ACLS — Advanced Cardiovascular Life Support — All Questions
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A patient collapses in witnessed VF arrest and a defibrillator is immediately available. The highest priority is to:
- a.Establish IV access and give epinephrine first
- b.Intubate the patient before anything else
- c.Deliver a defibrillation shock as soon as possible and then resume compressions✓
- d.Give amiodarone 300 mg before defibrillating
For VF/pVT, the single most important intervention is early defibrillation combined with high-quality CPR. When a defibrillator is at hand for a witnessed arrest, shock as soon as it is ready, then immediately resume compressions. Drugs and advanced airway are secondary and should not delay the first shock, because the chance of successful defibrillation falls with each passing minute in VF.
The monitor shows an organized rhythm but the patient has no pulse (PEA). Management includes:
- a.Immediate defibrillation
- b.High-quality CPR, epinephrine, and a search for reversible causes (H's and T's)✓
- c.Synchronized cardioversion
- d.Adenosine 6 mg rapid IV push
Pulseless electrical activity is non-shockable. The key to survival is identifying and correcting the underlying cause while giving high-quality CPR and epinephrine 1 mg every 3-5 minutes. The reversible causes are the H's (hypovolemia, hypoxia, hydrogen ion/acidosis, hypo-/hyperkalemia, hypothermia) and T's (tension pneumothorax, tamponade, toxins, thrombosis-pulmonary, thrombosis-coronary).
Immediately after delivering a defibrillation shock, the team should:
- a.Check a pulse for 30 seconds
- b.Resume chest compressions immediately and continue CPR for about 2 minutes✓
- c.Reanalyze the rhythm right away before touching the patient
- d.Deliver two rescue breaths before compressions
After a shock, resume compressions immediately without a pulse or rhythm check, and continue CPR for about 2 minutes before the next rhythm analysis. Even when a shock is successful, an organized rhythm and a palpable pulse often take time to appear, and pausing to check wastes critical perfusion time. Minimizing the post-shock pause is a cornerstone of high-quality resuscitation.