Advanced Cardiac Life Support (3rd Ed.) – Key Provider Facts

Question-and-answer flashcards summarizing essential ACLS provider knowledge: BLS, pediatric care, first aid, arrest algorithms, rhythms, drugs, airway, post-ROSC care, ACS, pacing, cardioversion, defibrillation and more.

What is the flagship goal of the Philippine Heart Association Council on CPR since 1982?

Continuous education and training of healthcare professionals in Basic and Advanced Cardiac Life Support.

During the COVID-19 pandemic, what is the correct single-rescuer BLS sequence?

Ensure scene safety → put on PPE → cover the victim’s mouth/nose → check pulse and breathing.

List the 5 Cs for out-of-hospital cardiac arrest during a pandemic in order.

Call → Cover → Check → Connect → Compress.

What is the sixth link in the adult out-of-hospital chain of survival?

Recovery (post-resuscitation care & rehabilitation).

Define ‘agonal gasps’ and their relevance to BLS.

Short, laboured, irregular breaths seen early in cardiac arrest; they are treated as NO BREATHING.

Give the recommended adult chest-compression rate and depth.

100-120 compressions /min at 5-6 cm (2.0-2.4 in) depth.

What compression-to-ventilation ratio is used for single-rescuer adult BLS without an advanced airway?

30 compressions : 2 breaths.

State the two main components of CPR.

High-quality chest compressions and airway/rescue breathing.

Which out-of-hospital arrhythmia is most common in adult cardiac arrest victims?

Ventricular fibrillation.

How does an AED decide whether to deliver a shock?

It analyzes the victim’s rhythm and advises a shock only for shockable rhythms.

Age cut-offs for infant, child, and adult BLS guidelines?

Infant: 28 days–<1 yr; Child: 1 yr–<8 yr; Adult: ≥8 yr.

When do you use the ‘phone FAST’ strategy in pediatric BLS?

For unwitnessed collapse in children <8 yr—give 2 min of CPR, then activate EMS/AED.

Where is the pulse checked in an infant?

Brachial artery.

Describe the infant chest-compression technique preferred when two rescuers are present.

Two-thumb-encircling hands just below the nipple line at ≥1/3 AP diameter (~4 cm).

What compression ratio is used by two rescuers in pediatric BLS without an advanced airway?

15 compressions : 2 breaths.

First aid: What are the ‘3 Ps’ that summarize the goals of a first-aid provider?

Preserve life, Prevent further illness/injury, Promote recovery.

Outline the BEFAST stroke assessment mnemonic.

Balance, Eyes, Face droop, Arm weakness, Speech difficulty, Time to call EMS.

Adult IM epinephrine dose for anaphylaxis?

0.3 mg of 1 mg/mL (1:1 000) solution into mid-lateral thigh.

Why is activated charcoal NOT routinely given by first-aid rescuers?

Its benefits do not outweigh risks; should be given only under poison-control guidance.

Describe the immediate management of witnessed electrocution.

Ensure power source is off, avoid contact until safe, then assess ABCs and start CPR if needed.

Name the two shockable adult arrest rhythms.

Ventricular fibrillation and pulseless ventricular tachycardia.

What drug and dose are first-line for all adult cardiac arrests?

Epinephrine 1 mg IV/IO every 3-5 min.

State the first and second amiodarone doses in refractory VF/pVT.

300 mg IV push after 3rd shock, then 150 mg after 4th shock.

List four reversible causes of PEA/Asystole remembered as the ‘Hs’.

Hypoxia, Hypovolemia, Hypo/Hyper-kalemia (metabolic), Hypothermia (also H+ acidosis).

What ETCO₂ level (

An ETCO₂ persistently <10 mmHg.

Define unstable bradycardia.

Heart rate usually <50 bpm producing hypotension, AMS, shock signs, ischemic chest pain or acute HF.

First-line drug, dose, and max total dose for symptomatic bradycardia.

Atropine 1 mg IV every 3-5 min, max 3 mg.

Give dopamine infusion range for bradycardia unresponsive to atropine.

5-20 µg/kg/min IV.

When should transcutaneous pacing be started in bradycardia?

If drug therapy ineffective or patient severely symptomatic/hemodynamically unstable.

Key question when approaching adult tachycardia (>100 bpm).

Is the patient stable or unstable (signs of poor perfusion)?

First treatment for unstable wide-complex or narrow-complex tachycardia.

Immediate synchronized cardioversion.

Initial adenosine dose for stable regular narrow-complex SVT.

6 mg rapid IV push followed by 20 mL saline flush.

