ADVANCED CARDIAC LIFE SUPPORT REFRESHER COURSE Pre-Course Test (2015 Guidelines)

Transcription

1 ADVANCED CARDIAC LIFE SUPPORT REFRESHER COURSE 2015 Pre-Course Test (2015 Guidelines) Please read each multiple-choice question carefully. Choose one option that best answers the question. One mark will be allocated for each correct answer. There is no negative marking. The pass mark for this paper is 80%. PLEASE BE PREPARED TO HAND THIS PAPER IN AT THE START OF THE COURSE

2 The following 6 questions relate to the scenario below. A 60 year old man (weight = 90kg) admitted to a medical ward reports several days of increasing periods of chest pain on exertion. He has a history of angina, hypertension and diabetes. He suddenly becomes unresponsive in front of you. Upon examination, you find he is not breathing normally. An AED is available on the ward. 1. Which of the following actions should be considered first? a) Start chest compressions b) Send for help and the AED c) Commence rescue breathing d) Insert an IV line and send for help 2. When is the technique of pre-cordial thump indicated? a) For monitored patients in VT where a defibrillator is not immediately available b) In any situation where a patient is found to be unconscious c) When cardiac arrest is witnessed and CPR has already begun d) In a situation where an adult patient has been found in respiratory arrest 3. When you attach the bag-valve-mask device with a reservoir to the oxygen source, what is the correct flow rate to administer oxygen? a) 4 l / min b) 6 l / min c) 8 l / min d) 10 l / min 4. When the AED arrives you should: a) Continue CPR for 2 minutes before analysing b) Attach pads in preparation for the arrival of the code team c) Turn it on, apply pads, follow prompts d) Be prepared to shock after administration of first dose of adrenaline The AED advises a shock (which is delivered), and a manual defibrillator arrives moments later with the code team. After 2 minutes of CPR, the manual defibrillator is charged and the following rhythm is noted:

3 5. A second shock is delivered, and an IV line established. What medication can now be given? a) Atropine, followed by 20-40mL flush b) Adrenaline, followed by 20-40mL flush c) Amiodarone, followed by 20-40mL flush d) Lignocaine, followed by 20-40mL flush 6. What is the correct ratio of compressions to ventilations for this non-intubated patient? a) 30 compressions to 2 breaths b) 15 compressions to 2 breaths c) 5 compressions to 1 breath d) 3 compressions to 1 breath The following 4 questions relate to the scenario below. A 43 year old woman has presented to her local A&M clinic stating she has palpitations, and feels a bit light headed. Her BP is 110/50. The monitor shows: 7. Which of the following is indicated first? a) Adenosine 6mg IV b) Verapamil 2.5mg IV c) Sedation and immediate synchronised cardioversion d) Perform vagal manoeuvres 8. Your initial intervention has been ineffective in terminating this arrhythmia. What drug should now be administered? a) Adenosine 6mg IV b) Amiodarone 300mg IV c) Adrenaline infusion 2-10 micrograms per minute d) Adenosine 12mg IV

4 9. The drug administered above has also been ineffective in terminating this arrhythmia. What is the next drug that should be administered? a) Amiodarone 300mg IV b) Adenosine 6mg IV c) Adenosine 12mg IV d) Adrenaline infusion 2-10 micrograms per minute 10. The patient now states she is more short of breath and thinks she is going to faint. Her BP is 70/40. Your next intervention will be: a) Adenosine 18mg IV b) Amiodarone 300mg IV c) Verapamil 2.5mg IV d) Sedation and immediate synchronised cardioversion The following 2 questions relate to the scenario below. A 73 year old patient has recently been admitted to hospital with a chest infection and has just rung his bell. When the nurse came in, he was poorly responsive. He has a slow, weak, brachial pulse. His BP is 88/53. He has oxygen and an IV line in place. The defibrillator has been attached using the pads and shows the following rhythm: 11. The next treatment you will initiate is: a) Dopamine infusion micrograms per kg per minute, and titrate to effect b) Atropine 0.6mg IV up to a total dose of 3mg; prepare for transcutaneous pacing c) Adrenaline 2-10 micrograms per minute, and titrate to effect d) Isoprenaline 2-10 micrograms per minute infusion, titrated to effect 12. If the patient requires transcutaneous pacing, you will need to: a) Attach the 3-lead ECG cable from the defibrillator to obtain a trace b) Remove the pads and attach leads c) Place defibrillator in AED mode d) Attach a bedside monitor in addition to the defibrillator

5 The next 8 questions relate to the following scenario. A 55 year old man presents to a GP clinic complaining of chest tightness and shortness of breath. He appears pale and states he feels dizzy. His blood pressure is 110/70 and his ECG is below. 13. Which of the following statements best describes the following ECG? a) There are no acute ECG changes b) There are acute changes consistent with a ST-Elevation myocardial infarction c) There are acute changes consistent with a Non-ST elevation myocardial infarction d) There are ECG changes consistent with LBBB 14. Which of the following treatments are not required for the immediate management of this patient s acute coronary syndrome? a) Oxygen, titrated to a SpO2 of 94-98% b) Aspirin PO c) Nitro-glycerine spray 0.4mg SL d) Glycoprotein IIb/IIIa Inhibitors

