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).

For a suspected acute ischemic stroke, the first critical imaging step to determine fibrinolytic eligibility is:

• a.MRI of the brain with contrast
• b.A noncontrast CT of the head to exclude hemorrhage✓
• c.Carotid ultrasound
• d.A chest x-ray

An emergent noncontrast head CT is obtained to rule out intracranial hemorrhage before any fibrinolytic is considered, because giving a clot-dissolving drug to a bleeding stroke is catastrophic. Alongside imaging, establishing the last-known-well time defines the treatment window. Rapid door-to-CT and door-to-treatment times are central to the AHA stroke chain of survival.

In a comatose patient after return of spontaneous circulation (ROSC), targeted temperature management involves maintaining a constant temperature between:

• a.32°C and 36°C (89.6°F to 96.8°F)✓
• b.38°C and 40°C (100.4°F to 104°F)
• c.28°C and 30°C (82.4°F to 86°F)
• d.An uncontrolled room temperature

For adults who remain comatose after ROSC, targeted temperature management (TTM) selects and maintains a constant target between 32°C and 36°C for at least 24 hours. Controlling temperature and preventing fever helps protect the brain from secondary injury. Post-arrest care also includes optimizing oxygenation and blood pressure and treating the precipitating cause (e.g., emergent PCI for a coronary occlusion).