ACLS — Advanced Cardiovascular Life Support — All Questions
17 questions
Once an advanced airway (e.g., endotracheal tube) is in place during cardiac arrest, how should ventilations be delivered?
- a.Pause compressions and give 30:2 cycles
- b.1 breath every 3 seconds with pauses
- c.10 per minute, compressions continuing✓
- d.20 per minute synchronized to compressions
With an advanced airway, compressions continue without pausing for breaths, and ventilations are given at about 10 per minute (1 every 6 seconds); no faster rate has been shown superior, and excessive ventilation lowers cardiac output.
What is the most reliable method to confirm and continuously monitor correct endotracheal tube placement during CPR?
- a.Auscultation alone
- b.A chest x-ray after the code
- c.Pulse oximetry readings
- d.Waveform capnography✓
In the studies cited by the 2025 AHA Guidelines, waveform capnography was 100% specific for confirming endotracheal tube position during cardiac arrest; auscultation and oximetry are less reliable, and an x-ray after the code is too late.
During bag-mask ventilation, delivering breaths too rapidly and forcefully is harmful mainly because it:
- a.Reduces cardiac output✓
- b.Cools the patient too quickly
- c.Improves oxygenation beyond need
- d.Has no measurable effect
The 2025 AHA Guidelines state that excessive ventilation can cause gastric inflation, regurgitation, aspiration and decreased cardiac output; each breath should only produce visible chest rise.
A paramedic intubates a patient in cardiac arrest a few minutes after collapse. Which finding best confirms the tube is in the trachea?
- a.Equal pupils
- b.Fogging inside the tube
- c.A capnography waveform✓
- d.The patient's color improving at once
Waveform capnography was 100% specific for confirming endotracheal tube position during cardiac arrest in the studies cited; tube fogging and color change are unreliable signs.
A team is choosing between a supraglottic airway and intubation during out-of-hospital arrest. What does the evidence show?
- a.No clear winner for survival✓
- b.Neither may be used during CPR
- c.Intubation always improves survival
- d.Supraglottic airways are harmful
Trials comparing supraglottic airways and intubation gave mixed results, and a systematic review found no clear survival benefit for either.
What should guide the choice of advanced airway during cardiac arrest?
- a.The patient's age alone
- b.Whatever the nearest device is
- c.Rescuer skill and setting✓
- d.The time since the last meal
The Guidelines stress that the use, type and timing of an advanced airway depend on patient and professional characteristics, especially airway skill and experience.
In VF arrest, when should an advanced airway be placed?
- a.Without delaying CPR and shocks✓
- b.Only after 30 minutes
- c.Before the first shock
- d.Before any compressions
In shockable rhythms, CPR and defibrillation must take priority, so an advanced airway is weighed against maintaining a high compression fraction.
What basic airway strategy does resuscitation usually start with?
- a.Bag-mask ventilation✓
- b.Supraglottic airway only
- c.Surgical airway
- d.Intubation before CPR
Airway management during cardiac arrest usually begins with bag-mask ventilation, with an advanced airway added according to skill and setting.
Minutes into a cardiac arrest, a newly placed endotracheal tube shows no capnography waveform. What is the most likely explanation?
- a.This is expected during CPR
- b.Compressions are too deep
- c.The tube may be misplaced✓
- d.ROSC has occurred
Waveform capnography is highly specific for confirming tube position; the absence of a waveform suggests the tube is not in the trachea, although sensitivity falls after prolonged arrest.
Why do the Guidelines emphasize frequent retraining for intubation?
- a.Tube designs change every year
- b.It shortens the arrest
- c.Skills fade without practice✓
- d.It replaces capnography
Frequent retraining is important to maintain psychomotor airway skills, and systems are encouraged to track intubation success rates.
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What ventilation rate is used after an advanced airway is placed in an adult during CPR?
- a.About 4 per minute
- b.2 after every 30 compressions
- c.About 30 per minute
- d.About 10 per minute✓
Evidence reviews found no rate superior to 10 breaths per minute after advanced airway placement, and that rate is retained.
An unconscious trauma patient has suspected basilar skull fracture. Which adjunct avoids risk of intracranial placement?
- a.Nasal cannula
- b.Oropharyngeal airway✓
- c.Nasogastric tube
- d.Nasopharyngeal airway
An oropharyngeal airway reduces the risk of intracranial passage that has occurred with nasopharyngeal airways in basilar skull fracture.
A team suggests cricoid pressure during bag-mask ventilation in cardiac arrest. What does the evidence show?
- a.It is required during CPR
- b.It improves ventilation volumes
- c.It prevents all aspiration
- d.It has not been shown to help✓
There is no evidence that cricoid pressure facilitates ventilation or reduces aspiration during cardiac arrest, and it may impede advanced airway placement.
What oxygen concentration is supported during adult CPR?
- a.Maximal available oxygen✓
- b.No oxygen until ROSC
- c.30% to avoid toxicity
- d.Room air only
BLS guidelines support maximal available oxygen during CPR, and higher intra-arrest oxygen levels have been associated with survival in retrospective studies.
During a nonshockable arrest with good CPR and epinephrine already given, when is early airway management reasonable?
- a.Never in nonshockable arrest
- b.Only after 30 minutes
- c.Before any epinephrine
- d.Once CPR and drugs are optimized✓
In nonshockable arrest, early airway management is possible in resuscitations where CPR performance and epinephrine have already been optimized.
In an intubated patient, what ETCO2 change during CPR may suggest ROSC?
- a.A sudden jump over 10 mm Hg✓
- b.A steady fall to below 5 mm Hg
- c.No change at all
- d.A value that stays at 12 mm Hg
Data suggest a sudden ETCO2 increase greater than 10 mm Hg may indicate ROSC, confirmed at a rhythm and pulse check.
Which factor, besides ROSC, can raise ETCO2 during CPR?
- a.A slower compression rate
- b.A dislodged tube
- c.Sodium bicarbonate✓
- d.Leaning on the chest
ETCO2 can be influenced by minute ventilation, CPR quality, and administration of epinephrine or sodium bicarbonate, so values are interpreted in context.