Download ACLS Pretest - Heartland CPR

ACLS PROVIDER
Course Study Guide/Pre-Test
*PLEASE COMPLETE AND BRING THIS DOCUMENT WITH YOU TO CLASS*
Heartland CPR, llc
8101 NW 10th St, Suite #C3
Oklahoma City, OK 73127
405-603-6666
[email protected]
www.HeartlandCPR.com
*source: American Heart Association ACLS Provider Manual supplementary material
http://ahainstructornetwork.americanheart.org/idc/groups/ahaecc-public/@wcm/@ecc/documents/downloadable/ucm_479382.pdf
Heartland CPR, llc
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PR interval:
Measures from the beginning of the P wave to the beginning of the Q wave
Normal: 0.12 - 0.20 sec
QRS complex:
Measures from the beginning of the Q wave to the end of the S wave
Normal: <0.12 sec
QT interval:
Measures from the beginning of the Q wave to the end of the T wave
Normal: Needs to be corrected for heart rate – usually 0.44 to 0.32 sec
(heart rate of 60 – 100 bpm for both men and women)
Intrinsic Rates:
SA Node 60 – 100
AV Node 40 – 60
PF 15 – 40
Heartland CPR, llc
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Method for estimating heart rate
To estimate heart rate, memorize the rate intervals: 300, 150, 100, 75, 60, 50, 40, and 30. This
method estimates heart rate. Although there are other methods and tools available, this method does
not require a 3-second or 6-second strip and it can be used easily at the bedside.
1. Pick a complex that falls on a heavy line
2. Estimate the rate by counting heavy boxes
3. Using 300, 150, 100, 75, 60, 50, 40, 30
Other heart rate measurements that can be used:
• Count the number of QRS complexes (R waves) on a 6-second strip and multiply by 10
• Divide 300 by the number of large boxes between 2 consecutive QRS complexes (R waves)
• Divide 1500 by the number of tiny boxes between 2 consecutive QRS complexes (R waves)
For atrial rate measurements, use the methods indicated above with P waves substituted for QRS
complexes (R waves).
Normal atrial rate: 60 – 100
Normal ventricular rate: 60 – 100
Heartland CPR, llc
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1.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
Regular; P to P is regular, 60 – 100 bpm
Regular; R to R is regular, 60 – 100 bpm
P wave before every QRS complex
Unchanged unless aberrant conduction due to premature beat or increased rate
PR: 0.12 - 0.20 sec
QRS: <0.12 sec
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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2.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
Regular; P to P is regular, <60 bpm
Regular; R to R is regular, <60 bpm
P wave before every QRS complex
Unchanged unless aberrant conduction due to premature beat or increased rate
PR: 0.12 - 0.20 sec
QRS: <0.12 sec
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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3.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
Regular; P to P is regular, >100 bpm
Regular; R to R is regular, >100 bpm
P wave before every QRS complex
Unchanged unless aberrant conduction due to premature beat or increased rate
PR: 0.12 - 0.20 sec
QRS: <0.12 sec
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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4.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
Regular; P to P is regular if P waves can be identified, 150 – 250 bpm
Regular; R to R intervals are regular, 150 - 250 bpm
Difficult to detect or hidden because of the fast heart rate
Unchanged unless aberrant conduction due to premature beat or increased rate
PR: not measureable
QRS: <0.12 sec
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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5.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
No P to P interval (no P waves, fibrillation “f” waves only), rate can’t be measured
R to R intervals are irregular, rate is variable – irregularly irregular
Small f waves create a wavy baseline
Unchanged unless aberrant conduction due to premature beat or increased rate
PR: not measureable
QRS: <0.12 sec
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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6.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
Regular; F to F is regular (no P waves - “F” or flutter waves), 250 – 400 bpm
R to R intervals are regular or irregular based on fixed or variable block,
60 – 150 bpm (usually 2:1 AV block)
Absent; more F’s than QRS’s; Flutter waves have sawtooth appearance
Unchanged unless aberrant conduction due to premature beat or increased rate
PR: not measureable
QRS: <0.12 sec
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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7.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
Regular; P to P is regular, 60 – 100 bpm
Regular; R to R is regular, 60 – 100 bpm
P wave before every QRS complex
Unchanged unless aberrant conduction due to premature beat or increased rate
