ACLS Readiness Trivia Quiz

1. Which of the following answers describes the highest quality CPR?

Perfomed by the strongest individual on the code team for the entirety of the resuscitation.

Compressions are performed gently to avoid injury to the patient at a speed that does not exceed 100 compressions/minute.

Recent evidence demonstrates that rescue breathing is more important than chest compressions, and therefore, no chest compressions should be performed.

The American Heart Association's 2010 ECC Standards identify that chest compressions are the most important component of CPR and must be performed at a speed exceeding 100 compressions per minute; at a depth of at least 2 inches on the adult; and with minimal interruptions (less than 10 seconds). Further rescuers should switch compressors every 2 minutes to avoid rescuer fatigue. Although patients may be injured by compressions, the benefit of survival from the cardiac event surpasses the risk of receiving CPR.

Explanation

The American Heart Association's 2010 ECC Standards identify that chest compressions are the most important component of CPR and must be performed at a speed exceeding 100 compressions per minute; at a depth of at least 2 inches on the adult; and with minimal interruptions (less than 10 seconds). Further rescuers should switch compressors every 2 minutes to avoid rescuer fatigue. Although patients may be injured by compressions, the benefit of survival from the cardiac event surpasses the risk of receiving CPR.

2. Which medications should be considered in the treatment of acute coronary syndromes?

DOOM - Digitalis, Oxycodone, Oxygen, Morphine

GNOME - Gabapentin, Nitroglycerine, Oxygen, Milk of Magnesia, Epinephrine

MONA - Morphine, Oxygen, Nitroglycerine, Aspirin

MOAN - Metformin, Ondansetron, Aspirin, Naloxone

Morphine, Oxygen, Nitroglycerine, and Aspirin have been identified as effective medications used in acute coronary syndromes.

Explanation

Morphine, Oxygen, Nitroglycerine, and Aspirin have been identified as effective medications used in acute coronary syndromes.

3. A conscious, awake, and alert male complaining of left sided chest pain for 2 hours duration is being seen in the emergency department. The patient has an easy work of breathing; RR 18; BP 148/92; HR 112; and SpO2 92% on room air. What is the best plan of action to manage this patient?

Page a cardiologist STAT to assess this patient.

Order a CT scan to rule out a stroke.

This patient should be identified as stable and a complete assessment can be performed to identify the underlying cause of the chest pain. The assessment should include a 12 lead EKG, a focused history, and laboratory tests which include troponin and CPK. The patient does not have signs of a stroke; all chest pain is considered serious until a non-serious cause can be identified; cardiology will rely upon your assessment to identify interventions for the patient.

Explanation

This patient should be identified as stable and a complete assessment can be performed to identify the underlying cause of the chest pain. The assessment should include a 12 lead EKG, a focused history, and laboratory tests which include troponin and CPK. The patient does not have signs of a stroke; all chest pain is considered serious until a non-serious cause can be identified; cardiology will rely upon your assessment to identify interventions for the patient.

4. A 72 year old male is being resuscitated after a witnessed cardiac arrest. One shock was administered approximately one minute ago to treat the rhythm seen below. Attempts to place an IV have failed and an intraosseous access has been established. What is the first appropriate pharmacological intervention?

0.5 mg Atropine, IO

1 mg Epinephrine, IO

300 mg Amiodarone, IO

6 mg Adenosine, IV

Epinephrine is the first medication given in VF/VT arrests as well as for PEA/Asystole arrests. Atropine is only given in symptomatic bradycardias; amiodarone is given to correct refractory VF/VT; and adenosine is used to chemically cardiovert supraventricular tachycardias (SVTs).

Explanation

Epinephrine is the first medication given in VF/VT arrests as well as for PEA/Asystole arrests. Atropine is only given in symptomatic bradycardias; amiodarone is given to correct refractory VF/VT; and adenosine is used to chemically cardiovert supraventricular tachycardias (SVTs).

5. A female who suddenly collapsed at a marathon race has the below lead 2 rhythm. This rhythm can be best described as:

Asystole

Ventricular Fibrillation (VFib)

Monomorphic wide complex ventricular tachycardia (VTach)

Polymorphic wide complex ventricular tachycardia (VTach)

This rhythm is a wide complex, monomorphic ventricular tachycardia.

Explanation

This rhythm is a wide complex, monomorphic ventricular tachycardia.

6. Which anti-cholinergic medication is used to block parasympathetic nervous system innervation that may be the cause of bradycardia?

