Advanced Cardiac Life Support (ACLS)
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Questions and Answers

Which of the following factors affecting transthoracic impedance is false?

  • Energy setting of the defibrillator
  • Contact material between the paddle and skin
  • Amount of pressure the paddles are applied to the chest
  • Distance between the paddles
  • Types of defibrillator (monophasic/biphasic) (correct)

    • A patient with PEA was intubated. 3 minutes after IV Adrenaline 1 mg is given, PEA continues at 50 bpm. Which of the following actions should be done next?

  • Start an IV Dopamine at 15 mcg/kg/min (correct)
  • Initiate transcutaneous pacing at a rate of 60bpm
  • Administer IV Adrenaline 1 mg of 1:10 000
  • Administer IV Atropine 0.6mg
  • Prepare for cardioversion

    • Which of the following statements regarding arrhythmia management is false?

  • Electrical cardioversion is necessary for patients with SVT
  • IV Amiodarone is recommended in PEA and asystole (correct)
  • Repeat emergency drug administration every 3-5 minutes interval
  • Sinus bradycardia of 56 beats per minute in a fit young athlete requires no treatment
  • Exclude underlying causes of cardiac arrest

    • Initial assessment reveals that the patient is pulseless and apneic. What is the immediate action?

    <p>Continue CPR, establish IV access, administer a rapid bolus IV 1 mg adrenaline and intubate (A)</p> Signup and view all the answers

    Which of the following statements on defibrillation is true?

    <p>The correct defibrillation pads position is one pad just below the right clavicle and the other pad to the left of the nipple in the mid-axillary line (C)</p> Signup and view all the answers

    Which of the following statements regarding chest compression post defibrillation is false?

    <p>Upon return of spontaneous circulation (ROSC) post defibrillation, continue chest compression for another 2 minutes. (D)</p> Signup and view all the answers

    After an advanced airway is inserted, compressions are delivered at what rate?

    <p>A rate of 100-120 per minute and ventilations at 10-12 per minute. (A)</p> Signup and view all the answers

    In the Singapore Resuscitation and First Aid Council guidelines for resuscitation, which of the following is true?

    <p>Initial head-tilt chin-lift maneuver is omitted. (A)</p> Signup and view all the answers

    Synchronized cardioversion should be considered in which of the following rhythms?

    <p>VT with pulse. (C)</p> Signup and view all the answers

    In considering the need for an electrocardiogram (ECG) in a 40-year-old man presenting with any of these symptoms, which of the following is false?

    <p>Iliac fossa pain. (E)</p> Signup and view all the answers

    The 3 key parameters used to evaluate a patient with AMI are:

    <p>Clinical history, cardiac markers and ECG. (C)</p> Signup and view all the answers

    Morphine: Which statements are correct?

    <p>i. Is the recommended opioid analgesic in AMI. (A), iii. Should be given together with an IV anti-emetic. (D)</p> Signup and view all the answers

    Aspirin: Which statements are correct?

    <p>i. Is indicated in patients with AMI who have no NSAID allergy. (A), ii. Should be used with caution in patients with a past history of peptic ulcer disease. (B)</p> Signup and view all the answers

    During an endotracheal intubation of a collapsed patient, the patient's SpO2 has dropped to 85%. What should be the most appropriate action?

    <p>Stop intubation and bag-valve-mask the patient with 100% oxygen before the next intubation attempt. (E)</p> Signup and view all the answers

    Patient with the following ECG rhythm may be...?

    <p>iv. Have a syncopal attack. (A), ii. have a seizure attack. (B), iii. Complain of palpitations. (C), i. Be Hemodynamically stable. (D)</p> Signup and view all the answers

    In the management of acute myocardial infarction (AMI), it is important to avoid intramuscular injections for the following reasons?

    <p>ii. Muscular hematoma. (A), i. Poor absorption. (B), iii. Altered cardiac markers. (D)</p> Signup and view all the answers

    Upon the arrival of the code team, nurse 1 should?

    <p>Give a brief verbal report to Doctor 1</p> Signup and view all the answers

    In a patient who has just achieved Return of Spontaneous Circulation (ROSC) after a cardiac event, what should be maintained?

    <p>Blood glucose level should be maintained at ≤10mmol/L. (C)</p> Signup and view all the answers

    Which of the following statements is true?

    <p>There is an increased risk of regurgitation and pulmonary aspiration in a pregnant woman in her third trimester who requires resuscitation. (D)</p> Signup and view all the answers

    Early CPR with _____ is most likely to improve survival rates for out-of-hospital cardiac arrest patients.

