Advanced Cardiac Life Support Free Sample Questions

According to 2020 AHA guidelines, maintaining adequate cerebral perfusion is critical post-ROSC to prevent secondary brain injury. The patient's hypotension (MAP of 60 mmHg) and low ETCO2 indicate poor systemic perfusion. A vasopressor infusion to achieve a Mean Arterial Pressure (MAP) of at least 65 mmHg is the priority. While TTM is crucial, it should be initiated after hemodynamic stability is addressed. A fluid bolus may be appropriate but can be detrimental in a patient with CHF; vasopressors are the preferred first step for this level of hypotension.

Fatigue is a common cause of increased pause duration and poor compression quality. Switching compressors regularly helps maintain high CCF.

Pre-charging the defibrillator minimizes the hands-off time during rhythm analysis and shock delivery, directly improving the CCF.

Many defibrillators default back to asynchronous (defibrillation) mode after a shock is delivered. If a subsequent shock is needed and the operator fails to press 'sync' again, an unsynchronized shock could be delivered on the T-wave, potentially inducing ventricular fibrillation. This is a critical safety step that is often overlooked.

The 2020 AHA guidelines do NOT recommend the routine use of sodium bicarbonate for patients in cardiac arrest. Its use is reserved for special circumstances, such as known pre-existing metabolic acidosis, hyperkalemia, or tricyclic antidepressant overdose. The primary treatment for acidosis in cardiac arrest is high-quality CPR and effective ventilation.

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.