Energy setting for synchronized cardioversion of narrow-regular SVT.

50-100 J (biphasic).

IV amiodarone dose and infusion time for stable monomorphic VT.

150 mg in 100 mL D5W over 10 min (15 mg/min).

What does cricoid pressure do, and is it recommended in adult arrest?

Compresses esophagus to limit regurgitation but impedes ventilation; NOT routinely recommended.

After advanced airway placement during CPR, give the ventilation rate.

1 breath every 6 seconds (10 breaths/min) with continuous compressions.

List two clinical and one waveform method to confirm correct ET-tube placement.

Bilateral chest rise/breath sounds, absence of epigastric sounds; waveform capnography ETCO₂ >30 mmHg.

Maximum chest-compression pause allowed for endotracheal intubation.

Recommended SpO₂ target after ROSC.

92-98 % (avoid both hypoxia and hyperoxia).

Give target blood pressure goals after ROSC.

SBP >90 mmHg or MAP >65 mmHg.

Define targeted temperature management (TTM).

Active control of core temperature 32-36 °C for ≥24 h in comatose post-arrest patients.

How long should you wait before neurologic prognostication after TTM?

≥72 h after return to normothermia.

List the BEFAST mnemonic purpose in post-arrest care.

To quickly identify post-arrest stroke requiring immediate action.

Adult IM epinephrine weight-based dose for children 15-30 kg (anaphylaxis).

0.15 mg IM.

Name the preferred vasoactive drug for septic or cardiogenic shock and its starting dose.

Norepinephrine 0.1-3 µg/kg/min IV infusion titrated to effect.

What beta-blocker is included in ACLS for rate control and give its IV loading dose.

Esmolol 0.5 mg/kg IV over 1 min followed by infusion.

List three contraindications to verapamil in tachyarrhythmia management.

Hypotension, heart failure with reduced EF, or severe ventricular dysfunction.

Drug of choice for torsades de pointes and its dose.

Magnesium sulfate 1-2 g IV over 1-2 min (may repeat).

Which ACLS drug can be given via endotracheal tube and at what dose multiple?

Epinephrine 2-2.5 mg diluted in 5-10 mL NS (2-2.5× IV dose).

Define defibrillation.

Delivery of a high-energy unsynchronized shock to terminate VF or pulseless VT.

Standard biphasic energy for adult defibrillation.

200 J (follow manufacturer’s recommendation).

Why is ‘anticipatory charging’ of the defibrillator used?

Charging during compressions shortens peri-shock pauses (<5 s) to improve outcomes.

Give initial energy doses for synchronized cardioversion of atrial fibrillation.

120-200 J biphasic (200 J monophasic).

Explain ‘capture’ when setting transcutaneous pacing.

Each pacing stimulus produces a ventricular depolarization seen as a QRS complex with associated pulse.

Preferred location to feel for mechanical capture during TCP.

Femoral artery (avoid carotid impulse confusion).

List two relative contraindications to transcutaneous pacing.

Severe hypothermia and asystolic cardiac arrest.

How far should defibrillator pads be placed from a permanent pacemaker?

8 cm, or use alternative pad positions (antero-posterior).

Energy for initial cardioversion of stable monomorphic VT (with pulse).

100 J synchronized shock.

What QRS width defines ‘wide-complex’ tachycardia?

QRS ≥0.12 s (≥3 small squares).

Which ACLS drug increases potassium conductance and is first-line for SVT?

Adenosine.

Dose escalation schedule for adenosine if first dose fails.

6 mg → 12 mg → 12 mg rapid IV pushes each followed by 20 mL flush.

Most common adult out-of-hospital cardiac arrest etiology

Acute coronary syndrome / myocardial ischemia.

When is fibrinolysis preferred over primary PCI in STEMI?

Symptom onset ≤2 h and PCI cannot be achieved within the guideline time; or any delay >120 min from first medical contact to balloon.

List the mnemonic ‘MONA’ in initial ACS treatment.

Morphine (if pain), Oxygen (if SpO₂<90 %), Nitroglycerin, Aspirin 160-325 mg chew.

Give the adult aspirin loading dose for suspected ACS.

162-325 mg chewed (preferably non-enteric-coated).

Which coronary artery is usually implicated in inferior-wall MI?

Right coronary artery.

What ST-segment criteria diagnose STEMI in V2-V3 for men ≥40 yrs?

ST elevation ≥2 mm (0.2 mV) in ≥2 contiguous leads.

Explain why chest hair may require shaving before defibrillation.

Excess hair increases transthoracic impedance, reducing shock effectiveness by up to 35 %.