ACLS 2021 Quiz and Flashcards for Emergency Care

Questions and Answers

Which class of medications commonly given to patients with acute coronary syndromes may be adversely affected by morphine administration?

Phosphodiesterase inhibitors

Oral antiplatelet medications (correct)

Beta blockers

Calcium channel blockers

What is a benefit of morphine when given for the management of acute coronary syndromes?

Vasoconstriction

Central nervous system analgesia (correct)

Increases left ventricular preload

Increases systemic vascular resistance

Which ECG finding is suggestive of high-risk non-ST segment elevation acute coronary syndromes?

Dynamic T-wave inversion (correct)

ST-segment elevation

ST depressions less than 0.5mm

New bundle branch block

How would you classify the electrocardiographic findings with ST-segment elevation of 2mm in leads II, III, and aVF?

STEMI Signup and view all the answers

What happens when teams rapidly assess and intervene when patients have abnormal vital signs?

The number of in-hospital cardiac arrests decreases. Signup and view all the answers

What is the goal for first medical contact-to-balloon inflation time for a patient receiving PCI?

90 minutes. Signup and view all the answers

What is the longest acceptable emergency department door-to-needle time when fibrinolysis is the intended reperfusion strategy?

30 minutes. Signup and view all the answers

What is the time goal for completing a fibrinolytic checklist once the patient arrives in the emergency department?

10 minutes. Signup and view all the answers

What is the recommended time window after symptom onset for early fibrinolytic therapy or direct catheter-based reperfusion for patients with STEMI and no contraindications?

Within 12 hours. Signup and view all the answers

What will your first actions include if a patient shows symptoms suggestive of MI within the first 10 minutes?

Provide prehospital notification to the receiving hospital, administer aspirin, if considering prehospital fibrinolysis, use the fibrinolytic checklist, assess ABC, obtain EKG, and consider oxygen, nitroglycerin, and morphine if needed. Signup and view all the answers

When considering oxygen saturation for a patient with HR 120/min, BP 135/88, RR 23, O2 87%, what is your course of action?

Start oxygen at 4L. Signup and view all the answers

What additional questions help you determine next steps in patient treatment?

When did the symptoms start, do you take any medication, do you have any allergies? Signup and view all the answers

What treatment can you repeat as long as it is not contraindicated by vital signs?

Nitroglycerin sublingual every 3-5 mins. Signup and view all the answers

What is your interpretation of the patient's EKG tracing with STEMI in V2-6?

Anterior STEMI. Signup and view all the answers

What is the most probable treatment with the possible diagnosis of STEMI?

Admission for PCI/fibrinolysis. Signup and view all the answers

What is the goal for PCI when treating a patient?

First medical contact to balloon inflation time of 90 minutes. Signup and view all the answers

Which action is part of the secondary assessment of a conscious patient?

Formulate a differential diagnosis. Signup and view all the answers

What is the most common type of stroke?

Ischemic stroke. Signup and view all the answers

What is the recommended time window after symptom onset for early fibrinolytic therapy or direct catheter-based reperfusion for patients with STEMI and no contraindications?

12 hours. Signup and view all the answers

What validated, abbreviated out-of-hospital neurologic evaluation tool contains 3 components: facial droop, arm drift, and abnormal speech test?

Cincinnati Prehospital Stroke Scale. Signup and view all the answers

What is the estimated probability of the CPSS with 1 abnormal finding when scored by prehospital providers?

72%. Signup and view all the answers

Which stroke severity tool helps EMS differentiate large vessel occlusion stroke from non-large vessel occlusion stroke?

Los Angeles Motor Scale. Signup and view all the answers

What is the primary advantage of using a stroke severity tool?

It helps identify large vessel occlusion stroke. Signup and view all the answers

During CPR, CCF should be at least __% and ideally greater than _%.

60/80. Signup and view all the answers

What is an advantage of EMS alerting the receiving facility of the impending arrival of a patient with suspected acute ischemic stroke?

The hospital can perform more efficient evaluation and management. Signup and view all the answers

What is the time goal for neurologic assessment by the stroke team or designee and non-contrast computed tomography or MRI performed after hospital arrival?

20 minutes. Signup and view all the answers

What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindication after hospital arrival?

45 minutes. Signup and view all the answers

What is the door-to-needle time goal for 85% or more of acute ischemic stroke patients treated with IV thrombolytics?

60 minutes. Signup and view all the answers

What is the door-to-device time goal for direct arriving patients with acute ischemic stroke treated with endovascular therapy?

90 minutes. Signup and view all the answers

Evidence suggests that there is a higher likelihood of good to excellent functional outcome when alteplase is given to adults with an acute ischemic stroke within what time frame?

3 hours. Signup and view all the answers

What is the maximum time from last known normal when endovascular therapy can be performed?

