ACLS Pulseless 2 — Questions and Answers
Question 1: A patient in pulseless VT fails to convert after the first defibrillation attempt and CPR is resumed. Which drug should be given next?
- Lidocaine 1.5 mg/kg IV
- Epinephrine 1 mg IV (Correct answer)
- Amiodarone 300 mg IV
- Magnesium sulfate 2 g IV
Correct answer: Epinephrine 1 mg IV
Epinephrine 1 mg IV is the first drug of choice in any pulseless arrest, given every 3–5 minutes.
Question 2: During CPR for a pulseless patient, you notice the waveform capnography reading is consistently below 10 mmHg after 20 minutes. What does this most likely indicate?
- Effective CPR with good perfusion
- ETT displacement into the esophagus
- Unlikely to achieve ROSC; consider stopping resuscitation (Correct answer)
- Need to increase ventilation rate
Correct answer: Unlikely to achieve ROSC; consider stopping resuscitation
PETCO2 persistently below 10 mmHg after 20 minutes of high-quality CPR suggests poor prognosis and may inform the decision to terminate resuscitation.
Question 3: What is the recommended energy for biphasic defibrillation of pulseless VT/VF when the manufacturer's recommendation is unknown?
- 100 J
- 150–200 J (Correct answer)
- 200 J and escalate
- 360 J
Correct answer: 150–200 J
When biphasic manufacturer settings are unknown, 150–200 J is recommended for the initial shock.
Question 4: A patient develops PEA after a witnessed cardiac arrest. The rate on the monitor is 40 bpm. Which reversible cause should be highest on your differential?
- Hyperkalemia
- Tension pneumothorax (Correct answer)
- Hypovolemia
- Hypothermia
Correct answer: Tension pneumothorax
A slow PEA rate (bradycardic PEA) raises strong suspicion for tension pneumothorax, cardiac tamponade, or severe acidosis.
Question 5: After defibrillation, CPR is immediately resumed. What is the primary reason to avoid checking the pulse immediately after a shock?
- Pulse checks interrupt compressions and reduce coronary perfusion (Correct answer)
- The shock may cause artifact making the pulse undetectable
- Checking the pulse resets the defibrillator charge time
- Pulse checks risk accidental re-shock to the provider
Correct answer: Pulse checks interrupt compressions and reduce coronary perfusion
Immediate CPR after defibrillation maintains coronary and cerebral perfusion; even if ROSC occurred, compressions cause minimal harm.
Question 6: Amiodarone 300 mg IV has been given for refractory VF. If VF persists, what is the correct supplemental dose?
- 300 mg repeat dose
- 150 mg once (Correct answer)
- 150 mg up to two additional doses
- Amiodarone should not be repeated
Correct answer: 150 mg once
A second dose of amiodarone 150 mg IV/IO can be given for persistent/recurrent VF/pVT after the initial 300 mg.
Question 7: A patient is found in asystole. After confirming the rhythm in two leads, which intervention should occur immediately?
- Defibrillation at 360 J
- Resume high-quality CPR and establish vascular access (Correct answer)
- Transcutaneous pacing at 80 bpm
- Administer atropine 1 mg IV
Correct answer: Resume high-quality CPR and establish vascular access
Asystole is not shockable; high-quality CPR with IV/IO access and epinephrine is the cornerstone of management.
ACLS Pulseless 2
A patient in pulseless VT fails to convert after the first defibrillation attempt and CPR is resumed.
Which drug should be given next?