ACLS Sample Questions & Answers

The patient is exhibiting symptomatic bradycardia with a high-degree AV block that is refractory to atropine. According to the ACLS bradycardia algorithm, the next step is transcutaneous pacing. If TCP is ineffective or not immediately available, a chronotropic agent infusion like dopamine or epinephrine would be the next consideration. Atropine is unlikely to be effective in third-degree block and further doses are not indicated.

During CPR for an intubated patient, an end-tidal CO2 (ETCO2) value of at least 10 mmHg is the minimum target to indicate high-quality chest compressions. Values below this suggest inadequate perfusion and should prompt an evaluation of CPR technique, including compression depth, rate, and recoil. While higher values are better, 10 mmHg is the critical threshold.

The standard window for administering intravenous tissue plasminogen activator (tPA) for acute ischemic stroke is within 3 hours of symptom onset for most eligible patients. This window can be extended to 4.5 hours for a select group of patients, but the 3 to 4.5-hour timeframe is the critical period emphasized in ACLS protocols. Time is brain, and earlier administration leads to better outcomes.

The patient has a clear ST-segment elevation myocardial infarction (STEMI). According to AHA guidelines, the preferred reperfusion strategy is primary PCI if it can be performed within 90 minutes of first medical contact (or 120 minutes of first medical contact if transfer is required). Since the facility has an available cath lab and the estimated door-to-balloon time is 60 minutes, this is the superior option over fibrinolysis. Pain management with nitroglycerin and morphine should be done concurrently, but activating the cath lab is the time-critical priority.

Once an advanced airway (like an endotracheal tube) is in place, chest compressions and ventilations are performed asynchronously. Compressions are continuous at a rate of 100-120 per minute, and one breath is given every 6 seconds (10 breaths per minute) without pausing compressions. This maximizes perfusion by maintaining a high chest compression fraction.

The Recovery link emphasizes a holistic approach, including mental and emotional health screening for survivors and their families.

Physical recovery and rehabilitation are core components of the long-term recovery process.

This ensures a smooth transition from hospital to home and addresses all aspects of the patient's recovery needs.

For refractory VF/pVT, lidocaine can be used as an alternative to amiodarone. The correct initial dose is 1 to 1.5 mg/kg IV push. If needed, a second dose of 0.5 to 0.75 mg/kg can be given.

The patient is stable with a regular, narrow-complex tachycardia, which is presumed to be supraventricular tachycardia (SVT). After vagal maneuvers fail, the first-line pharmacologic agent is adenosine. It should be administered as a 6 mg rapid IV push. If the rhythm does not convert, a second dose of 12 mg may be given. Cardioversion is reserved for unstable patients.

A rapid and sustained jump in ETCO2 (typically to >40 mmHg) is a strong indicator of Return of Spontaneous Circulation (ROSC). When the heart starts beating effectively again, it pumps the accumulated CO2 from the tissues to the lungs, causing a sharp rise in the exhaled CO2 level. This is often the earliest sign of ROSC, preceding a palpable pulse.