PR: >0.20 sec
QRS: <0.12 sec
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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8.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
Regular; P to P is regular, 60 – 100 bpm
R to R intervals decrease progressively; until QRS is dropped, rate is variable
More P waves than QRS complexes
Unchanged unless aberrant conduction due to premature beat or increased rate,
but dropped in a cyclic pattern
PR: increase with each beat
QRS: <0.12 sec
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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9.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
Regular; P to P is regular, rate is variable
Regular; until QRS is blocked, rate is less than atrial rate
More P waves than QRS complexes
Unchanged unless aberrant conduction due to premature beat or increased rate
PR: 0.12 – 0.20 sec where they can be measured
QRS: variable
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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10.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
Regular; P to P is regular (if underlying rhythm sinus), 60 – 100 bpm,
can be variable (eg atrial fibrillation)
Regular; R to R is regular, <60 bpm
(40 – 60 bpm if junctional, 15 – 40 if ventricular)
More P waves than QRS complexes (complete A-V dissociation)
Unchanged unless aberrant conduction due to premature beat or increased rate
PR: increases with each beat
QRS: variable, but usually >0.12 sec
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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11.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
Absent
Absent
Absent
Absent
PR: absent
QRS: absent
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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12.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
Obscured
Irregular and chaotic; 250 – 350 bpm
Obscured
Variable, wide and bizarre, not identical
PR: absent
QRS: >0.12 sec
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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13.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
Obscured (see discussion below)
Regular; R to R intervals are regular, >150 bpm
Obscured (see discussion below)
Wide and bizarre, unchanged unless aberrant conduction due to premature beat
or increased rate
PR: absent*
QRS: >0.12 sec
*Learn More-Advanced ECG. The rhythm strip here emphasizes the regular wide complex
tachycardia (WCT) aspect of VT. In most patients a WCT will be ventricular tachycardia, especially
with older age and history of cardiac disease or acute chest discomfort. In these settings, presume
and treat as VTG. With advanced rhythm training, you will learn that WCTs may be abnormally
conducted supraventricular rhythms and “look like” VT. Careful examination of a rhythm strip
attempts to identify atrioventricular dissociation (not shown here). The atria in VT continue to contract
in most instances, and the atrial and ventricular impulses are dissociated. This leads to the
“footprints” identifying VT on rhythm strips. These are (1) AV dissociation observed as P waves
“marching” through the wide complexes and occasional fusion or Dressler’s beats. Fusion beats
occur when the atrial contraction by chance conducts part of the QRS complex. This also is an
indication of independent atrial depolarization and AV dissociation.
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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14.
Atrial rate:
Ventricular rate:
P waves:
QRS:
Intervals:
Absent
Absent
Absent
Absent
PR: absent
QRS: absent
Regular or irregular: ________________________________________________________________
P waves present: __________________________________________________________________
Atrial rate: ________________________________________________________________________
Ventricular rate: ___________________________________________________________________
PR interval: _______________________________________________________________________
QRS interval: _____________________________________________________________________
Notes:
Heartland CPR, llc
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15.
A patient is in respiratory arrest with a pulse. The patient should be ventilated
a.
b.
c.
d.
16.
The dose for Dopamine IV infusion in post-arrest care is
a.
b.
c.
d.
17.
150 mg infused over 10 minutes
300 mgs IV
150 mg IV
300 mg infused over 10 minutes
In post-Cardiac Arrest care, optimal PETCO2 readings are
a.
b.
c.
d.
20.
12 mg
6 mg
6 mg, 12 mg
6 mg/ 12 mg, 12 mg
In a patient with wide unstable Tachycardia with a pulse, the dose of Amiodarone is
a.
b.
c.
d.
19.
5 – 10 mgs/kgs
1 – 20 mcg/kg per minute
5 – 25 mcg/kgs
5 – 10 mcg/kg per minute
In regular Monomorphic Tachycardia, the initial dose for Adenocard is
a.
b.
c.
d.
18.
