Ch. 39 - Responding to the Field Code

You are providing care for a 59 y/o male patient in cardiac arrest. The success of your resuscitation efforts is dependent primarily on:
A) the early arrival of ALS
B) effective ventilation and advanced airway management
C) high-quality, uninterrupted CPR
D) rapid transport to the hospital
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You are providing care for a 59 y/o male patient in cardiac arrest. The success of your resuscitation efforts is dependent primarily on:
A) the early arrival of ALS
B) effective ventilation and advanced airway management
C) high-quality, uninterrupted CPR
D) rapid transport to the hospital
C) high-quality, uninterrupted CPR
The majority of all out-of-hospital cardiac arrests occur in public places.
A) true
B) false
B) false
High-quality CPR should feature all of the following EXCEPT:
A) compression rate between 100-120/min
B) compression depth between 2-3 inches
C) full chest recoil
D) minimal interruptions
B) compression depth between 2-3 inches
You are providing care for a 5 y/o patient who was found in cardiac arrest. Pulse checks for this patient should be:
A) apical site
B) brachial artery
C) carotid or femoral artery
D) radial artery
C) carotid or femoral artery
You are providing care to a 62 y/o male found in cardiac arrest in his residence. The scene is safe. Based on this information, your first action should be to:
A) attach your defibrillator and analyze the rhythm
B) perform more assessment to determine the cause of the cardiac arrest
C) perform 2 minutes of CPR
D) perform CPR only long enough to attach the defibrillator
C) perform 2 minutes of CPR
You are providing care for a 49 y/o female in cardiac arrest. The monitor shows a sinus tachycardia at a rate of 112 bpm, but there is no pulse. High-quality CPR is in progress. Based on this information, the priority of management should be to:
A) continue CPR and transport the patient
B) consider potential causes and manage them appropriately
C) focus on effective airway management and intubate the patient
D) administer the appropriate drug therapy
B) consider potential causes and manage them appropriately
In the case of VF or pulseless VT, antidysrhythmic drugs are often given in combination to ensure effective dosing.
A) true
B) false
B) false
A device that is designed to enhance chest compressions by creating a vacuum in the chest that allows for more blood to flow to the heart and brain is known as a(n):
A) load distributing band CPR device
B) mechanical chest compression device
C) mechanical piston device
D) impedance threshold device
D) impedance threshold device
A field code runs MOST efficiently when:
A) the AED replaces manual defibrillation
B) a designated team leader is assigned
C) tracheal intubation is performed early
D) at least 5 paramedics are participating
B) a designated team leader is assigned
Which of the following interventions is emphasized the MOST in all AHA guidelines for emergency cardiac care since 2005?
A) defibrillation
B) chest compressions
C) artificial ventilation
D) tracheal intubation
B) chest compressions
In addition to high-quality CPR, which of the following interventions has clearly a positive and measurable difference in survival from sudden cardiac arrest? A) defibrillation B) IV fluid boluses C) epinephrine therapy D) tracheal intubationA) defibrillationAfter determining that an unresponsive adult is not breathing, you should: A) give two rescue breaths that make the chest visibly rise B) assess for a carotid pulse for no longer than 10 seconds C) reposition the patient's airway and reassess for breathing D) perform a finger sweep of the mouth to remove any debrisB) assess for a carotid pulse for no longer than 10 secondsYour partner returns with the AED as you are performing CPR on a 5 y/o child. As he opens the AED, he tells you there are no pediatric pads, only adult pads. You should: A) instruct him to apply the adult pads as you continue one-rescuer CPR B) tell him to resume one-rescuer CPR as you try to locate pediatric pads C) use the adult AED pads, but only provide a total of two defibrillations D) continue two-rescuer CPR until a manual defibrillator is availableA) instruct him to apply the adult pads as you continue one-rescuer CPRYou and your team are attempting to resuscitate a 45 y/o male who is in cardiac arrest. After 2 minutes, you assess his cardiac rhythm and determine that he is in asystole. After instructing your team to resume CPR, you should: A) insert an advanced airway device and then resume CPR B) establish IV or IO access and administer 1 mg atropine rapidly C) administer 1 mg of epinephrine 1:10000 after obtaining vascular access D) perform ET intubation and ventilate at a rate of 15/minC) administer 1 mg of epinephrine 1:10000 after obtaining vascular accessWhat is the current recommendation for the use of epinephrine for patients with VF or pVT? A) epinephrine