Atropine

Epinephrine

Amiodarone

Adenosine

Atropine is an anti-cholinergic medication which blocks vagal stimulation of the heart which may be the cause of bradycardias. This medication is used in the symptomatic bradycardia algorithm to allow the sympathetic nervous system to increase heart rate.

Explanation

Atropine is an anti-cholinergic medication which blocks vagal stimulation of the heart which may be the cause of bradycardias. This medication is used in the symptomatic bradycardia algorithm to allow the sympathetic nervous system to increase heart rate.

7. A 78 year old male is inbound with EMS to the hospital emergency department with a new onset of left sided weakness and slurred speech. Which of the following is the priority action?

Administer tPA to break down the intracerebral clots causing his symptoms.

Obtain a head CT to rule out the possibility of a hemorrhagic stroke.

Obtain a 12 lead EKG and cardiac markers to rule out acute coronary syndromes.

Offer the patient 324 milligrams of aspirin for his headache.

Patients being seen for stroke-like symptoms should have a CT scan performed to rule out intracerebral hemorrhage. Patients without intracerebral hemorrhage may be candidates for tPA which, if administered within 3 hours of symptom onset, may be effective at destroying clots and restoring bloodflow to ischemic portions of the brain.

Explanation

Patients being seen for stroke-like symptoms should have a CT scan performed to rule out intracerebral hemorrhage. Patients without intracerebral hemorrhage may be candidates for tPA which, if administered within 3 hours of symptom onset, may be effective at destroying clots and restoring bloodflow to ischemic portions of the brain.

8. A 46 year old intubated male is receiving CPR following a witnessed cardiac arrest. Which of the following describes the perfomance of CPR on a patient with an advanced airway?

CPR is perfomed without changes at a ratio of 30 compressions to 2 rescue breaths.

The compression to ventilation ratio is reduced to 15:2.

Compressions are performed at a rate of less than 100 per minute; ventilations are delivered twice every 3-5 seconds.

Compressions are performed at a rate of at least 100 per minute; ventilations are delivered once every 6-8 seconds.

CPR in adult, child, and infant patients with an advanced airway in place changes to continuous compressions at a rate of at least 100 per minute with 1 ventilation delivered every 6 to 8 seconds.

Explanation

CPR in adult, child, and infant patients with an advanced airway in place changes to continuous compressions at a rate of at least 100 per minute with 1 ventilation delivered every 6 to 8 seconds.

9. A 19 year old female in the emergency department for suspected opiate overdose is being ventilated using a bag-valve-mask at 12 breaths per minute and with a heart rate of 72. The respiratory therapist is reporting increasing resistance and reduced compliance with ventilations. You should:

Immediately intubate the patient.

Establish IV access and administer 8 mg of naloxone (Narcan).

Reposition the airway and use a simple airway adjunct, evaluate for improved compliance and reduced resistance.

Stop ventilating the patient and start compression only CPR.

Airway positioning, suctioning, and simple airway adjuncts are the first steps to correcting airway issues. If these actions are not effective, then more invasive procedures should be considered including intubation. Although IV naloxone will likely correct the patient's problem, the airway issues must be corrected first. CPR should not be performed if the patient has a perfusing heart rhythm.

Explanation

Airway positioning, suctioning, and simple airway adjuncts are the first steps to correcting airway issues. If these actions are not effective, then more invasive procedures should be considered including intubation. Although IV naloxone will likely correct the patient's problem, the airway issues must be corrected first. CPR should not be performed if the patient has a perfusing heart rhythm.

10. A 65 year old adult male being seen in the emergency department for respiratory failure suddenly stops breathing and displays a sinus bradycardic rhythm of 48/min on the monitor. Which of the following is the priority intervention for this patient?

Immediately administer 0.5 mg Atropine via IV to correct the bradycardia.

Begin CPR at a rate of 30 compressions to 2 rescue breaths.

Apply pads to patient's chest and begin to pace at 70/min.

BLS before ALS - The likely cause of this patient's bradycardia is hypoxia. Correction of hypoxia is likely to correct the bradycardia. Therefore, airway positioning and ventilation of the patient are indicated. Atropine and transcutaneous pacing can be considered if the patient remains symptomatic once the hypoxia has been corrected. CPR would be indicated if the patient became pulseless.

Explanation

BLS before ALS - The likely cause of this patient's bradycardia is hypoxia. Correction of hypoxia is likely to correct the bradycardia. Therefore, airway positioning and ventilation of the patient are indicated. Atropine and transcutaneous pacing can be considered if the patient remains symptomatic once the hypoxia has been corrected. CPR would be indicated if the patient became pulseless.