Twice every 5 – 6 seconds (10 – 12 times/min)
Once every 5 – 6 seconds (10 – 12 times/min)
Twice every 10 seconds
Once every 8 seconds
35 – 40 mm Hg
40 – 45 mm Hg
45 – 50 mm Hg
>50 mm Hg
What is the appropriate compression rate for an adult during cardiac arrest?
a.
b.
c.
d.
60-80 compressions/minute
80-100 compressions/minute
100-110 compressions/minute
100-120 compressions/minute
Heartland CPR, llc
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21.
Procainamide IV dose infusion for stable wide-QRS Tachycardia is:
a.
b.
c.
d.
22.
What is the most reliable method of confirming and monitory correct endotracheal tube
placement?
a.
b.
c.
d.
23.
chest pain or shortness of breath is present
the heart rate is less than 60/min with or without symptoms
the patient’s 12-lead ECG shows an MI
the blood pressure is less than 100 mm Hg systolic with or without symptoms
A 57-year-old woman has palpitations, chest discomfort, and tachycardia. The monitor shows
a regular wide-complex QRS at a rate of 180/min. She becomes diaphoretic, and her blood
pressure is 80/60 mm Hg. The next action is to
a.
b.
c.
d.
25.
visual confirmation
condensation in the ET tube
continuous waveform capnography
auscultation of lung fields
Bradycardia requires treatment when
a.
b.
c.
d.
24.
150 mg over 10 min
2 – 20 mcg/kg/min
25 mg/min
20 – 50 mg/min
perform immediate synchronized cardioversion
obtain a 12-lead ECG
establish IV access
give Amiodarone 300 mg IV push
A 62-year-old man suddenly experienced difficulty speaking and left-sided weakness. He was
brought to the emergency department. He meets initial criteria for fibrinolytic therapy, and a
CT scan of the brain is ordered. What are the guidelines for antiplatelet and fibrinolytic
therapy?
a.
b.
c.
d.
administer Heparin if CT scan is negative for hemorrhage
give Aspirin 160 mg and Clopidogrel 75 mg orally
do not give Aspirin for at least 24 hours
administer Aspirin 160 – 325 mg chewed immediately
Heartland CPR, llc
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26.
During treatment of a patient with chest pain, the patient becomes unresponsive. After calling
for help and determining that the patient is not breathing, you are unsure whether the patient
has a pulse. What is your next action?
a.
b.
c.
d.
27.
Initiation of fibrinolytic therapy in appropriate patients should occur
a.
b.
c.
d.
28.
leave and get an AED
deliver two quick breaths
begin chest compressions
continue to check for a pulse
within 30 minutes of hospital arrival and <3 hours from symptom onset
within 2 hours of hospital arrival and <3 hours from symptom onset
within 1.5 hours of hospital arrival and < 6 hours from symptom onset
within 1 hour of hospital arrival and <3 hours from symptom onset
A patient with possible acute coronary syndrome has ongoing chest discomfort unresponsive
to 3 sublingual nitroglycerin tablets. There are no contraindications, and 4 mg or Morphine
Sulfate was administered. Shortly afterward, blood pressure falls to 88/60 mm Hs, and the
patient has increased chest discomfort. You should
a. give normal Saline 250 – 500 mL fluid bolus
b. start Dopamine at 2 mcg/kg/min and titrate to a systolic blood pressure reading of 100
mm Hg
c. give sublingual nitroglycerin 0.4 mg
d. give an additional 2 mg of Morphine Sulfate
29.
When inducing Hypothermia, how much 4’ C fluid should be administered?
a.
b.
c.
d.
30.
In a patient with no pulse, the dose for Magnesium Sulfate is
a.
b.
c.
d.
31.
250 – 500 cc normal Saline
1 – 2 L normal Saline
500 cc – 1 L normal Saline
1 L normal Saline
1 – 2 mgs IV/IO
1 – 2 mcg/kg IV/IO
1 – 2 grams IV/IO
1 – 2 grams endotracheal tube
The advanced airway rule means
a.
b.
c.
d.
chest compressions are not interrupted and given at a rate of 100/min
no advanced airway is utilized
medications can be administered via endotracheal tube
chest compressions continue at a ratio of 30:2
Heartland CPR, llc
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32.
