ACLS Electrical Therapies and Defibrillation 3

Question 1

Which of the following is the most appropriate initial action before performing elective synchronized cardioversion of a stable but symptomatic patient?

Accepted Answer

Ensure IV access and provide procedural sedation/analgesia

Answer

Administer amiodarone to pre-treat the rhythm

Answer

Obtain a 12-lead ECG only — no sedation is needed

Answer

Place the patient in Trendelenburg position to improve perfusion

Question 2

What is the preferred pad placement when standard anterolateral positioning is not effective or feasible during defibrillation?

Accepted Answer

Anterior-posterior placement (one pad on front chest, one on back)

Answer

Bilateral anterior chest placement (both pads on front)

Answer

Both pads placed on the left lateral chest

Answer

Pad placement on the neck and abdomen

Question 3

If a patient with an implanted defibrillator (ICD) is in VF and the ICD has failed to convert the rhythm, what should the rescuer do?

Accepted Answer

Deliver external defibrillation, placing pads at least 1 inch from the device

Answer

Wait 5 minutes for the ICD to retry before attempting external defibrillation

Answer

Magnet placement is sufficient — no external defibrillation is needed

Answer

Only transcutaneous pacing should be used to avoid ICD damage

Question 4

What is the recommended current output starting point when initiating transcutaneous pacing, and how should it be adjusted?

Accepted Answer

Start at the lowest output and increase until electrical and mechanical capture is achieved

Answer

Start at maximum current and titrate down until capture is lost

Answer

Set to 40 mA and leave fixed for the duration of pacing

Answer

Start at 100 mA for all patients to ensure immediate capture

Question 5

During a cardiac arrest resuscitation, when should defibrillation be performed in relation to epinephrine administration?

Accepted Answer

Defibrillation takes priority and should not be delayed for drug administration

Answer

Epinephrine must be given before the first defibrillation attempt

Answer

Defibrillation and epinephrine must be given simultaneously

Answer

Epinephrine is given only after three failed defibrillation attempts, then no more shocks

Question 6

When synchronized cardioversion is urgently needed in an unstable patient but the synchronization feature fails to work, what is the correct next step?

Accepted Answer

Proceed with unsynchronized high-energy defibrillation if the patient is extremely unstable

Answer

Abandon cardioversion and manage with medications only

Answer

Proceed with unsynchronized defibrillation at the lowest energy available

Answer

Wait until the synchronization issue is resolved before proceeding

Question 7

What is the approximate hands-off time target that providers should aim for when performing defibrillation during CPR?

Accepted Answer

Less than 5 seconds from last compression to shock delivery

Answer

10–15 seconds is acceptable to ensure proper pad placement

Answer

20 seconds is the standard to allow full device charging

Answer

No specific limit — accurate pad placement is more important than speed