Questions and Answers
Which are the elements of a system of care? (Select all that apply)
What element of a system of care is represented by properly functioning resuscitation equipment?
Structure
Among others, which factor has been associated with improved survival in patients with cardiac arrest?
Immediate high-quality CPR
What is the first link in the out-of-hospital cardiac arrest (OHCA) chain of survival?
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What are signs of clinical deterioration that would prompt the activation of a rapid response system?
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What is the primary purpose of a rapid response team (RRT) or medical emergency team (MET)?
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What happens when teams rapidly assess and intervene when patients have abnormal vital signs?
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In addition to decreased IHCA, what are some other benefits of implementing a rapid response system?
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Which component of effective high-performance teams is represented by the use of real-time feedback devices?
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What is the main advantage of effective teamwork?
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Which is the best example of a role of the team leader?
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Which is the best example of a role of a team member?
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What is the primary purpose of the CPR coach on a resuscitation team?
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Which member of the high-performance team has the responsibility for assigning roles (positions)?
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Which high-performance team member is part of the resuscitation triangle?
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Which is an example of knowledge sharing by a team leader?
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Which is an example of summarizing and reevaluating?
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Which is a step of closed-loop communication?
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Which are examples of mutual respect? (Select all that apply)
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What are the components of high-quality CPR?
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Which of the following defines chest compression fraction (CCF)?
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During CPR, chest compression fraction (CCF) should be at least ___ and ideally greater than 80%.
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How do interruptions in chest compressions negatively impact survival after cardiac arrest?
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Coronary perfusion pressure (CPP) equals aortic ____ pressure minus right atrial diastolic pressure.
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What is the only intervention that can restore an organized rhythm in patients with ventricular fibrillation (VF)?
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How quickly does the chance of survival decrease for every minute of defibrillation delay in patients with ventricular fibrillation (VF) who do not receive bystander CPR?
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What is the advantage of a systematic approach to patient assessment?
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What is the first step in the systematic approach to patient assessment?
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What is the maximum amount of time you should simultaneously perform the pulse and breathing checks?
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The BLS Assessment is a systematic approach to BLS for trained healthcare providers. This approach stresses:
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While you are performing the BLS Assessment, you initiate high-quality CPR and assist ventilation with a bag-mask device. The AED does not recommend a shock. Which action in the Primary Assessment should you perform first?
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The initial assessment reveals a conscious patient. The patient's airway is patent, and an advanced airway is not indicated. Which action in the Primary Assessment should you perform next?
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Which action is part of the Secondary Assessment of a conscious patient?
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Which of the following are the 'H' causes of reversible cardiac arrest? (Select all that apply)
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Which of the following are the 'T' causes of reversible cardiac arrest? (Select all that apply)
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What is the most common symptom of myocardial ischemia and infarction?
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Which demographic group experiencing acute coronary syndrome is more likely to present without chest pain?
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Oxygen should be delivered to a patient who has obvious signs of heart failure if the oxygen saturation is less than ___ or unknown.
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Obtaining a ___ is the most important assessment tool for a patient displaying signs and symptoms of acute coronary syndromes.
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What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department?
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A patient without dyspnea has signs of acute coronary syndrome. There are no obvious signs of heart failure. You assess a non-invasively monitored oxyhemoglobin saturation. What is the oxygen saturation threshold below which supplemental oxygen would be required?
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What are signs of clinical deterioration that would prompt the activation of a rapid response system?
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What blood component is acted upon by aspirin administration during the management of a patient with acute coronary syndromes?
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Which is a contraindication to the administration of aspirin for the management of a patient with acute coronary syndrome?
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What is a physiologic effect of nitroglycerin?
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Which clinical finding represents a contraindication to the administration of nitroglycerin?
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Which class of medications commonly given to patients with acute coronary syndromes may be adversely affected by morphine administration?
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What is a benefit of morphine when given for the management of acute coronary syndromes?
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You obtain a 12-lead EKG in a patient with retrosternal chest pain. Which EKG finding is suggestive of high-risk non-ST-Segment Elevation acute coronary syndromes?
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Upon reviewing a patient's 12-lead EKG, you note ST-Segment elevation of 2mm in leads II, III and AVF. How would you classify the EKG findings?
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What is the goal for first medical contact-to-balloon inflation time for a patient receiving percutaneous coronary intervention?
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What is the longest acceptable emergency department-door-to-needle time when fibrinolysis is the intended reperfusion strategy?
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What is the recommended time window after symptom onset for early fibrinolytic therapy or direct catheter-based reperfusion for patients with ST-segment elevation myocardial infarction and no contraindications?
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What is the benefit of morphine when given for the management of ACS?
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What is the most common type of stroke?
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What type of stroke occurs when a blood vessel in the brain suddenly ruptures into the surrounding tissue?
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Which is a sign of stroke?
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Which is a symptom of stroke?
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What validated abbreviated out-of-hospital neurologic evaluation tool contains 3 components: the facial droop, arm drift, and abnormal speech tests?
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What is the estimated probability of the Cincinnati Prehospital Stroke Scale with 1 abnormal finding when scored by prehospital providers?
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Which is a stroke severity tool that helps EMS differentiate occlusion from non-large-vessel occlusion stroke?
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What is the primary advantage of using a stroke severity tool?
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What is the most appropriate destination for patients with suspected acute ischemic stroke?
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What is the highest level of stroke center certification?
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What is the advantage of EMS transport to a stroke hospital for a patient with suspected acute ischemic stroke?
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What is the door-to-needle time goal for 85% or more of acute ischemic stroke patients treated with IV thrombolytics?
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What is the maximum time from last known normal when endovascular therapy can be performed?
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What is the maximum time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment?
