waves and the QRS complexes.
If you measure the distance between each
P-wave it will be fixed.
If you measure the distance between each QRS
complex it will be fixed.
Since there is no relationship between the P-Wave and
the QRS complex, the PR interval will be entirely varied.

An advanced airway, i.e. and ET tube, is NOT necessary, as per ACLS
guidelines. As long as the patient is being ventilated adequately, any method
is acceptable.

The patient with atrial fibrillation is at increased risk
of an embolic stroke unless they are appropriately
anticoagulated.

Atropine does not have a role in complete heart block.