    <p>Early defibrillation. (B)</p> Signup and view all the answers

    In the chain of survival, which of the following is false?

    <p>Early intubation. (D)</p> Signup and view all the answers

    When approaching an unconscious casualty, which of the following measures is false?

    <p>Perform head tilt chin lift. (E)</p> Signup and view all the answers

    The most lethal arrhythmia in acute myocardial infarction is:

    <p>Ventricular fibrillation. (E)</p> Signup and view all the answers

    The drug of choice in the management of Torsades de Pointe is:

    <p>Magnesium sulfate. (C)</p> Signup and view all the answers

    Which of the following statements regarding Lignocaine is false?

    <p>Can be used for the treatment of atrial fibrillation. (A)</p> Signup and view all the answers

    Flashcards

    Transthoracic impedance factors

    Factors affecting the impedance during defibrillation, excluding type of defibrillator.

    PEA treatment

    Administration of IV adrenaline is done for PEA; after 3 mins, IV dopamine is next.

    Incorrect arrhythmia management

    IV amiodarone is NOT recommended in PEA and asystole.

    Initial action pulseless patient

    CPR and establish IV access are immediate actions for pulseless and apneic patients.

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    Defibrillation pad placement

    Correct placement is below right clavicle and left nipple in mid-axillary line.

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    Post-defibrillation CPR

    CPR should start immediately after defibrillation regardless of ECG rhythms.

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    Compression rate after intubation

    Rate of compressions should be 100-120 per minute with ventilations at 10-12 per minute.

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    Singapore resuscitation guidelines

    Initial head-tilt chin-lift maneuver is omitted in resuscitation guidelines.

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    Synchronized cardioversion

    Considered for rhythms such as VT with pulse.

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    ECG symptoms assessment

    Iliac fossa pain is not a symptom justifying ECG in this context.

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    AMI evaluation parameters

    Key parameters include clinical history, cardiac markers, and ECG.

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    Morphine use in AMI

    Recommended for AMI and pulmonary edema; should be used with anti-emetics.

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    Aspirin indications

    Aspirin is indicated for AMI unless NSAID allergies exist and must be cautious with peptic ulcers.

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    Intubation action with low SpO2

    Best action is to bag-valve-mask and provide 100% oxygen before intubation if SpO2 is low.

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    ROSC post-event care

    Blood glucose level should be maintained at ≤10mmol/L after achieving ROSC.

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    Pregnancy and resuscitation risks

    Increased risk of regurgitation and pulmonary aspiration exists for pregnant women in resuscitation.

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    Survival rates improvement

    Early defibrillation significantly improves survival rates for out-of-hospital cardiac arrests.

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    Chain of survival elements

    Early intubation is a false element in the chain of survival.

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    Unconscious casualty approach

    False measure: performing head tilt chin lift when approaching an unconscious casualty.

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    Lethal arrhythmia

    Ventricular fibrillation is the most lethal arrhythmia during an acute myocardial infarction.

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    Torsades de Pointe treatment

    Magnesium sulfate is the drug of choice for managing Torsades de Pointe.

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    False statement on Lignocaine

    Lignocaine is NOT used for atrial fibrillation treatment; it responds mainly in ventricular issues.

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    Study Notes

    Transthoracic Impedance Factors

    • Distance between paddles is a factor.
    • Energy setting of the defibrillator is a factor.
    • Contact material type (e.g., paddle to skin) is a factor.
    • Types of defibrillators (monophasic/biphasic) are not a factor affecting transthoracic impedance.
    • Amount of pressure applied to the chest is a factor.

    PEA Patient Management

    • If a patient with PEA is intubated and, 3 minutes after receiving 1 mg IV adrenaline, the heart rate remains at 50 bpm, the next step is to administer IV dopamine at 15 mcg/kg/min.

    Arrhythmia Management

    • Electrical cardioversion is necessary for supraventricular tachycardia (SVT).
    • Sinus bradycardia of 56 beats per minute in a fit young adult does not require treatment.
    • IV amiodarone is not recommended for pulseless electrical activity (PEA) or asystole.
    • Underlying causes of cardiac arrest should be excluded.
    • Repeat emergency drug administration every 3-5 minutes is not recommended.

    Immediate Action for Pulseless, Apneic Patient

    • Continue CPR, establish IV access, and administer a rapid bolus of 1 mg adrenaline. Intubate the patient.

