ACLS Quiz Flashcards
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Questions and Answers

Which are the elements of a system of care? (Select all that apply)

  • Patient outcome (correct)
  • Processes (correct)
  • System (correct)
  • Structure (correct)

    • 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?

    <p>Activation of emergency response</p> Signup and view all the answers

    What are signs of clinical deterioration that would prompt the activation of a rapid response system?

    <p>Systemic hypertension, unexplained agitation, seizure</p> Signup and view all the answers

    What is the primary purpose of a rapid response team (RRT) or medical emergency team (MET)?

    <p>To improve patient outcomes by identifying and treating early clinical deterioration</p> Signup and view all the answers

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

    <p>The number of in-hospital cardiac arrests decreases</p> Signup and view all the answers

    In addition to decreased IHCA, what are some other benefits of implementing a rapid response system?

    <p>Decrease ICU length of stay, decreased in total hospital length of stay</p> Signup and view all the answers

    Which component of effective high-performance teams is represented by the use of real-time feedback devices?

    <p>Quality</p> Signup and view all the answers

    What is the main advantage of effective teamwork?

    <p>Division of tasks</p> Signup and view all the answers

    Which is the best example of a role of the team leader?

    <p>Models excellent team behavior</p> Signup and view all the answers

    Which is the best example of a role of a team member?

    <p>Prepared to fulfill their role responsibilities</p> Signup and view all the answers

    What is the primary purpose of the CPR coach on a resuscitation team?

    <p>Increasing CPR quality</p> Signup and view all the answers

    Which member of the high-performance team has the responsibility for assigning roles (positions)?

    <p>Team leader</p> Signup and view all the answers

    Which high-performance team member is part of the resuscitation triangle?

    <p>Monitor/defibrillator/CPR coach</p> Signup and view all the answers

    Which is an example of knowledge sharing by a team leader?

    <p>Asking for suggestions about interventions</p> Signup and view all the answers

    Which is an example of summarizing and reevaluating?

    <p>Increasing monitoring of the patient's condition deteriorates</p> Signup and view all the answers

    Which is a step of closed-loop communication?

    <p>Confirming task completion before assigning another task</p> Signup and view all the answers

    Which are examples of mutual respect? (Select all that apply)

    <p>Acknowledging correctly completed tasks in a positive way</p> Signup and view all the answers

    What are the components of high-quality CPR?

    <p>Compression depth of at least 2 inches (5cm), complete chest recoil after each compression, interruptions limited to ≤ 10 seconds, switching compressions every 2 minutes, avoiding excessive ventilation</p> Signup and view all the answers

    Which of the following defines chest compression fraction (CCF)?

    <p>CCF = actual chest compression time / total code time</p> Signup and view all the answers

    During CPR, chest compression fraction (CCF) should be at least ___ and ideally greater than 80%.

    <p>60%</p> Signup and view all the answers

    How do interruptions in chest compressions negatively impact survival after cardiac arrest?

    <p>Decrease coronary perfusion pressure</p> Signup and view all the answers

    Coronary perfusion pressure (CPP) equals aortic ____ pressure minus right atrial diastolic pressure.

    <p>diastolic</p> Signup and view all the answers

    What is the only intervention that can restore an organized rhythm in patients with ventricular fibrillation (VF)?

    <p>Early and effective defibrillation</p> Signup and view all the answers

    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?

    <p>7-10%</p> Signup and view all the answers

    What is the advantage of a systematic approach to patient assessment?

    <p>Reduces the chances of missing important signs and symptoms</p> Signup and view all the answers

    What is the first step in the systematic approach to patient assessment?

    <p>Initial impression</p> Signup and view all the answers

    What is the maximum amount of time you should simultaneously perform the pulse and breathing checks?

    <p>10 seconds</p> Signup and view all the answers

    The BLS Assessment is a systematic approach to BLS for trained healthcare providers. This approach stresses:

    <p>Early CPR and defibrillation</p> Signup and view all the answers

    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?

    <p>Determine if the patient's airway is patent</p> Signup and view all the answers

    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?

    <p>Administer oxygen as needed</p> Signup and view all the answers

    Which action is part of the Secondary Assessment of a conscious patient?

    <p>Formulate a differential diagnosis</p> Signup and view all the answers

    Which of the following are the 'H' causes of reversible cardiac arrest? (Select all that apply)

    <p>Hypothermia</p> Signup and view all the answers

    Which of the following are the 'T' causes of reversible cardiac arrest? (Select all that apply)

    <p>Pulmonary thrombosis</p> Signup and view all the answers

    What is the most common symptom of myocardial ischemia and infarction?

    <p>Retrosternal chest pain</p> Signup and view all the answers

    Which demographic group experiencing acute coronary syndrome is more likely to present without chest pain?

    <p>Females</p> Signup and view all the answers

    Oxygen should be delivered to a patient who has obvious signs of heart failure if the oxygen saturation is less than ___ or unknown.

    <p>90%</p> Signup and view all the answers

    Obtaining a ___ is the most important assessment tool for a patient displaying signs and symptoms of acute coronary syndromes.

    <p>12 lead EKG</p> Signup and view all the answers

    What is the time goal for how quickly you should complete a fibrinolytic checklist once the patient arrives in the emergency department?

