ACLS Exam | American Heart Association Standards Aligned | 2026/2027 Update | Questions and Correct Answers | 100% correct solutions

1 /4 ACLS Exam | American Heart Association Standards Aligned | 2026/2027 Update | Questions and Correct Answers | 100% correct solutions Rate of chest compressions for adults 100-120 compressions per minute Ratio of compressions to breaths in adults 30:2 Rate of bag valve mask ventilation for adults in respiratory arrest Once every 5-6 seconds or 10-12 times per minute Treatments for hypotension following cardiac arrest IV dopamine infusion, IV epinephrine infusion IV Ringer's lactate, IV normal saline The leader in team resuscitation must be able to perform all the skills if needed. Recommended ED door-to-balloon inflation time for a STEMI patient No longer than 90 minutes Ways to estimate effectiveness of CPR Arterial diastolic blood pressure, quantitative waveform capnography, central venous oxygen saturation Best drug used for narrow complex supraventricular tachycardia Adenosine Drug used for pulseless electrical activity Epinephrine Sequence of basic life support Compressions, airway, breathing (CAB) Initial dose of adenosine for treatment of supraventricular tachycardia 6 mg IV Heart rate at which tachycardia usually becomes symptomatic 150 bpm Longest duration for pulse check 10 seconds Recommended initial dosage of atropine for symptomatic bradycardia 0.5 mg IV Recommended dose of oxygen during CPR 100% Goal for initiation of fibrinolytic therapy in stroke patients Within 1 hour of ED arrival 2 /4 Common reversible causes of cardiac arrest ("H's and T's") Hypotension, hypoxia, hypothermia, hydrogen ions (acidosis), hypo /hyperkalemia Tension pneumothorax, tamponade, thrombosis (coronary), thrombosis (pulmonary), toxins Best option for treatment of STEMI diagnosed in ambulance via 12-lead ECG Transport to PCI-capable hospital Components of Cincinnati Prehospital Stroke Scale (CPSS) Facial droop, arm drift, speech abnormality Asystole should be treated with all of the following Asystole should be treated with all of the following EXCEPT: EXCEPT: CPR CPR Ventilations Ventilations Defibrillation Defibrillation Epinephrine Epinephrine Appropriate response to an AED that is having problems analyzing rhythm Continue chest compressions Which of the following is treated with synchronized Which of the following is treated with synchronized shocks? shocks? Unstable atrial fibrillation Unstable atrial fibrillation Sinus tachycardia Sinus tachycardia VT without a pulse VT without a pulse VF VF Dose for procainamide 20-50 mg/min Drug that should be given to all acute coronary syndrome (ACS) patients Aspirin Concentration of maintenance amiodarone drip 900 mg amiodarone in 500 mL D5W (1.8 mg/mL) EMS dispatchers who recognize ACS symptoms should instruct patients to: Take aspirin Longest acceptable delay in chest compressions 10 seconds Persistent hypotension in a patient paced at an adjusted rate of 75/minute Other underlying cause for hypotension Effective resuscitation requires an integrated response known as: A system of care Intervention that may be helpful in cardiac arrest patient with hypokalemia Magnesium sulfate Appropriate tidal volume with bag valve mask ventilation 600 mL Goal for PCI after arrival to hospital 90 minutes Most common cause of upper airway obstruction in unconscious patient Loss of tone in throat muscles 3 /4 ABCD of BLS primary survey Airway, breathing, circulation, defibrillation ABCD of ACLS secondary survey Airway, breathing, circulation, differential diagnosis Risks associated with hyperventilation Increased intrathoracic pressure, leading to decreased venous return/cardiac output Target oxygen saturation 90% Most commonly used method for providing positive- pressure ventilation Bag-mask ventilation A rigid catheter type is more effective than a soft catheter type when suctioning the oropharynx. Energy setting for monophasic defibrillator 360 J Two most easily reversible causes of PEA Hypoxia and hypoglycemia Cardiac arrest rhythm associated with no discernible electrical activity on ECG Asystole Which of the following is not a recommended agent to be Which of the following is not a recommended agent to be administered to patients administered to patients under evaluation for ACS? under evaluation for ACS? Morphine Morphine Epinephrine Epinephrine Aspirin Aspirin Nitroglycerin Nitroglycerin Standard treatment procedure for patients with STEMI Reperfusion therapy Rhythm disorder with a heart rate less than 60 bpm Bradycardia Which of the following is an adverse sign of bradycardia? Which of the following is an adverse sign of bradycardia? Congestive heart failure Congestive heart failure Hypertension Hypertension Chest pain Chest pain Impaired speech Impaired speech Indications for transcutaneous pacing (TCP) Standby pacing, bradycardia with escape rhythms, hemodynamically significant bradyarrhythmia Rhythm disorder with a heart rate greater than 100 bpm Tachyarrythmia Which of the following is a recommended agent to be Which of the following is a recommended agent to be administered to patients administered to patients under evaluation for unstable under evaluation for unstable tachycardia? tachycardia? No agents are recommended No agents are recommended Morphine Morphine Oxygen Oxygen Aspirin Aspirin Symptoms of unstable tachycardia Shortness of breath, altered mental status, fatigue 4 /4 8 D's of stroke care Detection, dispatch, delivery, door, data, decision, drug/device, disposition Percentage of strokes that are caused by occlusion of an artery to a region of brain (ischemic) 85% Warning signs and symptoms of stroke Trouble speaking, dizziness, sudden severe headache, sudden confusion Treatment for bradycardia due to acetylcholine Atropine Adverse effects of excess use of sodium bicarbonate Hyperosmolarity, hypernatremia, cerebral vasoconstriction during CPR Thrombolytic door-to-drug administration time in a patient Within 30 minutes with acute MI Primary goal in initial resuscitation of a cardiac arrest Brain perfusion 1 /8 You find an unresponsive pt. who is not breathing. After Start chest compressions of at least 100 per min. activating the emergency response system, you determine there is no pulse. What