ACLS Pulseless 3 — Questions and Answers
Question 1: A 55-year-old patient is in PEA arrest. The team suspects massive pulmonary embolism. Which intervention is most appropriate?
- Immediate defibrillation at 200 J
- Empirical systemic thrombolysis (Correct answer)
- Synchronized cardioversion at 100 J
- Epinephrine withheld until PE confirmed
Correct answer: Empirical systemic thrombolysis
If PE is the suspected cause of cardiac arrest, empirical systemic thrombolysis (e.g., tPA) should be strongly considered during CPR.
Question 2: Which of the following best describes the correct hand placement for external chest compressions in an adult?
- Two fingers above the xiphoid process
- Center of the chest on the lower half of the sternum (Correct answer)
- Left lateral chest wall over the heart
- Upper sternum between the clavicles
Correct answer: Center of the chest on the lower half of the sternum
Compressions are placed at the center of the chest on the lower half of the sternum to maximize cardiac output.
Question 3: A pulseless patient has a known history of Wolff-Parkinson-White syndrome and is now in a wide-complex tachyarrhythmia. What is the ACLS treatment?
- Adenosine 6 mg IV rapidly
- Amiodarone 150 mg IV over 10 minutes
- Immediate unsynchronized defibrillation (Correct answer)
- Verapamil 5 mg IV
Correct answer: Immediate unsynchronized defibrillation
Pulselessness requires immediate unsynchronized defibrillation regardless of the underlying rhythm or history.
Question 4: What is the maximum acceptable pause in chest compressions for rhythm check and defibrillation during a cardiac arrest?
- 5 seconds
- 10 seconds (Correct answer)
- 15 seconds
- 20 seconds
Correct answer: 10 seconds
ACLS guidelines recommend limiting all peri-shock pauses in CPR to less than 10 seconds.
Question 5: Lidocaine 1–1.5 mg/kg IV is an acceptable alternative to amiodarone for which pulseless rhythm?
- Asystole
- Pulseless electrical activity
- Ventricular fibrillation/pulseless VT (Correct answer)
- Third-degree AV block
Correct answer: Ventricular fibrillation/pulseless VT
Lidocaine is an acceptable alternative antiarrhythmic to amiodarone for shock-refractory VF/pulseless VT.
Question 6: A patient with no IV access is in pulseless VT. The team is preparing the IO device. Which site is preferred for adult IO access?
- Femoral vein
- Proximal tibia or proximal humerus (Correct answer)
- Distal radius
- Internal jugular vein
Correct answer: Proximal tibia or proximal humerus
The proximal tibia and proximal humerus are the preferred IO sites in adults during cardiac arrest when IV access cannot be established.
Question 7: After ROSC is achieved, the patient's SpO2 is 96% on 100% FiO2. What should you do?
- Maintain 100% O2 to prevent rearrest
- Titrate FiO2 to achieve SpO2 92–98% (Correct answer)
- Reduce FiO2 to 21% immediately
- Switch to non-rebreather mask
Correct answer: Titrate FiO2 to achieve SpO2 92–98%
Post-ROSC, oxygen should be titrated to an SpO2 of 92–98% to avoid hyperoxia-related reperfusion injury.
ACLS Pulseless 3
A 55-year-old patient is in PEA arrest.
The team suspects massive pulmonary embolism.
Which intervention is most appropriate?