ACLS Cheat Sheet 2026

The 30 highest-yield ACLS facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. What does a delta wave on an ECG indicate? → Wolff-Parkinson-White (WPW) syndrome with ventricular pre-excitation
2. A patient with symptomatic bradycardia fails to respond to atropine. Which of the following is the NEXT best step? → Begin transcutaneous pacing
3. A patient with bradycardia has no symptoms — normal blood pressure, no chest pain, no altered mentation. What is the appropriate ACLS action? → Observe and monitor; no immediate intervention required
4. When providing basic life support to an adult, the proper procedure is: → CAB - Compressions, Airway, Breathing
5. A patient presents with complete heart block. On the ECG, the ventricular escape rate is 25 bpm and QRS complexes are wide. Which statement is most accurate? → This rhythm indicates an infranodal block and requires pacing
6. In the ACLS algorithm, after the second shock for refractory VF/pulseless VT, which drug combination is given? → Epinephrine 1 mg IV and consider amiodarone 300 mg IV after the third shock
7. In ACLS, what is the maximum single dose of atropine for symptomatic bradycardia in adults? → 2 mg
8. What is the primary reason atropine is NOT recommended for Mobitz type II second-degree AV block? → It causes paradoxical slowing of the ventricular rate
9. What is the recommended initial dose of dopamine infusion for hemodynamically significant bradycardia when atropine fails? → 2–10 mcg/kg/min
10. Which rhythm on ECG shows regular narrow QRS complexes at 150 bpm with a 'sawtooth' baseline pattern? → Atrial flutter with 2:1 block
11. What is the primary advantage of video laryngoscopy over direct laryngoscopy in emergency intubation? → Provides an improved glottic view, particularly in difficult airways
12. Torsades de pointes is a form of polymorphic VT associated with: → Prolonged QT interval
13. What would you do if a 79-year-old man was in SVT, had a blood pressure of 80/50, complained of chest pain, and wanted to pass out? → Synchronized cardioversion
14. A 55-year-old patient presents with sudden onset of the 'worst headache of my life.' CT head is normal. What is the next diagnostic step? → Lumbar puncture to detect xanthochromia
15. A patient with acute stroke has blood glucose of 35 mg/dL. What is the appropriate management? → Treat hypoglycemia with IV dextrose; reassess neurological status after normalization
16. A patient develops torsades de pointes. Which treatment is specifically indicated for this arrhythmia? → Magnesium sulfate 1–2 g IV
17. A patient develops Torsades de Pointes with a pulse. Which drug is the treatment of choice? → Magnesium sulfate 1–2 g IV over 15 min
18. Which of the following is a Class III indication (harmful) for adenosine in tachycardia management? → Irregular wide-complex tachycardia consistent with pre-excited AF
19. Which of the following is the MOST sensitive early imaging modality for detecting acute ischemic stroke within the first few hours of onset? → Diffusion-weighted MRI (DWI)
20. Which rhythm is NOT considered a shockable rhythm in ACLS? → Pulseless electrical activity
21. Which of the following calcium channel blockers is most commonly associated with causing bradycardia and AV block? → Verapamil
22. The concept of 'time is brain' refers to approximately how many neurons lost per minute in untreated ischemic stroke? → 1.9 million neurons/minute
23. During a cardiac arrest scenario with a non-shockable rhythm (Asystole/PEA), what is the correct timing and dosage for Epinephrine administration? → As soon as possible, 1 mg every 3-5 minutes
24. A patient with narrow-complex tachycardia receives adenosine 6 mg without effect. What is the next step? → Administer adenosine 12 mg IV rapid push
25. What is the BLS Chain of Survival's appropriate order? → Check responsiveness, call EMS and get AED, chest compressions, and early defibrillation
26. What is the maximum single dose of aspirin recommended for initial ACS treatment in the prehospital or ED setting? → 162–325 mg
27. During ACLS megacode practice, when should chest compressions be paused? → Only to deliver a shock or check pulse after rhythm change
28. Which condition is classified as an 'H' in the ACLS reversible causes mnemonic? → Hypothermia
29. Which of the following rhythms is most likely to be converted by vagal maneuvers? → AV nodal reentrant tachycardia (AVNRT)
30. During stroke assessment, a patient scores 4 points on the Los Angeles Prehospital Stroke Screen (LAPSS). What does this indicate? → Stroke is likely; activate the stroke team immediately