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Identify the systolic BP threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke.
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What is the diastolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke?
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Which action is NOT part of the acute stroke pathway?
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What blood glucose level should trigger the administration of IV or subcutaneous insulin for a patient with acute ischemic stroke?
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What is the average respiratory rate (RR) for an adult at rest?
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What is the tidal volume typically maintaining normal oxygenation and elimination of carbon dioxide?
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An 18-year-old patient is reporting difficulty breathing and is displaying increased respiratory effort. Auscultation reveals bilateral wheezing; the respiratory rate is 28 breaths per minute. Oxygen saturation is 91%. PETCO2 is 44 mmHg. How would you categorize this patient's condition?
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A 59-year-old patient is reporting difficulty breathing. Physical exam reveals nasal flaring, intercostal retraction, and use of accessory muscles. RR is 28 breaths per minute. O2 saturation is 92% and PETCO2 is 36 mmHg. How would you categorize this patient's condition?
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A 75-year-old patient is having difficulty breathing, with increased respiratory effort. The patient has a history of emphysema. The patient is drowsy, and auscultation reveals bilateral wheezing, although the lung sounds are difficult to appreciate. RR is 38/min, O2 saturation = 85%, PETCO2= 49 mmHg. How would you categorize this patient's condition?
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What is the term for the rise in arterial CO2 levels typically associated with respiratory failure?
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How much tidal volume must be provided with a bag-mask device to produce visible chest rise for an adult patient in respiratory arrest?
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What device on a resuscitation bag-mask device may prevent sufficient tidal volume in patients with poor lung compliance?
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Patients with perfusing rhythms should receive ventilations once every ___ seconds.
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What is the most effective way to deliver bag-mask ventilation?
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How long should the second rescuer squeeze the bag-mask device when providing 2-rescuer ventilation?
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When performing the jaw-thrust maneuver on patients with suspected cervical spine injury, where should you place your fingers?
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When you use a bag-mask device, you should deliver approximately ___ tidal volume.
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What is a contraindication to the use of an oropharyngeal airway?
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In which of the following patients can nasopharyngeal airways be used?
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Select the first step in the use of an oropharyngeal airway.
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What is a potential complication of inserting an oropharyngeal airway that is too small?
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The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patient's nose to the ____.
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Study Notes
System of Care
- Core elements include structure, processes, system, and patient outcomes.
- Properly functioning resuscitation equipment exemplifies the structural element of care.
Resuscitation and Cardiac Arrest
- Immediate high-quality CPR is linked to improved survival rates in cardiac arrest patients.
- The first step in out-of-hospital cardiac arrest (OHCA) is the activation of emergency response systems.
Rapid Response Systems
- Signs of clinical deterioration include systemic hypertension, unexplained agitation, and seizures.
- Rapid response teams (RRT) aim to enhance patient outcomes by detecting and managing clinical decline early.
- Rapid interventions for abnormal vital signs can considerably reduce in-hospital cardiac arrests.
Effective Teamwork
- Real-time feedback devices contribute to the quality of high-performance teams during resuscitation.
- Effective teamwork facilitates task division, improving overall efficacy during emergencies.
- Team leaders model exemplary behavior and assign roles, while members ensure preparedness for responsibilities.
CPR Quality and Techniques
- Key components of high-quality CPR include:
- Compression depth of at least 2 inches (5 cm).
- Complete chest recoil and minimal interruptions (≤ 10 seconds).
- Rotation of compressors every 2 minutes and prevention of excessive ventilation.
Communication and Feedback
- Chest compression fraction (CCF) quantifies effective compression time relative to total code time.
- At least 60% CCF is necessary during CPR, ideally exceeding 80%.
- Closed-loop communication includes confirming task completion before reassigning duties.
Assessment and Management of Cardiac Events
- A 12-lead EKG is crucial for assessing acute coronary syndromes, with retrosternal chest pain being the most common symptom of myocardial ischemia.
- Women may present atypically for acute coronary syndrome, often without chest pain.
Stroke Recognition and Response
- Common stroke symptoms include trouble speaking and sudden vision issues.
- The Cincinnati Prehospital Stroke Scale (CPSS) is a validated tool for evaluating stroke symptoms.
- The Los Angeles Motor Scale assists EMS in distinguishing large-vessel occlusions.
Timing for Treatment
- The target time for first medical contact to balloon inflation for percutaneous coronary intervention is 90 minutes.
- Door-to-needle time should not exceed 30 minutes for fibrinolytics in stroke management, with a 60-minute goal for 85% of patients treated.
Respiratory Assessment and Management
- Average respiratory rate for adults at rest is 12 to 20 breaths per minute; tidal volume ranges from 6 to 8 mL/kg.
- Conditions can be categorized as respiratory distress or failure based on respiratory effort and saturation levels.
- Hypercapnia denotes elevated arterial CO2 levels commonly linked with respiratory failure.
Airway Management
- Bag-mask ventilation optimally utilizes a two-rescuer technique, delivering approximately 500 to 600 mL of tidal volume.
- Oropharyngeal airways are contraindicated in conscious patients, while nasopharyngeal airways can be used in varying consciousness levels.
- Proper sizing of airway devices is critical to avoid complications, such as tongue obstruction.
Additional Considerations
- Blood glucose levels over 180 mg/dL warrant insulin administration in acute ischemic stroke scenarios.
- The systolic BP threshold for withholding fibrinolytic therapy is set at 185 mmHg, while the diastolic threshold is 110 mmHg.
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Description
Test your knowledge of Advanced Cardiovascular Life Support (ACLS) concepts with these flashcards. This quiz covers elements of a system of care, including structure, processes, and patient outcomes. Strengthen your understanding of key components that influence survival in cardiac arrest situations.