ACLS Cardiac Arrest and Emergencies in Special Situations (Pregnancy, Opioid Overdose, Anaphylaxis)

Question 1

A woman at about 30 weeks of gestation has a cardiac arrest. Which modification to standard resuscitation is recommended?

Accepted Answer

Manually displace the uterus to the left while giving chest compressions

Answer

In a pregnancy with a fundus at or above the umbilicus, manual left uterine displacement relieves aortocaval compression and improves venous return. Standard CPR and defibrillation continue as usual, and tilting the patient is not recommended because it reduces compression quality.

Question 2

In a pregnant patient in cardiac arrest, if there is no ROSC with standard ACLS, when should perimortem cesarean delivery be considered?

Accepted Answer

Within about 4 minutes of arrest, aiming for delivery by about 5 minutes

Answer

Delivery empties the uterus, which relieves aortocaval compression and can improve maternal circulation. The goal is delivery by 5 minutes after arrest begins, so preparation should start early, and it is considered when the uterus is at or above the umbilicus.

Question 3

An unresponsive adult has a pulse of 60/min but only 4 breaths per minute, and pinpoint pupils suggest an opioid overdose. What is the best next step?

Accepted Answer

Support ventilation with a bag-mask and give naloxone

Answer

For a patient with a pulse and respiratory depression from an opioid, support breathing with oxygen and ventilation and give naloxone (for example 0.4 to 2 mg IV or IM, or 2 to 4 mg intranasal). Ventilation remains the priority while naloxone takes effect.

Question 4

An adult with a suspected opioid overdose has no pulse and is not breathing. What is the correct approach?

Accepted Answer

Follow the standard cardiac arrest algorithm; naloxone may be given but must not delay CPR

Answer

Once pulseless, the patient is treated with standard BLS and ACLS. Naloxone can be given as an addition, but there is no evidence it improves outcomes in true arrest, and it should never delay compressions or defibrillation.

Question 5

A patient develops stridor, wheezing, hypotension, and diffuse hives minutes after receiving an IV antibiotic. What is the first-line treatment?

Accepted Answer

IM epinephrine in the anterolateral thigh

Answer

This is anaphylaxis. Intramuscular epinephrine (typically 0.3 to 0.5 mg of 1 mg/mL) into the mid-outer thigh is the first-line treatment and should not be delayed for antihistamines or steroids, which are only adjuncts.

ACLS Practice Test

ACLS Practice Test

ACLS Cardiac Arrest and Emergencies in Special Situations (Pregnancy, Opioid Overdose, Anaphylaxis)