24 hours. Signup and view all the answers

What is the maximum time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment?

6 hours. Signup and view all the answers

Identify the SBP threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke.

185 mmHg. Signup and view all the answers

What is the DBP threshold for withholding fibrinolytic to otherwise eligible patients with acute ischemic stroke?

110 mmHg. Signup and view all the answers

Which action is not part of the acute stroke pathway?

Seizure prophylaxis. Signup and view all the answers

What BG should trigger the administration of IV or subQ insulin for a patient with acute ischemic stroke?

<ol start="180"> <li></li> </ol> Signup and view all the answers

What additional assessment and stabilization activities should be completed for a patient presenting with sudden left arm weakness and left-sided paralysis?

Establish time of symptom onset (last known normal), perform a validated prehospital stroke screen and stroke severity tool, provide prehospital notification to the receiving hospital, initiate stroke protocol, check glucose. Signup and view all the answers

What needs to be completed for this patient within 20 mins after hospital arrival?

Neurologic assessment. Signup and view all the answers

What are some of the general questions you need to ask a patient presenting symptoms?

When did the symptoms start, do you have any allergies, do you take any medications, what other symptoms do you have? Signup and view all the answers

Is this patient a potential candidate for fibrinolytic therapy if the neuroimaging interpretation suggests an acute ischemic infarction without signs of hemorrhage or mass lesions?

Yes. Signup and view all the answers

What actions should the hospital staff take to determine whether the patient is a candidate for fibrinolytic therapy?

Repeat neurologic exam. Signup and view all the answers

Is this patient still a candidate for fibrinolytic therapy if the patient's neurologic function is rapidly improving?

No. Signup and view all the answers

Because the patient is no longer a candidate for fibrinolytic therapy, what are your next steps for him?

Support ABC, begin stroke pathway, admit to ICU. Signup and view all the answers

What tidal volume typically maintains normal oxygenation and elimination of carbon dioxide?

6-8 mL/kg. Signup and view all the answers

What is the term for the rise in arterial carbon dioxide levels typically associated with respiratory failure?

Hypercapnia. Signup and view all the answers

How much tidal volume must you provide with a bag mask device to produce visible chest rise for an adult patient in respiratory arrest?

6-7 mL/kg. Signup and view all the answers

What device on a resuscitation bag mask device may prevent sufficient tidal volume in patients with poor lung compliance?

Pressure relief valve. Signup and view all the answers

Patients with perfusing rhythms should receive ventilation once every _____ seconds.

<ol start="6"> <li></li> </ol> Signup and view all the answers

What is the most effective way to deliver bag mask ventilation?

2 person technique. Signup and view all the answers

How long should the second rescuer squeeze the bag mask device when providing 2 rescuer ventilation?

1 second. Signup and view all the answers

When performing the jaw thrust maneuver on patients with suspected cervical spine injury, where should you place your fingers?

Just under the angle of the lower jaw. Signup and view all the answers

When you use a bag mask device you should deliver 500- _______ mL tidal volume.

<ol start="600"> <li></li> </ol> Signup and view all the answers

In which of the following patients can nasopharyngeal airways be used?

Unconscious, semi-conscious. Signup and view all the answers

Select the first step in the use of an oropharyngeal airway.

Clear the mouth and pharynx. Signup and view all the answers

What is a potential complication of inserting an oropharyngeal airway?

Pushing the base of the tongue back. Signup and view all the answers

The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patient's nose to the _____?

Earlobe. Signup and view all the answers

What is a potential complication using a nasopharyngeal airway that is too long?

Entering the esophagus. Signup and view all the answers

What is the most serious potential complication of nasopharyngeal airway insertion into a patient with facial trauma?

Misplacement into the cranial cavity. Signup and view all the answers

What is the max length of suction catheter that should be inserted into the patient's oropharynx beyond the tongue?

Tip of nose to earlobe. Signup and view all the answers

What is the most reliable method of confirming and monitoring correct placement of an ET tube?

Quantitative waveform capnography. Signup and view all the answers

What is the recommended ventilation rate for an adult in cardiac arrest with an advanced airway device in place?

Once every 6 seconds. Signup and view all the answers

What initial actions should be taken for a patient who loses consciousness upon arrival at the ED after experiencing severe shortness of breath?

Assess ABC, call for help, check for responsiveness. Signup and view all the answers

What should your initial actions include if the patient is unresponsive and not breathing but has a strong pulse?

Open the patient's airway via a head tilt chin lift or jaw thrust, initiate ventilation with a bag mask device attached to supplemental oxygen. Signup and view all the answers

What is the recommended rate for rescue breaths for a patient in respiratory distress?

1 breath every 6 seconds. Signup and view all the answers

Which signs and symptoms indicate symptomatic bradycardia?