is not recommended for this subset of patients B) higher doses of epinephrine should be used for these patients C) epinephrine should not be given in the first 10 minutes D) epinephrine should be administered after the second shockD) epinephrine should be administered after the second shockWhich of the following should occur when integrating a mechanical CPR device into your resuscitation attempt of an adult patient? A) compression depth should be at least 1.5 inches after the device is applied B) compressions should be continuous after an advanced airway is inserted C) the compression rate should be set to deliver at least 80 compressions per minute D) one breath should be given every 6 seconds until an advanced airway is insertedB) compressions should be continuous after an advanced airway is insertedThe paramedic should consider extending the resuscitation effort of a patient with refractory cardiac arrest if: A) the cardiac arrest was caused by submersion in warm water B) v-fib occurred at any time during the arrest C) the patient has no known significant past medical history D) ROSC of any duration occurredD) ROSC of any duration occurredDuring an attempted resuscitation, a compression fraction of at least ____ percent is recommended. A) 50 B) 60 C) 70 D) 80B) 60What is the correct depth of compressions for a 5 y/o child? A) 2-2.4 inches B) one-third the anterior/posterior diameter of the chest C) one-half the diameter of the chest D) 1-1.5 inchesB) one-third the anterior/posterior diameter of the chestWhich of the following are criteria for stopping CPR in the field? A) the patient achieves ROSC B) the patient is transferred to a healthcare provider with equal or more advanced training C) the arrest was not witnessed D) the rescuer can no longer physically perform CPRA, B, and DYou are treating a patient in cardiac arrest and you see VF after the initial shock. Which drug dose should you administer first? A) amiodarone 300 mg B) atropine 1 mg C) epinephrine 1 mg D) vasopressin 20 UC) epinephrine 1 mgThe patient was just defibrillated. What is the next step? A) administer 1 mg of epinephrine B) administer a 10 mL/kg fluid bolus C) prepare for a second shock D) begin chest compressionsD) begin chest compressionsWhich of the following interventions is NOT appropriate for the patient in asystole or PEA? A) high-quality CPR B) defibrillation C) consideration of possible reversible causes D) administration of a vasopressorB) defibrillationWhat is the goal SBP in post-resuscitative care? A) 100 mmHg B) 120 mmHg C) 80 mmHg D) 90 mmHgA) 100 mmHgWhat is the focus when delivering CPR to an infant or child? A) foreign body obstruction B) airway and breathing C) circulation D) compressionsB) airway and breathingWhat is the first step in treating a patient presenting with asystole? A) begin chest compressions B) confirm it is asystole C) begin ventilations D) gain IV/IO accessA) begin chest compressionsWhich of the following patients should you NOT defibrillate? A) a patient submerged in water B) an infant C) a patient with a hairy chest D) a patient with an implanted pacemakerA) a patient submerged in waterWhich of the following is correct regarding chest compressions? A) never pause more than 30 seconds unless the AED is analyzing the rhythm B) never pause more than 30 seconds even if the AED is analyzing the rhythm C) never delay compressions for more than 10 seconds D) never delay compressions for more than 20 secondsC) never delay compressions for more than 10 secondsFor which patient should you use magnesium sulfate in cardiac arrest? A) VT with a normal QT interval B) VF refractory to shock C) VF or pulseless VT associated with torsades de pointes D) shock-refractory monomorphic VTC) VF or pulseless VT associated with torsades de pointesEpinephrine is primarily administered during cardiac arrest because its ____ effects cause _____. A) vasodilatory; a reduction in cardiac afterload B) beta-2 agonist; dilation of the bronchioles C) antidysrhythmic; decreased cardiac irritability D) vasoconstrictive; enhanced coronary blood flowD) vasoconstrictive; enhanced coronary blood flowA 6 y/o, 40 lb child remains in VF after an initial defibrillation and 2 minutes of CPR. Vascular access has not been obtained. Your next action should be to: A) insert an advanced airway B) defibrillate with 70 J C) insert an IO catheter D) check for a carotid pulseB) defibrillate with 70 JYou have just defibrillated an adult woman who is in pulseless VT. After performing CPR for 2 minutes, you assess her cardiac rhythm and determine that she is experiencing torsades de pointes; she also remains pulseless. It has been approximately 2 minutes since you administered the last dose of epinephrine. You should next: A) begin a lidocaine infusion at 2 mg/min B) push the synchronize button on the defibrillator and cardiovert with 200 J C) give 1-2 g of magnesium sulfate without interrupting chest