A patient with sinus Bradycardia and a heart rate of 42/min has diaphoresis and a blood
pressure of 80/60 mm Hg. What is the initial dose of Atropine?
a.
b.
c.
d.
33.
A patient is in cardiac arrest. Ventricular fibrillation has been refractory to an initial shock.
What is the recommended route for drug administration during CPR?
a.
b.
c.
d.
34.
gain IV or IO access
call the patient and discontinue code
attempt endotracheal intubation with minimal interruptions in CPR
place an esophageal-tracheal tube or laryngeal mask airway
A patient has Sinus Bradycardia with a heart rate of 36/min. Atropine has been administered
to a total dose of 3 mg. A transcutaneous pacemaker has failed to capture. The patient is
confused, and her blood pressure is 100/60 mm Hg. Which of the following is now indicated?
a.
b.
c.
d.
36.
endotracheal
external jugular vein
femoral vein
peripheral IV
You arrive on the scene with the code team. High-quality CPR is in progress. An AED has
previously advised “no shock indicated”. A rhythm check now finds Asystole. After resuming
high-quality compressions, your next action is to
a.
b.
c.
d.
35.
0.5 mg
1 mg
3 mg
0.1 mg
give normal saline bolus 250 – 500 mL
start Epinephrine 2 – 10 mcg/min
give additional 1 mg Atropine
start Dopamine 10 – 20 mcg/kg per minute
A patient is in cardiac arrest. Ventricular Fibrillation has been refractory to a second shock. Of
the following, which drug and dose should be administered first by the IV/IO route?
a.
b.
c.
d.
Atropine 1 mg
Sodium bicarbonate 50 mEq
Vasopressin 20 units
Epinephrine 1 mg
Heartland CPR, llc
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37.
A patient is in Refractory Ventricular Fibrillation and has received multiple appropriate
defibrillation shocks, Epinephrine 1 mg IV twice, and an initial dose of 300 mg Amiodarone IV.
The patient is intubated. A second dose of Amiodarone is now called for. The recommended
second dose of Amiodarone is
a.
b.
c.
d.
38.
A patient is in pulseless Ventricular Tachycardia. Two shocks and one dose of Epinephrine
have been given. Which is the next drug/dose to anticipate to administer?
a.
b.
c.
d.
39.
escalating dose of Epinephrine 3 mg
repeat the antiarrhythmic drug
Sodium Bicarbonate 50 mEq
second dose of Epinephrine 1 mg
Which of the following statements about the use of Magnesium in Cardiac Arrest is most
accurate?
a.
b.
c.
d.
41.
Lidocaine 0.5 mg/kg
Epinephrine 3 mg
Vasopressin 40 units
Amiodarone 300 mg
A patient is in Refractory Ventricular Fibrillation. High-quality CPR is in progress, and shocks
have been given. One dose of Epinephrine was given after the second shock. An
antiarrhythmic drug was given immediately after the third shock. What drug should the team
a.
b.
c.
d.
40.
150 mg IV push
1 mg/kg IV push
300 mg IV push
an infusion of 1 – 2 mg/min
Magnesium is indicated for shock –refractory Monomorphic VT
Magnesium is indicated for VF refractory to shock and Amiodarone or Lidocaine
Magnesium is contraindicated for VT associated with a normal QT interval
Magnesium is indicated for VF/pulseless VT associated with Torsades de pointes
A patient is in Cardiac Arrest. High-quality chest compressions are being given. The patient is
intubated and an IV has been started. The rhythm is Asystole. Which is the first drug/dose to
administer?
a.
b.
c.
d.
Epinephrine 3 mg via endotracheal route
Atropine 0.5 mg IV or IO
Atropine 1 mg IV or IO
Epinephrine 1 mg
Heartland CPR, llc
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42.
A patient with possible ST-segment elevation MI has ongoing chest discomfort. Which of the
following would be a contraindication to the administration of nitrates?
a.
b.
c.
d.
