ACLS Acute Coronary Syndromes 3

Question 1

A patient in the ED is diagnosed with STEMI. The nearest PCI-capable hospital is 3 hours away. What is the most appropriate reperfusion strategy?

Accepted Answer

Administer fibrinolytic therapy if no contraindications

Answer

When PCI cannot be performed within 120 minutes of first medical contact, fibrinolytic therapy should be administered if there are no contraindications.

Question 2

Which of the following is an absolute contraindication to fibrinolytic therapy in STEMI?

Accepted Answer

Active internal bleeding or bleeding diathesis

Answer

Active internal bleeding or bleeding diathesis is an absolute contraindication to fibrinolytic therapy due to the risk of life-threatening hemorrhage.

Question 3

After successful fibrinolysis for STEMI, what is the recommended time frame for transfer to a PCI-capable facility?

Accepted Answer

3 to 24 hours after fibrinolysis

Answer

Guidelines recommend pharmacoinvasive strategy with transfer for angiography 3–24 hours after successful fibrinolysis.

Question 4

Which ECG change most reliably indicates complete reperfusion after fibrinolytic therapy?

Accepted Answer

Greater than 50% reduction in ST elevation at 90 minutes

Answer

A >50% reduction in ST elevation in the worst lead at 90 minutes post-fibrinolysis is a reliable marker of successful reperfusion.

Question 5

A patient with STEMI develops cardiogenic shock. Which intervention has the strongest evidence for improving mortality?

Accepted Answer

Emergency primary PCI

Answer

Emergency revascularization with primary PCI is the only intervention shown to reduce mortality in STEMI complicated by cardiogenic shock.

ACLS Practice Test

ACLS Practice Test

ACLS Acute Coronary Syndromes 3