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Quiz about Advanced Life Support Australian Guidelines

Advanced Life Support - Australian Guidelines Quiz

Previously I have covered some of the basics of Patient Assessment and Care, and many quizzers have indicated that they are ready to show off their advanced knowledge. Are you ready to step up to Advanced Life Support?

A multiple-choice quiz by ecnalubma. Estimated time: 7 mins.

Author
ecnalubma

Time
7 mins

Type
Multiple Choice

Quiz #
295,054

Updated
Dec 03 21

# Qns
10

Difficulty
Tough

Avg Score
6 / 10

Plays
760

Awards
Top 35% Quiz

One at a Time - Single Page - Timed Game

Question 1 of 10

1. Advanced Life Support (ALS) is often concerned with the cardiac arrest and the peri-arrest time frames, and the Advanced Cardiac Life Support (ACLS) is no exception. Both ALS and ACLS can deal with Acute Coronary Syndromes (ACS). Which of the following is NOT considered to be an Acute Coronary Syndrome (ACS)? Hint

Unstable Angina

Stable Angina

ST-segment elevation Myocardial Infarction (STEMI)

Non-ST segment elevation Myocardial Infarction (Non-STEMI)

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Question 2 of 10

2. As an EMT or Paramedic, you are examining a patient whom you suspect of suffering with an Acute Coronary Syndrome (ACS). Which of the following treatment regimes is perhaps ill-advised for the pre-hospital care provider? Hint

High-concentration oxygen administration

IV Morphine, titrated to pain, but avoiding sedation and respiratory depression

300-350mg aspirin, chewed, as soon as possible, unless contraindicated

1000mL bolus IV Saline as a fluid challenge

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Question 3 of 10

3. Thrombolytic therapy has been shown to provide a substantial reduction in mortality from Acute Myocardial Infarction (AMI) when administered in the first few hours after the onset of pain or discomfort. Which of the following would contraindicate the administration of thrombolytic therapy to a patient with an AMI? Hint

Transient Ischaemic Attack (TIA), more that 12 months prior

Minor surgery more than 6 months prior, but less than 12 months prior

Previous haemorrhagic stroke

Previous history of peptic ulcer disease, which has now resolved

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Question 4 of 10

4. Heart rhythms associated with cardiac arrest generally fall into two categories - Shockable, and Non-Shockable. Shockable rhythms are those in which defibrillation should be attempted. Which of the following are shockable rhythms? Hint

Ventricular Tachycardia (VT) and Pulseless Electrical Activity (PEA)

Asystole and Pulseless Electrical Activity (PEA)

Ventricular Tachycardia (VT) and Ventricular Fibrillation (VF)

Asystole and Ventricular Fibrillation (VF)

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Question 5 of 10

5. Reversible causes of cardiac arrest should be considered during treatment. In an effort to make these easier to remember, they may be divided into two groups, known as the 4Hs and the 4Ts.
Which of the following best represents the 4Ts? Hint

Thrombosis, Tension Pneumothorax, Trachea, and Thoracotomy

Toxins, Thrombosis, Trachea, and Tension Pneumothorax

Tamponade, Toxins, Thrombosis, and Tension Pneumothorax

Thoracotomy, Tamponade, Toxins, and Thrombosis

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Question 6 of 10

6. It is not uncommon, especially in the pre-hospital setting, to have a cardiac monitor that enables monitoring on 'modified limb leads' I, II, and III. This requires placement of only 3 leads - and in Australia, these leads are often coloured red, white, and black.
What is the correct placement for these leads to monitor leads I, II, and III? Hint

Red - Right upper chest, White - Left upper chest, Black - Left upper abdominal wall

Red - Right upper abdominal wall, White - Left upper chest, Black - Left upper abdominal wall

Red - Left upper chest, White - Left upper abdominal wall, Black - Right upper chest

Red - Left upper abdominal wall, White - Right upper chest, Black - Left upper chest

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Question 7 of 10

7. Access to the circulation is required during CPR in order to give drugs and fluids, to take blood samples, and in some settings for transvenous pacing, and intravenous access is the most reliable for giving drugs during resuscitation. The EMT / Paramedic must decide on accessing a central vein or a peripheral vein in order to achieve venous access to the circulation. Which of the following best indicates circulation time (from infusion site, through the heart, down to the femoral artery) for each of these choices? Hint

Approximately 1 minute for either site - skill and experience is the only determining factor in deciding between central or peripheral venous access

30-seconds for a central vein, up to 5 minutes for a peripheral vein

90-seconds for a central vein, 150-seconds for a peripheral vein

60-seconds for a central vein, 120-seconds for a peripheral vein

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Question 8 of 10

8. Drugs are often used in the peri-arrest patient as well as those who advance to cardiac arrest. Which of the following drugs is listed in the amount used in the cardiac arrest situation rather than the peri-arrest situation? Hint

Adenosine - 6mg for narrow-complex tachycardia not terminated by vagal manoeuvres

Aspirin - 300-325mg Per Oral for any Acute Coronary Syndrome (ACS)

Amiodarone - 300mg IV for a haemodynamically unstable tachycardia unresponsive to cardioversion

Atropine - 3mg IV for Asystole

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Question 9 of 10

9. Advanced Life Support (ALS) treatment of peri-arrest arrhythmias involves consideration of several treatment options, including vagal manoeuvres, drug therapy, and electrical cardioversion. Electrical cardioversion is relatively reliable at restoring sinus rhythm by terminating a tachyarrhythmia, however, cardioversion must be synchronised with a particular part of the ECG. Which part of the ECG should shock deliver coincide with? Hint

