DCAS Cardiac Emergencies (ACLS) 1 — Questions and Answers
Question 1: The ACLS algorithm for ventricular fibrillation (VF) calls for defibrillation at which energy level with a biphasic defibrillator?
- 200 joules (manufacturer-specific) for the first shock, escalating if needed (Correct answer)
- 100 joules for all shocks
- 360 joules for all shocks
- 50 joules initially, doubling with each shock
Correct answer: 200 joules (manufacturer-specific) for the first shock, escalating if needed
Biphasic defibrillators deliver effective shocks at lower energies than monophasic devices; the first shock is typically 200J (or manufacturer-specified dose), with equivalent or higher energy for subsequent shocks.
Question 2: In ACLS, CPR cycles consist of:
- 30 compressions to 2 ventilations (30:2) until an advanced airway is placed, then asynchronous (Correct answer)
- 15:2 ratio throughout the resuscitation
- 15 compressions to 1 ventilation for all patients
- Continuous compressions without ventilation for the first 10 minutes
Correct answer: 30 compressions to 2 ventilations (30:2) until an advanced airway is placed, then asynchronous
The 30:2 ratio applies until an advanced airway (ETT or supraglottic) is placed; once secured, continuous compressions at 100-120/min are given with ventilation at 10 breaths/min asynchronously.
Question 3: Epinephrine dosing in ACLS cardiac arrest is:
- 1mg IV every 3-5 minutes (Correct answer)
- 2mg IV once only
- 0.5mg IV every 10 minutes
- 1mg IV every minute until ROSC
Correct answer: 1mg IV every 3-5 minutes
Epinephrine 1mg IV/IO is administered every 3-5 minutes during cardiac arrest; it increases coronary and cerebral perfusion pressure through peripheral vasoconstriction, improving the probability of ROSC.
Question 4: Amiodarone is given in ACLS for shock-refractory VF/pVT at which dose?
- 300mg IV bolus first dose, followed by 150mg if needed (Correct answer)
- 150mg IV as the only dose
- 600mg IV loading dose
- 1mg/kg IV bolus
Correct answer: 300mg IV bolus first dose, followed by 150mg if needed
Amiodarone 300mg IV is given for VF/pVT that persists after 2-3 defibrillations; a second dose of 150mg can be administered for recurrent or refractory VF/VT.
Question 5: Post-ROSC targeted temperature management (TTM) aims to maintain core temperature at:
- 32-36°C for at least 24 hours in comatose survivors (Correct answer)
- 37-38°C (normothermia only)
- 28-30°C (deep hypothermia)
- 40°C (therapeutic hyperthermia)
Correct answer: 32-36°C for at least 24 hours in comatose survivors
TTM at 32-36°C for 24+ hours in comatose post-cardiac arrest survivors reduces neurological injury by decreasing cerebral metabolic demand, inflammation, and excitotoxicity following ischaemia-reperfusion injury.
Question 6: In ACLS, pulseless electrical activity (PEA) is managed by:
- CPR, epinephrine every 3-5 minutes, and treatment of reversible causes (Hs and Ts) (Correct answer)
- Immediate defibrillation
- Atropine 1mg IV
- Calcium gluconate IV as first-line
Correct answer: CPR, epinephrine every 3-5 minutes, and treatment of reversible causes (Hs and Ts)
PEA is treated with high-quality CPR and epinephrine while simultaneously searching for and treating reversible causes (Hypovolaemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyperkalaemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis).
DCAS Cardiac Emergencies (ACLS) 1
The ACLS algorithm for ventricular fibrillation (VF) calls for defibrillation at which energy level with a biphasic defibrillator?