CMT CMT Emergency Response and ACLS Protocols 2 — Questions and Answers
Question 1: The H's and T's mnemonic in ACLS represents reversible causes of cardiac arrest. Which of the following is NOT one of the H's?
- Hypovolemia
- Hypoxia
- Hypertension (Correct answer)
- Hypothermia
Correct answer: Hypertension
The H's of cardiac arrest are Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, and Hypothermia — Hypertension is not included.
Question 2: A patient in the telemetry unit develops a rapid wide-complex tachycardia at 180 bpm with a blood pressure of 60/40 mmHg. The CMT's priority notification should emphasize:
- The exact QRS morphology details
- Hemodynamic instability requiring immediate bedside response (Correct answer)
- The precise rate calculation
- Whether the patient ate recently
Correct answer: Hemodynamic instability requiring immediate bedside response
Hemodynamic instability with a dangerous tachyarrhythmia is a critical emergency requiring immediate bedside response; unstable patients may need cardioversion.
Question 3: Synchronized cardioversion is used instead of defibrillation for which arrhythmia?
- Ventricular fibrillation
- Pulseless ventricular tachycardia
- Unstable atrial flutter with a pulse (Correct answer)
- Asystole
Correct answer: Unstable atrial flutter with a pulse
Synchronized cardioversion delivers a shock timed to the QRS complex and is used for organized rhythms with a pulse, such as unstable SVT or atrial flutter.
Question 4: When transcutaneous pacing is initiated for complete heart block, the CMT confirms effective capture by:
- Seeing pacing spikes only on the monitor
- Observing pacing spikes followed by wide QRS complexes plus a palpable pulse confirmed by bedside staff (Correct answer)
- Hearing the pacemaker beep
- Observing the patient's discomfort from pacing
Correct answer: Observing pacing spikes followed by wide QRS complexes plus a palpable pulse confirmed by bedside staff
Electrical capture is confirmed by pacing spikes followed by wide QRS complexes, and mechanical capture is confirmed by a palpable pulse.
Question 5: What does a post-resuscitation 12-lead ECG primarily evaluate for after return of spontaneous circulation (ROSC)?
- Presence of U waves
- ST elevation indicating STEMI requiring urgent cath lab activation (Correct answer)
- Lead placement accuracy
- Presence of sinus rhythm only
Correct answer: ST elevation indicating STEMI requiring urgent cath lab activation
Post-ROSC 12-lead ECG is essential to detect STEMI, as myocardial infarction is a leading cause of cardiac arrest requiring emergent reperfusion.
Question 6: During a code, the CMT observes the rhythm change from VF to a slow wide-complex rhythm. The team should be informed that this may represent:
- Normal sinus rhythm restoration
- Agonal rhythm (idioventricular) suggesting poor perfusion (Correct answer)
- Atrial flutter with block
- Artifact from chest compressions
Correct answer: Agonal rhythm (idioventricular) suggesting poor perfusion
A slow wide-complex agonal rhythm following VF suggests a dying heart with poor perfusion, requiring continued aggressive resuscitation efforts.
CMT CMT Emergency Response and ACLS Protocols 2
The H's and T's mnemonic in ACLS represents reversible causes of cardiac arrest.
Which of the following is NOT one of the H's?