    <p>10 minutes</p> Signup and view all the answers

    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?

    <p>90%</p> Signup and view all the answers

    What are signs of clinical deterioration that would prompt the activation of a rapid response system?

    <p>Unexplained agitation, symptomatic hypertension, seizure</p> Signup and view all the answers

    What blood component is acted upon by aspirin administration during the management of a patient with acute coronary syndromes?

    <p>Platelets</p> Signup and view all the answers

    Which is a contraindication to the administration of aspirin for the management of a patient with acute coronary syndrome?

    <p>Recent GI bleeding</p> Signup and view all the answers

    What is a physiologic effect of nitroglycerin?

    <p>Reduces preload</p> Signup and view all the answers

    Which clinical finding represents a contraindication to the administration of nitroglycerin?

    <p>Confirmed right ventricular infarction</p> Signup and view all the answers

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

    <p>Oral antiplatelet medications</p> Signup and view all the answers

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

    <p>Central nervous system analgesia</p> Signup and view all the answers

    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?

    <p>Dynamic T-wave inversion</p> Signup and view all the answers

    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?

    <p>ST-segment elevation myocardial infarction</p> Signup and view all the answers

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

    <p>90 minutes</p> Signup and view all the answers

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

    <p>30 minutes</p> 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 ST-segment elevation myocardial infarction and no contraindications?

    <p>Within 12 hours</p> Signup and view all the answers

    What is the benefit of morphine when given for the management of ACS?

    <p>Central nervous system analgesia</p> Signup and view all the answers

    What is the most common type of stroke?

    <p>Ischemic stroke</p> Signup and view all the answers

    What type of stroke occurs when a blood vessel in the brain suddenly ruptures into the surrounding tissue?

    <p>Hemorrhagic stroke</p> Signup and view all the answers

    Which is a sign of stroke?

    <p>Trouble speaking</p> Signup and view all the answers

    Which is a symptom of stroke?

    <p>Sudden trouble seeing</p> Signup and view all the answers

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

    <p>(CPSS) Cincinnati Prehospital Stroke Scale</p> Signup and view all the answers

    What is the estimated probability of the Cincinnati Prehospital Stroke Scale with 1 abnormal finding when scored by prehospital providers?

    <p>72%</p> Signup and view all the answers

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

    <p>Los Angeles Motor Scale</p> Signup and view all the answers

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

    <p>It helps identify large-vessel occlusion stroke</p> Signup and view all the answers

    What is the most appropriate destination for patients with suspected acute ischemic stroke?

    <p>Certified stroke center</p> Signup and view all the answers

    What is the highest level of stroke center certification?

    <p>Comprehensive stroke center</p> Signup and view all the answers

    What is the advantage of EMS transport to a stroke hospital for a patient with suspected acute ischemic stroke?

    <p>Responding providers can stabilize critical issues</p> 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?

    <p>60 minutes</p> Signup and view all the answers

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

    <p>24 hours</p> 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?

    <p>6 hours</p> Signup and view all the answers

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

    <p>185 mmHg</p> Signup and view all the answers

    What is the diastolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke?

    <p>110 mmHg</p> Signup and view all the answers

    Which action is NOT part of the acute stroke pathway?

    <p>Seizure prophylaxis</p> Signup and view all the answers

    What blood glucose level should trigger the administration of IV or subcutaneous insulin for a patient with acute ischemic stroke?

    <p>180 mg/dl</p> Signup and view all the answers

    What is the average respiratory rate (RR) for an adult at rest?

    <p>12 to 20/min</p> Signup and view all the answers

    What is the tidal volume typically maintaining normal oxygenation and elimination of carbon dioxide?

    <p>6 to 8 mL/kg</p> Signup and view all the answers

    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?

    <p>Respiratory distress</p> Signup and view all the answers

    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?

    <p>Respiratory distress</p> Signup and view all the answers

    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?

    <p>Respiratory failure</p> Signup and view all the answers

    What is the term for the rise in arterial CO2 levels typically associated with respiratory failure?

    <p>Hypercapnia</p> Signup and view all the answers

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

    <p>6 to 7 mL/kg</p> 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?

    <p>Pressure-relief valve</p> Signup and view all the answers

    Patients with perfusing rhythms should receive ventilations once every ___ seconds.

    <p>6 seconds</p> Signup and view all the answers

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

    <p>Using a 2-person technique</p> Signup and view all the answers

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

    <p>1 second</p> 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?

    <p>Just under the angle of the lower jaw</p> Signup and view all the answers

    When you use a bag-mask device, you should deliver approximately ___ tidal volume.

    <p>500 to 600 mL</p> Signup and view all the answers

    What is a contraindication to the use of an oropharyngeal airway?

    <p>Conscious patient</p> Signup and view all the answers

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

    <p>Unconscious, semiconscious, conscious</p> Signup and view all the answers

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

    <p>Clear the mouth and pharynx</p> Signup and view all the answers

    What is a potential complication of inserting an oropharyngeal airway that is too small?

    <p>Pushing the base of the tongue back</p> 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 ____.

    <p>earlobe</p> Signup and view all the answers

    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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    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.

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