    Defibrillation

    • Correct defibrillation pad placement is one pad below the right clavicle and the other pad to the left of the nipple in the mid-axillary line.
    • 160J is the recommended energy level for ventricular fibrillation (VF).
    • A pacemaker is not an absolute contraindication.
    • Synchronized mode is turned on for VT with a pulse.

    Chest Compression Post-Defibrillation

    • CPR should be started immediately after defibrillation.
    • If the ECG shows sinus rhythm (SR) after defibrillation, and upon completion of 2 minutes of CPR, check the pulse.
    • Continue CPR for another 2 minutes after confirming return of spontaneous circulation (ROSC).

    Advanced Airway Compressions

    • Compressions are delivered at a rate of 100-120 per minute with 2 breaths every 15 compressions.

    Singapore Resuscitation Guidelines

    • Initial head-tilt chin-lift maneuver is omitted.
    • Check breathing and pulse within 5 seconds.
    • Chest compression landmark is the upper mid-sternum.
    • Continue CPR for 1 minute after defibrillation.

    Synchronized Cardioversion

    • Synchronized cardioversion should be considered for ventricular tachycardia (VT) with a pulse.

    ECG in a 40-Year-Old Man

    • Iliac fossa pain is not a reason to do an ECG.
    • Other symptoms include breathlessness, acute confusion, syncope, and epigastric discomfort.

    AMI Evaluation

    • Key evaluation parameters for acute myocardial infarction (AMI) are clinical history, cardiac markers, and electrocardiogram (ECG).

    Morphine Use

    • Morphine is often recommended for AMI patients and is useful in pulmonary edema.
    • IV anti-emetics should be given with morphine.
    • Flumazenil is the reversal agent.

    Aspirin Use

    • Aspirin is indicated in AMI patients if they don't have an NSAID allergy.
    • Use caution with peptic ulcer disease history.
    • Aspirin is often given intravenously in AMI.
    • Aspirin is generally given with an IV anti-emetic.

    Endotracheal Intubation

    • If SpO2 drops to 85% during endotracheal intubation, stop the intubation procedure, bag-valve-mask the patient with 100% oxygen, and repeat intubation.

    ECG Rhythm Recognition

    • Patient with the ECG rhythm described may be hemodynamically stable, experience a seizure, complain of palpitations, or have a syncopal attack.
    • Multiple possible diagnoses should be considered and ruled out (e.g., arrhythmia or seizure versus syncope).

    Intramuscular Injections in AMI

    • Intramuscular injection should be avoided due to poor absorption, risk of hematoma, and potential for altered cardiac markers and arrhythmias.

    Code Team Arrival

    • Upon the arrival of the code team, the nurse should prepare drugs, attach monitor leads and check the ECG rhythm, assess responsiveness, continue chest compressions, and give a brief verbal report to the doctor.

    ROSC Maintenance

    • Maintain blood glucose ≤10 mmol/L.
    • Maintain Glasgow Coma Scale ≥8.
    • Maintain oxygen saturation (SpO2) at 100%.
    • Maintain mean arterial pressure (MAP) ≥ 60 mmHg.
    • Maintain temperature at 34-36°C for 12-24 hours.

    Child Pronouncement of Death

    • A child can be pronounced dead after 30 minutes of continuous resuscitation efforts if no response is observed.
    • Pregnant women with pulmonary conditions and near-drowning cases increase the risk of regurgitation and pulmonary aspiration.

    Early CPR

    • Early CPR, defibrillation, and access to EMS increase survival rates for out-of-hospital cardiac arrest patients.

    Chain of Survival

    • Early CPR, early defibrillation, advanced cardiac life support, and emergency medical services make up the chain of survival.

    Unconscious Casualty Approach

    • Before approaching an unconscious person, check for potential danger and ensure the area is safe.
    • Assess level of consciousness and if there's spontaneous breathing.
    • Activate EMS if needed.

    Lethal Arrhythmias in AMI

    • Ventricular fibrillation is the most lethal arrhythmia in acute myocardial infarction (AMI).

    Torsades de Pointe Treatment

    • Magnesium sulfate is the drug of choice for torsades de pointes.

    Lignocaine Use

    • Lignocaine can cause seizures if given in overdose, but it can be used for persistent ventricular tachycardia, controlling premature ventricular contractions, and in cardiac collapse situations.
    • It also can be used to treat atrial fibrillation.

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    Quiz on Cardiac Procedures PDF

    Description

    This quiz covers essential concepts in Advanced Cardiac Life Support (ACLS), including factors affecting transthoracic impedance and management protocols for patients in PEA and arrhythmia scenarios. Test your knowledge on electrical cardioversion, drug administration, and the assessment of cardiac events.

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