ACLS Practice Questions

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.

The statement is false. The correct infusion rate for epinephrine in the bradycardia algorithm is 2-10 mcg/min. An infusion of 20-30 mcg/min is excessively high and would cause severe tachycardia and hypertension, likely worsening the patient's condition. The correct rate for a dopamine infusion is 5-20 mcg/kg/min.

Given the patient's history of end-stage renal disease and missed dialysis appointments, severe hyperkalemia is a highly probable cause of her cardiac arrest. Missed dialysis leads to the accumulation of potassium, which can cause severe cardiac conduction abnormalities, including bradycardia, PEA, and asystole. The immediate ACLS treatment for suspected hyperkalemia in cardiac arrest is intravenous calcium chloride or calcium gluconate to stabilize the cardiac membrane.

Complete chest recoil is a critical component of high-quality CPR. It involves allowing the chest to return to its normal, neutral position after each compression. This creates negative intrathoracic pressure, which is essential for venous return and refilling of the heart chambers, thereby maximizing cardiac output on the next compression. Leaning on the chest between compressions prevents this and reduces the effectiveness of CPR.

The 'Disability' component of the ABCD primary assessment focuses on the patient's neurological status. A key part of this is assessing the level of consciousness, which is often done by checking if the patient can follow simple commands (e.g., 'squeeze my hand,' 'open your eyes'). This initial check helps guide decisions regarding sedation and targeted temperature management.

The patient is in monomorphic ventricular tachycardia with clear signs of instability (hypotension, altered mental status). According to the ACLS Tachycardia Algorithm, any patient with a tachyarrhythmia and signs of instability requires immediate synchronized cardioversion. Pharmacological interventions are reserved for stable patients.

Closed-loop communication is a cornerstone of effective team dynamics, ensuring that messages are heard and understood correctly, which minimizes errors.

Mutual respect and a culture of safety encourage team members to speak up, which is critical for preventing mistakes and ensuring patient safety.

A key role of the team leader is to maintain a global view of the resuscitation, which includes monitoring the performance of all tasks, especially the quality of CPR, and providing constructive feedback.

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.