compressions D) give 300 mg of amiodarone via rapid IV or IO pushC) give 1-2 g of magnesium sulfate without interrupting chest compressionsYou and your partner are performing CPR on a 60 y/o woman who was initially in asystole. After 2 minutes, you look at the cardiac monitor and determine that she is in VF. Your next action should be to: A) check her cardiac rhythm in two contiguous leads to confirm that she is in VF B) quickly assess for a carotid or femoral pulse and then deliver a single shock with 200 J C) continue CPR, establish vascular access, and administer 300 mg of amiodarone or 1.5 mg/kg of lidocaine D) deliver a single shock and instruct your partner to resume chest compressions while you resume ventilationsD) deliver a single shock and instruct your partner to resume chest compressions while you resume ventilationsA non-traumatic arrest patient who has not responded to a successfully executed prehospital ACLS resuscitation effort: A) should receive higher doses of epinephrine B) should be transported to the hospital for further care C) should have additional BLS treatment for 10 more minutes D) should likely not be transported to the hospitalD) should likely not be transported to the hospitalYour team is attempting resuscitation of a man in cardiac arrest. One of the team members intubates the patient and confirms proper placement of the ET tube. Your MOST appropriate next action should be to: A) administer 2.5 mg of epinephrine 1:10000 via the ET tube without interrupting compressions B) defibrillate the patient with the maximum energy setting, reassess for a pulse, and continue CPR if he remains pulseless C) instruct the person ventilating to provide one breath every 6 seconds while chest compressions are continuous D) presume that the patient is in severe metabolic acidosis and hyperventilate him for at least 2-3 minutesC) instruct the person ventilating to provide one breath every 6 seconds while chest compressions are continuousYou have an impedance threshold device attached to the ET tube as you ventilate an apneic and pulseless patient. Following defibrillation and 2 additional minutes of CPR, it is determined that ROSC has occurred. However, the patient is still apneic. You should: A) hyperventilate the patient to eliminate excess CO2 from the blood B) leave the ITD attached but increase your ventilation rate to 15/min C) leave the ITD attached and continue to ventilate D) remove the ITD and continue ventilations at a rate of 10-12/minD) remove the ITD and continue ventilations at a rate of 10-12/minA patient remains in pulseless VT despite two shocks, a dose of epinephrine, high-quality CPR, and 300 mg of amiodarone. Following the next shock, you should resume CPR and then: A) cardiovert with 100 J B) double the dose of the epinephrine C) administer 150 mg amiodarone D) administer 1.5 mg/kg of lidocaineC) administer 150 mg amiodaroneAfter approximately 6 minutes of attempted resuscitation, your patient experiences ROSC. He remains unresponsive and apneic, and the cardiac monitor reveals sinus bradycardia at a rate of 30 bpm. What should be done next in addition to continuing ventilations? A) lidocaine bolus B) amiodarone infusion C) crystalloid fluid bolus D) TCPD) TCPAnterior-posterior placement of the defibrillation pads should be used if the patient is younger than ____ years of age or less than ____ kg. A) 5; 30 B) 4; 20 C) 3; 15 D) 1; 10D) 1; 10How does CPR change after an advanced airway device is inserted? A) ventilations should be asynchronous with compressions B) one breath should be delivered every 10-12 seconds C) ventilations should be faster after the device is inserted D) cycles of 30 compressions and 2 breaths should be deliveredA) ventilations should be asynchronous with compressionsPrior to defibrillating a patient who is in pulseless VT, you should: A) ensure that the patient is not touching any metal B) ensure that the synchronize button has been pushed C) check for a palpable central pulse for 5-10 seconds D) ensure that the patient's body is totally dryA) ensure that the patient is not touching any metalWhen using an ITD, it is important to: A) hyperinflate the lungs to improve coronary perfusion B) increase the ventilation rate by 6-8/min C) allow partial chest recoil in between compressions D) deliver each ventilation over a period of 1 secondD) deliver each ventilation over a period of 1 secondYou and your partner arrive at the scene of an unresponsive middle-aged man. Your primary assessment reveals that he is apneic and pulseless. Which of the following interventions will provide the BEST chance of survival for this patient? A) immediate defibrillation for presumed VF B) CPR at the appropriate rate and with minimal interruptions C) prompt insertion of an advanced airway device to prevent aspiration D) five minutes of CPR prior to analyzing his cardiac rhythmB) CPR at the appropriate rate and with minimal interruptionsDefibrillation