ACLS Pulseless 4 — Questions and Answers
Question 1: You are resuscitating a patient in VF. The team has delivered 3 shocks and 2 doses of epinephrine. Which antiarrhythmic should be considered next?
- Magnesium sulfate 2 g IV
- Amiodarone 300 mg IV (Correct answer)
- Atropine 1 mg IV
- Adenosine 6 mg IV
Correct answer: Amiodarone 300 mg IV
Amiodarone 300 mg IV is the first antiarrhythmic recommended after epinephrine for shock-refractory VF/pulseless VT.
Question 2: Which of the following is a 'T' in the Hs and Ts of reversible causes of cardiac arrest?
- Thyrotoxicosis
- Tachycardia
- Tension pneumothorax (Correct answer)
- Thromboembolism (only DVT)
Correct answer: Tension pneumothorax
The 5 Ts are Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary and coronary), and Trauma.
Question 3: A patient in cardiac arrest is suspected to have hyperkalemia as the cause. Which drug is most appropriate to stabilize the myocardium?
- Sodium bicarbonate 1 mEq/kg IV
- Calcium chloride 500–1000 mg IV (Correct answer)
- Insulin 10 units IV
- Albuterol nebulization
Correct answer: Calcium chloride 500–1000 mg IV
Calcium chloride (or calcium gluconate) directly antagonizes the cardiac membrane effects of hyperkalemia and is the first-line treatment.
Question 4: What chest compression depth is recommended for adults during CPR?
- At least 1.5 inches (3.8 cm)
- At least 2 inches (5 cm), not exceeding 2.4 inches (6 cm) (Correct answer)
- Exactly 3 inches (7.6 cm)
- At least 2.5 inches (6.4 cm)
Correct answer: At least 2 inches (5 cm), not exceeding 2.4 inches (6 cm)
Adult CPR guidelines recommend a compression depth of at least 2 inches (5 cm) but not more than 2.4 inches (6 cm).
Question 5: A patient is resuscitated and ROSC is achieved. The 12-lead ECG shows ST elevation in leads II, III, and aVF. What is the next priority?
- Continue therapeutic hypothermia and observe for 48 hours
- Emergent coronary angiography/PCI (Correct answer)
- Give thrombolytics immediately in the ED
- Repeat defibrillation to prevent recurrence
Correct answer: Emergent coronary angiography/PCI
STEMI identified post-ROSC warrants emergent coronary angiography and PCI regardless of the patient's neurological status.
Question 6: Which statement about atropine use in cardiac arrest is correct per current ACLS guidelines?
- Atropine 1 mg is first-line for asystole
- Atropine is no longer recommended for asystole or PEA (Correct answer)
- Atropine can convert VF to a perfusing rhythm
- Atropine 0.5 mg is used for pulseless bradycardia
Correct answer: Atropine is no longer recommended for asystole or PEA
Current ACLS guidelines removed atropine from the cardiac arrest algorithm; it is no longer recommended for asystole or PEA.
Question 7: In a patient with pulseless VT, a synchronized shock is attempted but the defibrillator cannot synchronize. What should you do?
- Delay until synchronization is achieved
- Use the lowest available energy
- Deliver an unsynchronized shock immediately (Correct answer)
- Give amiodarone and retry synchronization
Correct answer: Deliver an unsynchronized shock immediately
If the defibrillator cannot synchronize on a VT waveform and the patient is pulseless, deliver an unsynchronized (defibrillation) shock immediately.
ACLS Pulseless 4
You are resuscitating a patient in VF.
The team has delivered 3 shocks and 2 doses of epinephrine.
Which antiarrhythmic should be considered next?