Chest pain, shortness of breath, altered mental status, pulmonary edema, hypotension. Signup and view all the answers

What is the interpretation of PR intervals being uniform but random QRS dropped?

Second degree type II. Signup and view all the answers

What is the interpretation of having more P waves than QRS with an absence of relationship between the P wave and QRS?

3rd degree. Signup and view all the answers

What is the definition of bradycardia?

HR less than 60 beats per minute. Signup and view all the answers

Study Notes

Acute Coronary Syndromes (ACS) and Treatment

Morphine administration can negatively affect oral antiplatelet medications used during acute coronary syndromes.
Morphine provides central nervous system analgesia, beneficial for managing acute coronary syndromes.
A 12-lead ECG revealing dynamic T-wave inversion indicates high-risk non-ST elevation acute coronary syndromes.
ST-segment elevation of 2mm in leads II, III, and aVF on ECG classifies as STEMI (ST-Elevation Myocardial Infarction).
Rapid assessment and intervention for abnormal vital signs reduce in-hospital cardiac arrest rates.

Timeliness in Acute Care

The goal for first medical contact to balloon inflation time for PCI (Percutaneous Coronary Intervention) is 90 minutes.
Acceptable emergency department door-to-needle time for fibrinolysis is 30 minutes.
Completion of a fibrinolytic checklist should occur within 10 minutes upon patient arrival in the emergency department.
Early fibrinolytic therapy or direct catheter-based reperfusion should be initiated within 12 hours of symptom onset for STEMI patients.

Initial Patient Management

In cases of MI symptoms, actions include prehospital notification, aspirin administration, cardiac assessment, and obtaining an ECG.
For oxygen saturation below 90%, start oxygen therapy at 4L.
Patient responses regarding symptom onset, medications, and allergies are vital for determining next steps.
Sublingual nitroglycerin may be repeated every 3-5 minutes if not contraindicated.

Stroke Assessment and Management

Cincinnati Prehospital Stroke Scale evaluates stroke risk with components like facial droop and abnormal speech tests, yielding a 72% probability of identifying a stroke with one abnormal finding.
Acute ischemic stroke treatment protocols stress timely assessments: neurologic assessment within 20 minutes, initiation of fibrinolytic therapy within 45 minutes.
The maximum time from the last known normal for endovascular therapy is 24 hours.

Respiratory Management

A tidal volume of 6-8 mL/kg is crucial for maintaining adequate oxygenation and carbon dioxide elimination.
Signs of respiratory distress include increased respiratory rate and low oxygen saturation.
Hypercapnia refers to elevated arterial carbon dioxide levels associated with respiratory failure.
Effective bag-mask ventilation utilizes a 2-person technique for optimal delivery.

Airway Management

The first step for using an oropharyngeal airway is clearing the mouth and pharynx.
Complications can arise from improper airway insertion, such as pushing the tongue back or misplacement into the cranial cavity.
Nasopharyngeal airways are suitable for unconscious or semi-conscious patients; correct length corresponds to the distance from nose to earlobe.

Cardiac Rhythms and Interventions

Symptomatic bradycardia presents with symptoms such as chest pain and altered mental status.
Types of heart block include second-degree type II, characterized by dropped QRS complexes, and third-degree AV block, showing more P waves than QRS without a relationship.
Low oxygen saturation (SpO2) in patients warrants rescue breaths every 6 seconds to ensure adequate ventilation.

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Test your knowledge with ACLS 2021 flashcards. This quiz focuses on key medications and their effects in managing acute coronary syndromes. Each question aids in understanding critical care practices and pharmacology relevant to emergency response.

ACLS 2021 Flashcards

Questions and Answers

Which class of medications commonly given to patients with acute coronary syndromes may be adversely affected by morphine administration?

What is a benefit of morphine when given for the management of acute coronary syndromes?

Which ECG finding is suggestive of high-risk non-ST segment elevation acute coronary syndromes?

How would you classify the electrocardiographic findings with ST-segment elevation of 2mm in leads II, III, and aVF?

What happens when teams rapidly assess and intervene when patients have abnormal vital signs?

What is the goal for first medical contact-to-balloon inflation time for a patient receiving PCI?

What is the longest acceptable emergency department door-to-needle time when fibrinolysis is the intended reperfusion strategy?

What is the time goal for completing a fibrinolytic checklist once the patient arrives in the emergency department?

What is the recommended time window after symptom onset for early fibrinolytic therapy or direct catheter-based reperfusion for patients with STEMI and no contraindications?

What will your first actions include if a patient shows symptoms suggestive of MI within the first 10 minutes?

When considering oxygen saturation for a patient with HR 120/min, BP 135/88, RR 23, O2 87%, what is your course of action?

What additional questions help you determine next steps in patient treatment?

What treatment can you repeat as long as it is not contraindicated by vital signs?