43.
left Ventricular Infarct with Bilateral Rales
use of Phosphodiesterase inhibitor within 12 hours
blood pressure greater than 180 mm Hg
heart rate 90/min
A 35-year-old woman has palpitations, light-headedness, and a stable Tachycardia. The
monitor shows a regular narrow-complex QRS at a rate of 180min. Vagal maneuvers have not
been effective in terminating the rhythm. An IV has been established. What drug should be
administered IV?
a.
b.
c.
d.
Lidocaine 1 mg/kg
Adenosine 6 mg
Atropine 0.5 mg
Epinephrine 2 – 10 mcg/kg per minute
44.
The patient suddenly becomes unconscious and has a weak carotid pulse. Cardiac monitoring,
supplementary oxygen, and an IV have been initiated. The code card with all drugs and a
transcutaneous pacer are immediately available. Next you would:
a.
b.
c.
d.
begin transcutaneous pacing
give Atropine 0.5 mg IV
initiate Dopamine at 10 – 20 mcg/kg per minute and titrate to patient response
initiate Epinephrine at 2 – 10 mcg/kg per minute
Heartland CPR, llc
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45.
A 35-year-old woman presents to the ER Department with a chief complaint of palpitations. She has
no chest discomfort, shortness of breath, or light-headedness. Which of the following is indicated
first?
a.
b.
c.
d.
give Adenosine 12 mg IV slow push over 1 – 2 minutes
give Adenosine 3 mg IV bolus
perform vagal maneuvers
give Metoprolol 5 mg IV and repeat if necessary
46.
You are monitoring a patient with chest discomfort who suddenly becomes unresponsive. You
observe the above rhythm on the cardiac monitor. A defibrillator is present. What is your first action?
a.
b.
c.
d.
establish an IV and give Epinephrine 1 mg
intubate the patient and give Epinephrine 2 – 4 mg via the endotracheal tube
begin CPR with chest compressions for 2 minutes/5 cycles of compressions/ventilations
give a single shock
Heartland CPR, llc
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47.
Following initiation of CPR and 1 shock for VF, this rhythm is present on the next rhythm check. A
second shock is given, and chest compressions are resumed immediately. An IV is in place, and no
drugs have been given. Bag-mask ventilations are producing visible chest rise. What is your next
order?
a.
b.
c.
d.
prepare to give Amiodarone 300 mg IV
administer 3 stacked shocks at 200 J
prepare to give Epinephrine 1 mg IV
perform endotracheal intubation; administer 100% oxygen
48.
A 45-year-old woman with a history of palpitations develops light-headedness and palpitations. She
has received Adenosine 6 mg IV for the rhythm shown above without conversion of the rhythm. She
is now extremely apprehensive. Blood pressure is 108/70 mm Hg What is the next appropriate
intervention?
a.
b.
c.
d.
perform immediate unsynchronized cardioversion
sedate and perform synchronized cardioversion
perform vagal maneuvers and repeat Adenosine 6 mg IV
repeat Adenosine 12 mg IV
Heartland CPR, llc
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49.
A patient presents with the above rhythm and reports and irregular heartbeat. She has no other
symptoms. Her medical history is significant for a Myocardial Infarction 7 years ago. Blood pressure
is 110/70 mm Hg. What would you do at this time?
a.
b.
c.
d.
administer Nitroglycerin 0.4 mg sublingual or spray
perform emergency synchronized cardioversion
administer Lidocaine 1 mg/kg IV
continue monitoring and seek expert consultation
50.
This patient was admitted to the general medical ward with a history of alcoholism. A code is in
progress, and he has recurrent episodes of this rhythm. You review his chart. Notes about the 12lead ECG say that his baseline QT interval is high normal to slightly prolonged. He has received two
doses of Epinephrine 1 mg and one dose of Amiodarone 300 mg IV so far. What would you order for
his next medication?
a.
b.
c.
d.
repeat Amiodarone 300 mg IV
repeat Amiodarone 150 mg IV
give Magnesium Sulfate 1 – 2 grams IV diluted in 10 mL D5W over 5 – 20 minutes
give Lidocaine 1 – 1.5 mg IV and start infusion 2 mg/min
Heartland CPR, llc
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