ACLS Practice Test

To avoid confusion, the universal ratio of chest compression to
CPR is 30:2, regardless.

When a c-spine injury is suspected, open the airway
with the jaw thrust maneuver

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 Atrial Flutter.
Notice the flutter give the telltale 'sawtooth' pattern.
the rate of the flutter waves is 300 BPM, and in this example
every 3rd or every 4th flutter wave is conducted.

For every minute that passes between a witnessed VF arrest
and defibrillation, the chance of survival decreased by 7-10%.
With bystander CPR, the decline is more gradual and falls by 3-4% per minute.

CPR saves lives.

Chest compressions should not be withheld.
The respiratory rate should be approximately
one breath every 6-8 seconds.

A pulse check is appropriate after about 2 minutes of
CPR following defibrillation.

This is a HUGE change in BLS.
Since adults have approximately 5 minutes of oxygen reserve,
newer recommendations are to begin chest compressions and
restore circulation before addressing oxygenation.

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.

This is Atrial Fibrillation.
Notice that there are no discernible P-waves and that the interval
between each QRS varies, beat-to-beat.

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

The above rhythm is Sinus Tachycardia.
Of note, had the rhythm been over 150 bpm,
the P waves would have been harder to see,
merging with the preceding T wave, and
other rhythms would need to be considered,
such as SVT or Atrial flutter with 2:1 block.
The first four items on the above differential
are unlikely to cause a Sinus Tachycardia
above 150 bpm.

This is a wide complex tachycardia and is most likely Ventricular
tachycardia. While it appears monomorphic, since the patient is
pulseless, it should be defibrillated.

In synchronized cardioversion, a lower energy is used and it is
timed to the QRS. In unsynchronized defibrillation, a higher
energy is used and the shock is applied immediately, without
being timed to the QRS complex.

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.

80% of acute strokes are ischemic.
The above patient had a hemorrhagic stroke.
This is an absolute contraindication to tPA.

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 VT.
Notice that this is a wide-complex, rapid, regular rhythm.
There are no discernible P-waves.

This is Ventricular Fibrillation.
Notice that this is wide-complex and irregular.
This rhythm will not generate any mechanical systoles.

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 Second Degree Heart Block, Type 1 (Wenckebach).
Notice the PR interval lengthens with each subsequent beat
until a P wave is not followed by a QRS. After this dropped beat,
the PR interval shortens again.

This pt is stable, in SVT. Treatment with vagal maneuvers, as well
as adenosine are appropriate interventions.

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

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.

An oxygen saturation of 100% is unnecessary and potentially harmful. Supplemental oxygen should be given until the oxygen saturation is approximately 94%.

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.

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.

There is no indication of escalating or high dose epinephrine.

Treatment with tPA comes with a real risk of bleeding and
it should only be given where appropriate.
If the patient presents with a seizure, it is not possible to
differentiate between an Acute CVA and a Todd's Paralysis.
If the patient awakened with symptoms, the time of onset
cannot be established.
If the symptoms are minor and quickly resolving, the risks of
tPA will exceed its benefits.

A distant history of GI is not a contraindication.

This patient is in an SVT.
Because his vital are unstable,
he needs to be returned to sinus
rhythm immediately. Either Adenosine or
Electrical Synchronized cardioversion would
be appropriate.

This is Second Degree Heart Block, Mobitz 2.
Notice that the PR interval is fixed, and that many
P waves are not conducted so they are not followed
by a QRS complex. In this example, every third P-wave
is conducted

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

These are the H's and T's of PEA.
Know them.

Atropine does not have a role in complete heart block.