ACLS Pretest

“Airway, Breathing, Circulation…” was the BLS survey prior to the last ILCOR guideline revision in 2010 and has been replaced. Responsiveness, Activate EMS and get AED, Circulation, and Defibrillation is the correct sequence in the ILCOR 2020 guidelines. Blood Pressure is not part of the BLS survey. Cardiac assessment and drugs are not part of the BLS survey.

In the 2020 guidelines, it's emphasized that limiting interruptions to chest compressions to 10 seconds or less. When chest compressions are interrupted perfusion to the heart and brain rapidly drops, increasing the chance of damage due to lack of oxygen. Keeping the heart well-perfused increases the likelihood of return of spontaneous circulation, as well as the effectiveness of defibrillation.

While deformity may provide clues to traumatic injury, deformity is not part of the ACLS survey. While defibrillation is an important intervention, it is covered under “Circulation” and is not the “D” represented in the ACLS survey. While blood pressure is an important vital sign, it is a component of “Circulation”. In the ACLS survey the “B” stands for “Breathing”. The ACLS survey is Airway, Breathing, Circulation, and Differential Diagnosis.

Closed loop communication is present when team members repeat instructions back to the team leader confirming that the instruction was heard and understood as intended. This is an element of effective resuscitation team dynamics. Clear roles and responsibilities allow each team member to perform tasks and be accountable for them. Overlap and omission are both eliminated with clear roles and responsibilities of team members and therefore are essential to effective resuscitation team dynamics. Multiple team leaders create overlap and conflict and will reduce the effectiveness of a resuscitation team. Knowing one’s limitations is important to effective resuscitation team dynamics to allow roles and responsibilities to be assigned to team members proficient in them.

Hyperventilation increases intrathoracic pressure during diastole which decreases venous return to the heart. This decreases preload which diminishes cardiac output.

Head tilt-chin lift is the basic method of managing an airway in ACLS and BLS protocols. Jaw thrust without manipulation of the cervical spine is the basic method of managing the airway in victims in whom a spinal injury is suspected. Bag-mask ventilation is a basic airway skill for two rescuer CPR when equipment is available. Intubation with a laryngeal mask airway (LMA) is an advanced airway management device and is not considered a basic airway skill.

The pediatric soft flexible catheter has small openings, poorly suited to suctioning thick secretions and particulate matter. The Yankauer rigid suction catheter has large openings and a bulb shaped head which allow it to suction thick secretions and particulates from the oropharynx. The laryngeal tube is an intubation tube, not a suction catheter.

The Combitube™, laryngeal mask airway (LMA), and endotracheal tube (ET tube) are all examples of advanced airways. The nasopharyngeal airway is used to keep oral structures from falling to the back of the oropharynx and occluding the airway. It is an airway adjunct and not considered an advanced airway.

30:1 is incorrect. 30:2 is the correct ratio for compressions to ventilations according to the 2020 ILCOR guidelines. 15:2 is incorrect. 15:1 is incorrect.

Ventricular fibrillation is a common out-of-hospital arrhythmia which results in sudden cardiac arrest and should be treated with rapid defibrillation. Delayed defibrillation increases myocardial ischemia, further disorganizes cardiac electrical activity, and reduces the likelihood of successful defibrillation. Asystole is the absence of meaningful electrical activity in the heart. It is not a fibrillating rhythm and therefore does not respond to defibrillation.