6 15. What is the correct dose of aspirin to be administered? a) 50mg b) 100mg c) 300mg d) 500mg 16. After initiating the immediate management, the patient s chest pain and shortness of breath seems to have resolved. His BP has remained 110/70. Which of the following interventions is most important in reducing in-hospital stay and 30-day mortality? a) Thrombolysis or PCI as appropriate b) Transcutaneous pacing c) Cardioversion d) A beta blocker 17. Several minutes later the ambulance arrives, and the patient starts to complain of worsening pain. Suddenly, he can no longer be roused. He is not breathing, so CPR starts. A manual defibrillator is attached, charged and shows the following rhythm: 18. What is the name of this rhythm? a) Ventricular fibrillation b) Supraventricular tachycardia c) Ventricular tachycardia d) Junctional tachycardia 18. The patient is defibrillated, CPR resumes, and after 2 minutes the defibrillator is charged. A rhythm check is performed and the monitor shows: A second shock is delivered, and immediately after adrenaline is administered.

7 Two minutes later the defibrillator is charged, and a third shock is delivered; CPR resumes (3rd loop). What medication would you administer next? a) Adrenaline 0.5mg IM b) Atropine 3mg IV c) Adrenaline 1mg IV d) Amiodarone 300mg IV 19. What is the correct rate and depth of compressions for this patient? a) per minute / At least 5cm b) per minute / At least 5cm c) 100 per minute / At least 4cm d) per minute / 4-5cm 20. What is the correct dose of adrenaline to be administered intravenously? a) 4mg every 4 minutes b) 2mg every 4 minutes c) 1mg every 4 minutes d) 0.5mg every 4 minutes The next 4 questions relate to the following scenario. A 6 year old girl is transported by ambulance to a small rural hospital where you are working. Paramedics have commenced resuscitation in the field. They state she was found face down in a pool. Her temperature is 36 C. She is blue, respirations are absent and no pulse can be found. CPR with a bag-mask and oropharyngeal airway is in progress. The monitor shows the following rhythm: 21. Which of the following adjunct priorities should be considered first in this situation? a) Supraglottic airway device (SAD) or endotracheal tube b) Intravenous or intraosseous access c) Transcutaneous pacing d) Oxygen 12L/min via non-breather mask

8 22. What is the correct ratio of compressions to ventilations for this patient? a) 1 breath to 3 compressions b) 5 compressions to 1 breath c) 2 breaths to 15 compressions d) 30 compressions to 2 breaths 23. What is the correct sized endotracheal tube and estimated weight for this patient? a) 3.5 / 15kg b) 4.0 / 20kg c) 5.5 / 20kg d) 6.0 / 25kg 24. What is the correct dose of adrenaline to be administered to this patient via the IV/IO route? a) 1mcg/kg, followed by 5-10mL flush b) 10mcg/kg, followed by 5-10mL flush c) 100mcg/kg, followed by 5-10mL flush d) 1000mcg/kg, followed by 5-10mL flush The following 3 questions relate to the scenario below. A 28 year old woman has returned to the orthopaedic ward following surgery. She is charted IV antibiotics and soon after administration complains of difficulty breathing, an itchy chest and stomach cramps. On examination her BP is 70/40; HR 110; RR 30; and SpO2 of 87%. There is an urticarial rash on her upper chest, her lips are swollen and a widespread expiratory wheeze can be heard. 25. Which of the following actions should be considered first? a) Slow down the antibiotic infusion rate and contact the anaesthetist or surgeon for advice b) Administer 5mg of salbutamol via nebuliser and prepare IM adrenaline c) Sit the patient up, administer high-flow oxygen and prepare 25-50mg promethazine for IV injection d) Stop the antibiotic infusion and call for help 26. What is the first drug that should be administered in this situation?. a) Promethazine 25-50mg IV b) Adrenaline 0.5mg IM c) Adrenaline 1mg IV d) Hydrocortisone 200mg IV

9 27. After 5 minutes the patient s BP is 80/55; HR 104; RR 26 and SpO2 89%. A rapid infusion of 1000mL saline has commenced. What medication should be administered next? a) Adrenaline 0.5mg IM b) Adrenaline 1mg IV by slow push c) Hydrocortisone 200mg IV d) Ranitidine 50mg IV by slow push The following 3 questions are related to the following case presentation. A 76 year old man (weight = 75kg) has presented to a community A&M clinic following a fall at the local bowling club. X-rays reveal he has a fracture of the L) tibia, and clinical fractures to his 5 th and 6 th ribs on the L) side. While waiting for the ambulance to arrive he receives 6 boluses of 3mg IV morphine for pain relief within a one hour period. His wife is with him. Suddenly she calls for help as he cannot be roused. His pulse rate is 45/min; respirations are absent. 28. Which of the following options is the most likely diagnosis? a) Respiratory arrest due to tension pneumothorax b) Respiratory arrest due to narcotic overdose c) Respiratory arrest due to fat embolus syndrome d) Respiratory failure due to respiratory insufficiency 29. The medication most likely to be administered to this patient is: a) Naloxone 0.4mg IV b) Adrenaline 1mg IV c) Flumazenil 0.2mg IV d) Atropine 0.6mg IV 30. An advanced airway is inserted and following 5 minutes of ventilation the patient s saturations drop from 96% to 89% His heart rate increases from 80 to 110. Which of the following options should be considered first? a) Assess the patient for a pneumothorax b) Suction the advanced airway in case of blockage c) Check the bag-mask is not faulty d) Check the advanced airway is still in the correct position