of a patient who is in asystole is detrimental to the patient because it: A) has been shown to render epinephrine ineffective B) causes an unnecessary interruption in chest compressions C) stops the cardiac cells from spontaneously depolarizing D) makes ruling out underlying causes impossibleB) causes an unnecessary interruption in chest compressionsThe chance for ROSC is BEST when: A) an antidysrhythmic drug is used if VF is present B) timely chest compressions are performed with little to no interruption C) a vasopressor is administered every 3-5 minutes during CPR D) an advanced airway device is inserted during a resuscitation attemptB) timely chest compressions are performed with little to no interruptionITDs function by: A) facilitating vasoconstriction, which maintains coronary perfusion pressure B) creating a vacuum in the chest, which increases blood flow to the heart C) dilating the coronary arteries, which reduces cardiac afterload D) increasing intrathoracic pressure, which reduces blood return to the heartB) creating a vacuum in the chest, which increases blood flow to the heartYou have been attempting resuscitation of an 80 y/o woman for approximately 15 minutes. An advanced airway has bene placed, ventilations have been delivered at the appropriate rate, high-quality CPR was performed with minimal interruptions, and rhythm-specific medications were administered. Despite your efforts, the patient remains in asystole. Which of the following statements regarding this scenario is correct? A) since older people are prone to hypothermia, and hypothermia protects the hypoxic brain, you should continue your efforts for 5 more minutes B) TCP may restore a perfusing rhythm and should be attempted immediately C) you have clearly performed all the appropriate interventions and termination of resuscitative efforts should be strongly considered D) it would be advisable to attempt a single defibrillation in case the patient was actually in fine VFC) you have clearly performed all the appropriate interventions and termination of resuscitative efforts should be strongly consideredYou and your partner are off duty and are playing golf. Suddenly, you see an elderly man grab his chest and collapse. You should: A) tell your partner to call 911 and proceed to assess the man B) tell the man's golf buddy to perform a precordial thump C) both proceed to the man and begin two-rescuer CPR if needed D) perform 2 minutes of CPR if needed and then call an ambulanceA) tell your partner to call 911 and proceed to assess the manYou are the team leader in the attempted resuscitation of an adult man in VF. An advanced airway device has been inserted and vascular access has been obtained. As you observe the actions of your team members, you should ensure that: A) the person managing the airway delivers one breath every 3-5 seconds B) compressions are hard and fast, with full chest recoil between compressions C) no one person performs chest compressions for more than 5 minute at a time D) the patient is defibrillated once every 60 seconds as necessaryB) compressions are hard and fast, with full chest recoil between compressionsIf a cardiac arrest patient's airway is maintained with an oral airway, and ventilation with a BVM is producing adequate chest rise, then: A) there should be no pause in chest compressions to deliver a breath B) the paramedic should deliver one breath every 5-6 seconds C) insertion of an advanced airway device is not a high priority D) a King LT or Combitube is preferred over tracheal intubationC) insertion of an advanced airway device is not a high priorityWhich of the following roles would the code team leader MOST likely perform? A) chest compressions B) airway management C) interpreting the ECG D) establishing IV accessC) interpreting the ECGAs you are administering epinephrine to an adult woman in VF, your team members continue CPR. After 2 minutes, you assess her and determine that she is still in VF. You should: A) administer 300 mg of amiodarone while CPR remains uninterrupted B) deliver monophasic defibrillation with 200 J and resume CPR C) advise your team to stop CPR and prepare to deliver another shock D) instruct your team to continue CPR as the defibrillator is chargingD) instruct your team to continue CPR as the defibrillator is chargingYour assessment of a 68 y/o woman reveals an organized cardiac rhythm at a rate of 80 bpm with no carotid pulse. Treatment for this patient may include all of the following EXCEPT: A) tracheal intubation B) cardiac pacing C) IV fluid boluses D) epinephrineB) cardiac pacingAccording to the flat management hierarchy: A) closed-loop communication should be used at all times B) everyone has a responsibility to speak up about safety issues C) everyone should be quiet during a critical procedure D) team members should not question the team leaderB) everyone has a responsibility to speak up about safety issues