R wave

P wave

T wave

U wave

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Question 10 of 10

10. In many cases involving out-of-hospital cardiac arrest, a close friend or loved one will have performed CPR on the patient, and the needs of this person or people are often overlooked in the ongoing care and treatment of the patient. Which of the following has NOT been recognised by loved ones as an advantage to being present during resuscitation efforts? Hint

Loved ones can see first-hand that every effort was made for the dying person

Loved ones may have the opportunity to speak while the patient can still hear

Loved ones may physically or emotionally hinder staff involved in the resuscitation attempts

Loved ones can touch and speak with the deceased while they are still warm

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Quiz Answer Key and Fun Facts

Answer: Stable Angina

The discomfort associated with angina (either stable or unstable) is similar in nature to Myocardial Infarction (MI). As angina involves narrowing (due to muscle spasm) of the coronary vessels, angina that continues for too long can result in MI due to the decrease in delivery of blood (and therefore oxygen) to the myocardium.

When provoked only by exercise, and with pain settling promptly upon cessation of the activity, angina is considered to be stable in nature, and therefore not an Acute Coronary Syndrome.

Answer: 1000mL bolus IV Saline as a fluid challenge

1000mL, or 1 litre, of IV fluid, is probably a little excessive for a patient you suspect of cardiac compromise, and fluid challenges for patients with suspect ACS is not recommended at all in many protocols. If available, anti-emetics should be considered in any patient with suspected ACS who complains of nausea.

Did you know that many patients with ischaemic cardiac pain will be more comfortable sitting up? In some cases, lying flat may worsen, or even provoke, cardiac chest pain.

Answer: Previous haemorrhagic stroke

Any history of haemorrhagic stroke will exclude a patient from thrombolytic therapy, irrespective of how long ago the stroke occurred. Ischaemic stroke will only exclude a patient if it occurred within the 6 months prior to the AMI. Major surgery within the preceding 3 weeks will also rule a patient out of thrombolytic therapy.

One of the major advantages of thrombolytic therapy is that it can be commenced prior to the patient arriving at the hospital - in many places, it is now carried out by paramedics, and research is showing that this is saving lives in remote locations.

Answer: Ventricular Tachycardia (VT) and Ventricular Fibrillation (VF)

Other actions, such as chest compressions, airway management and ventilations, obtaining venous access, and the identification and correction of the reversible causes of cardiac arrest, should be performed irrespective of the cardiac rhythm.

Never underestimate the value of quality CPR - providing oxygenation and chest compression may increase the amplitude of the waveform of VF, and change a patient with a non-shockable rhythm into a patient with a shockable rhythm.

Answer: Tamponade, Toxins, Thrombosis, and Tension Pneumothorax

Tension Pneumothorax requires rapid decompression.
The appropriate antidote should be given for specific toxins (if available), and general supportive measures should be used in all cases involving poisoning.
The commonest cause of thromboembolic cardiac arrest is massive Pulmonary Embolism (PE).
Cardiac Tamponade is difficult to diagnose in cardiac arrest, as distended neck veins and hypotension cannot be assessed.

6. It is not uncommon, especially in the pre-hospital setting, to have a cardiac monitor that enables monitoring on 'modified limb leads' I, II, and III. This requires placement of only 3 leads - and in Australia, these leads are often coloured red, white, and black. What is the correct placement for these leads to monitor leads I, II, and III?

Answer: Red - Left upper abdominal wall, White - Right upper chest, Black - Left upper chest

Electrodes should be placed over bone rather than muscle to minimise artifact.

Single-lead ECG monitoring (as described above)is not a reliable technique for detecting evidence of Myocardial Infarction (MI). Whenever possible, serial 12-lead ECGs should be recorded in patients experiencing chest pain/discomfort suggestive of Acute Coronary Syndromes (ACS).

Answer: 30-seconds for a central vein, up to 5 minutes for a peripheral vein

Peripheral placement is considered to be more convenient for venous access, and often allows for faster placement through being used by less experienced operators, as well as requiring less equipment.

If a peripheral vein is used, it is advisable to flush up to 20mL of IV fluid after each drug administration, as well as raising the limb in an effort to speed up delivery to the central circulation.

Answer: Atropine - 3mg IV for Asystole

Atropine may be indicated in both the peri-arrest and full arrest scenarios, however the dose listed above is used in the asystole cardiac arrest scenario. When given in a peri-arrest scenario, it is advised to be given in 500mcg increments, while in cardiac arrest it may be given from 1mg up to 3mg as a single dose depending upon the circumstances.

Always remember that drugs used to treat arrhythmias can also cause arrhythmias.

Answer: R wave

Defibrillation delivered to coincide with the T wave could actually precipitate Ventricular Fibrillation (VF).

It is important to remember that all anti-arrhythmic treatments have the potential to make the rhythm worse rather than better, causing clinical deterioration of the patient.

Answer: Loved ones may physically or emotionally hinder staff involved in the resuscitation attempts

I believe it to be important that care and consideration of loved ones (encompassing spouses, partners, significant others, close friends as well as family members) occurs during resuscitation attempts. It is important to explain procedures in simple terms, and coming to terms with explaining that resuscitation attempts have not been successful and will be stopped at some point.

Be aware that resuscitating a person in cardiac arrest can be an emotional time for all involved, including you. Try to allow yourself some time to deal with any emotions that this may raise, and seek assistance if you feel that you are not coping as well as you would like.

Source: Author ecnalubma

This quiz was reviewed by FunTrivia editor crisw before going online.
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