ACLS — Advanced Cardiovascular Life Support — All Questions

For a patient with a STEMI, the goal for first-medical-contact-to-device time with primary PCI is within:

• a.30 minutes
• b.90 minutes✓
• c.4 hours
• d.12 hours

For STEMI, the reperfusion goal for primary percutaneous coronary intervention (PCI) is a first-medical-contact-to-device time of 90 minutes or less. 'Time is muscle' — the sooner the occluded coronary artery is reopened, the more myocardium is salvaged. When timely PCI is unavailable, fibrinolytic therapy is targeted within 30 minutes of arrival (door-to-needle).

Before a clot-dissolving drug is given for suspected acute ischemic stroke, what must brain imaging do?

• a.Show the carotid arteries
• b.Exclude bleeding in the brain✓
• c.Measure brain temperature
• d.Replace the neurologic exam

Brain scans show what type of stroke has occurred, and CT or MRI identifies bleeding; thrombolytic therapy is for strokes caused by a clot, so hemorrhage must be excluded first.

For an adult who remains unresponsive to commands after ROSC, what temperature control do the 2025 AHA Guidelines recommend?

• a.32–37.5 °C for at least 36 hours✓
• b.38–40 °C for 12 hours
• c.28–30 °C for 72 hours
• d.No temperature management

The 2025 Guidelines recommend maintaining a temperature between 32 °C and 37.5 °C in adults unresponsive to verbal commands after ROSC, and consider 36 hours of total temperature control the shortest recommended duration.

Within what time should a 12-lead ECG be obtained and interpreted for suspected ACS?

• a.10 minutes✓
• b.30 minutes
• c.60 minutes
• d.2 hours

The ACS guideline sets a goal to obtain and interpret an ECG by a trained clinician within 10 minutes of presentation.

What aspirin loading dose does the 2025 ACS guideline recommend?

• a.5 mg
• b.650 to 1000 mg
• c.20 to 40 mg
• d.162 to 325 mg✓

Aspirin is started with a loading dose of 162 to 325 mg as soon as possible, and nonenteric-coated aspirin should be chewed for faster effect.

When is supplemental oxygen indicated in suspected ACS?

• a.For every patient
• b.SpO2 below 90%✓
• c.Never
• d.SpO2 below 99%

Oxygen may benefit patients with saturations below 90%, while routine oxygen shows no benefit at saturations of 90% or more.

Which condition is a reason to avoid nitroglycerin in ACS?

• a.A normal first ECG
• b.A suspected RV infarction✓
• c.A heart rate of 80
• d.A blood pressure of 150/90

The guideline advises avoiding nitroglycerin in suspected RV infarction, SBP below 90 mm Hg or a drop of more than 30 mm Hg below baseline.

What first-contact-to-device goal applies to STEMI patients taken to a PCI-capable hospital?

• a.12 hours or less
• b.90 minutes or less✓
• c.6 hours or less
• d.24 hours or less

The ACS guideline sets a goal of first-medical-contact-to-device time of 90 minutes or less, with 120 minutes as the limit for considering direct transport.

When is fibrinolysis used for STEMI instead of primary PCI?

• a.Only after 24 hours of symptoms
• b.Whenever a patient is over 65
• c.When the ECG is normal
• d.PCI delay over 120 minutes✓

Fibrinolytic therapy is used at non-PCI hospitals when transfer to PCI is anticipated to exceed 120 minutes and symptoms have been present under 12 hours.

A patient with stroke symptoms wakes up with them. What time matters for treatment decisions?

• a.When last known to be well✓
• b.When they reached the hospital
• c.When they woke up
• d.When the scan was read

Onset time guides treatment; for someone who woke with symptoms, eligibility depends on how long before waking the symptoms could have begun, so the last-known-well time matters.

A patient's brain CT for sudden weakness shows bleeding in the brain. What does this mean for clot-dissolving treatment?

• a.Imaging results do not affect it
• b.It is for clot-caused strokes, not bleeds✓
• c.Give it at half dose
• d.Give it faster because time is short

Thrombolytic therapy is given when a stroke is caused by a blood clot; brain imaging determines the type of stroke and shows bleeding, which is a hemorrhagic stroke.

What is the minimum MAP target after ROSC in adults?

• a.120 mm Hg
• b.45 mm Hg
• c.65 mm Hg✓
• d.100 mm Hg

Hypotension should be avoided after ROSC by maintaining a MAP of at least 65 mm Hg; the previous systolic target was removed.

What temperature range is recommended for adults who remain unresponsive to commands after ROSC?

• a.32–37.5 °C✓
• b.No range is recommended
• c.28–30 °C
• d.38–40 °C

Maintaining a temperature between 32 °C and 37.5 °C is recommended for adults unresponsive to verbal commands after ROSC, for at least 36 hours.

What is the shortest recommended total duration of temperature control after ROSC?

• a.36 hours✓
• b.12 hours
• c.6 hours
• d.7 days

The 2025 Guidelines consider 36 hours of total temperature control the shortest recommended duration.

After ROSC, what oxygen saturation range reflects the key trials?

• a.80% to 85%
• b.90% to 98%✓
• c.99% to 100% only
• d.70% to 80%

An SpO2 target of 90% to 98% (PaO2 60–105 mm Hg) reflects the ranges studied in key randomized trials after ROSC.

A comatose post-arrest patient has jerking movements. What test is recommended?

• a.Lumbar puncture
• b.Bone scan
• c.Chest X-ray
• d.EEG✓

After ROSC, promptly performing and interpreting an EEG is recommended to diagnose seizures in adults with myoclonus.

What PaCO2 range defines normocapnia in the post-arrest trial cited by the 2025 Guidelines?

• a.35–45 mm Hg✓
• b.60–70 mm Hg
• c.20–25 mm Hg
• d.10–15 mm Hg

The TAME trial compared normocapnia (PaCO2 35–45 mm Hg) with mild hypercapnia and found no difference in neurologic outcome.

After ROSC with STEMI on the ECG, what is recommended?

• a.Early coronary angiography and PCI✓
• b.No angiography after arrest
• c.Wait 7 days before angiography
• d.Angiography only if troponin doubles

Observational studies show improved neurologically favorable survival with early angiography and PCI in arrest patients with STEMI, matching recommendations for all STEMI.