What is your interpretation of the patient's EKG tracing with STEMI in V2-6?

What is the most probable treatment with the possible diagnosis of STEMI?

What is the goal for PCI when treating a patient?

Which action is part of the secondary assessment of a conscious patient?

What is the most common type of stroke?

What is the recommended time window after symptom onset for early fibrinolytic therapy or direct catheter-based reperfusion for patients with STEMI and no contraindications?

What validated, abbreviated out-of-hospital neurologic evaluation tool contains 3 components: facial droop, arm drift, and abnormal speech test?

What is the estimated probability of the CPSS with 1 abnormal finding when scored by prehospital providers?

Which stroke severity tool helps EMS differentiate large vessel occlusion stroke from non-large vessel occlusion stroke?

What is the primary advantage of using a stroke severity tool?

During CPR, CCF should be at least ______% and ideally greater than _____%.

What is an advantage of EMS alerting the receiving facility of the impending arrival of a patient with suspected acute ischemic stroke?

What is the time goal for neurologic assessment by the stroke team or designee and non-contrast computed tomography or MRI performed after hospital arrival?

What is the time goal for initiation of fibrinolytic therapy in appropriate patients without contraindication after hospital arrival?

What is the door-to-needle time goal for 85% or more of acute ischemic stroke patients treated with IV thrombolytics?

What is the door-to-device time goal for direct arriving patients with acute ischemic stroke treated with endovascular therapy?

Evidence suggests that there is a higher likelihood of good to excellent functional outcome when alteplase is given to adults with an acute ischemic stroke within what time frame?

What is the maximum time from last known normal when endovascular therapy can be performed?

What is the maximum time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment?

Identify the SBP threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke.

What is the DBP threshold for withholding fibrinolytic to otherwise eligible patients with acute ischemic stroke?

Which action is not part of the acute stroke pathway?

What BG should trigger the administration of IV or subQ insulin for a patient with acute ischemic stroke?

What additional assessment and stabilization activities should be completed for a patient presenting with sudden left arm weakness and left-sided paralysis?

What needs to be completed for this patient within 20 mins after hospital arrival?

What are some of the general questions you need to ask a patient presenting symptoms?

Is this patient a potential candidate for fibrinolytic therapy if the neuroimaging interpretation suggests an acute ischemic infarction without signs of hemorrhage or mass lesions?

What actions should the hospital staff take to determine whether the patient is a candidate for fibrinolytic therapy?

Is this patient still a candidate for fibrinolytic therapy if the patient's neurologic function is rapidly improving?

Because the patient is no longer a candidate for fibrinolytic therapy, what are your next steps for him?

What tidal volume typically maintains normal oxygenation and elimination of carbon dioxide?

What is the term for the rise in arterial carbon dioxide levels typically associated with respiratory failure?

How much tidal volume must you provide with a bag mask device to produce visible chest rise for an adult patient in respiratory arrest?

What device on a resuscitation bag mask device may prevent sufficient tidal volume in patients with poor lung compliance?

Patients with perfusing rhythms should receive ventilation once every _____ seconds.

What is the most effective way to deliver bag mask ventilation?

How long should the second rescuer squeeze the bag mask device when providing 2 rescuer ventilation?

When performing the jaw thrust maneuver on patients with suspected cervical spine injury, where should you place your fingers?

When you use a bag mask device you should deliver 500- _______ mL tidal volume.

In which of the following patients can nasopharyngeal airways be used?

Select the first step in the use of an oropharyngeal airway.

What is a potential complication of inserting an oropharyngeal airway?

The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patient's nose to the _____?

What is a potential complication using a nasopharyngeal airway that is too long?

What is the most serious potential complication of nasopharyngeal airway insertion into a patient with facial trauma?

What is the max length of suction catheter that should be inserted into the patient's oropharynx beyond the tongue?

What is the most reliable method of confirming and monitoring correct placement of an ET tube?

What is the recommended ventilation rate for an adult in cardiac arrest with an advanced airway device in place?

What initial actions should be taken for a patient who loses consciousness upon arrival at the ED after experiencing severe shortness of breath?

What should your initial actions include if the patient is unresponsive and not breathing but has a strong pulse?

What is the recommended rate for rescue breaths for a patient in respiratory distress?

Which signs and symptoms indicate symptomatic bradycardia?

What is the interpretation of PR intervals being uniform but random QRS dropped?

What is the interpretation of having more P waves than QRS with an absence of relationship between the P wave and QRS?

What is the definition of bradycardia?

Study Notes

Acute Coronary Syndromes (ACS) and Treatment

Timeliness in Acute Care

Initial Patient Management

Stroke Assessment and Management

Respiratory Management

Airway Management

Cardiac Rhythms and Interventions

Studying That Suits You

Description

During CPR, CCF should be at least __% and ideally greater than _%.