is your next action? You are evaluating a 58-year-old man with chest pain. The Obtaining a 12 lead ECG. blood pressure is 92/50 mm Hg, the heart rate is 92/min, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry reading is 97%. What assessment step is most important now? What is the preferred method of access for epi Peripheral IV administration during cardiac arrest in most pts? An AED does not promptly analyze a rythm. What is your Begin chest compressions. next step? You have completed 2 minutes of CPR. The ECG monitor Administer 1mg of epinephrine displays the lead II rhythm below, and the patient has no pulse. Another member of your team resumes chest compressions, and an IV is in place. What management step is your next priority? During a pause in CPR, you see this lead II ECG rhythm Resume compressions on the monitor. The patient has no pulse. What is the next action? What is a common but sometimes fatal mistake in cardiac Prolonged interruptions in chest compressions. arrest management? Which action is a componant of high-quality chest Allowing complete chest recoil comressions? Which action increases the chance of successful Providing quality compressions immediately before a defibrillation attempt. conversion of ventricular fibrillation? Which situation BEST describes pulseless electrical Sinus rythm without a pulse activity? What is the BEST strategy for performing high-quality CPR Provide continuous chest compressions without pauses and 10 ventilations per on a patient with an advanced airway in place? minute. Three minutes after witnessing a cardiac arrest, one Chest compressions may not be effective. member of your team inserts an endotracheal tube while another performs continuous chest compressions. During subsequent ventilation, you notice the presence of a waveform on the capnography screen and a PETCO2 level of 8 mm Hg. What is the significance of this finding? The use of quantitative capnography in intubated patients allows for monitoring of CPR quality. For the past 25 minutes, an EMS crew has attempted Consider terminating resuscitive efforts after consulting medical control. resuscitation of a patient who originally presented in ventricular fibrillation. After the first shock, the ECG screen displayed asystole, which has persisted despite 2 doses of epinephrine, a fluid bolus, and high-quality CPR. What is your next treatment? Which is a safe and effective practice within the Be sure oxygen is not blowing over the patient's chest during the shock. defibrillation sequence? During your assessment, your patient suddenly loses Begin chest compressions. consciousness. After calling for help and determining that the patient is not breathing, you are unsure whether the patient has a pulse. What is your next action? What is an advantage of using hands-free defibrillation Hands-free pads allow for a more rapid defibrillation. pads instead of defibrillation paddles? 2 /8 What action is recommended to help minimize Continue CPR while charging the defibrillator. interruptions in chest compressions during CPR? Which action is included in the BLS survey? Early defibrillation Which drug and dose are recommended for the Amioderone 300mg management of a patient in refractory ventricular fibrillation? What is the appropriate interval for an interruption in chest 10 seconds or less compressions? Which of the following is a sign of effective CPR? PETCO2 ≥10 mm Hg What is the primary purpose of a medical emergency team Identifying and treating early clinical deterioration. (MET) or rapid response team (RRT)? Which action improves the quality of chest compressions Switch providers about every 2 minutes or every 5 compression cycles. delivered during a resuscitation attempt? What is the appropriate ventilation strategy for an adult in 1 breath every 5-6 seconds respiratory arrest with a pulse rate of 80/min? A patient presents to the emergency department with new Atropine 0.5mg onset of dizziness and fatigue. On examination, the patient's heart rate is 35/min, the blood pressure is 70/50 mm Hg, the respiratory rate is 22 breaths/min, and the oxygen saturation is 95%. What is the appropriate first medication? A patient with dizziness and shortness of breath with a 2 to 10 mcg/kg per minute sinus bradycardia of 40/min. The initial atropine dose was ineffective, and your monitor/defibrillator is not equipped with a transcutaneous pacemaker. What is the appropriate dose of dopamine for this patient? A patient has sudden onset of dizziness. The patient's Vagal manuever. heart rate is 180/min, blood pressure is 110/70 mm Hg, respiratory rate is 18 breaths/min, and pulse oximetry reading is 98% on room air. The lead II ECG is shown below: A monitored patient in the ICU developed a sudden onset Adenosine 6mg IV push of narrow-complex tachycardia at a rate of 220/min. The patient's blood pressure is 128/58 mm Hg, the PETCO2 is 38 mm Hg, and the pulse oximetry reading is 98%. There is vascular access at the left internal jugular vein, and the patient has not been given any vasoactive drugs. A 12- lead ECG confirms a supraventricular tachycardia with no evidence of ischemia or infarction. The heart rate has not responded to vagal maneuvers. What is the next recommended intervention? You are receiving a radio report from an EMS team en Divert the patient to a hospital 15 minutes away with CT capabilities. route with a patient who may be having an acute stroke. The hospital CT scanner is not working at this time. What should you do in this situation? Choose an appropriate indication to stop or withhold Evidence of rigor mortis. resuscitative efforts. A 49-year-old woman arrives in the emergency department Obtain a 12 lead ECG. with persistent epigastric pain. She had been taking oral antacids for the past 6 hours because she thought she had heartburn. The initial blood pressure is 118/72 mm Hg, the heart rate is 92/min and regular, the nonlabored respiratory rate is 14 breaths/min, and the pulse oximetry reading is 96%. Which is the most appropriate intervention to perform next? 3 /8 A patient in respiratory failure becomes apneic but Simple airway manuevers and assisted ventilations. continues to have a strong pulse. The heart rate is dropping rapidly and now shows a sinus bradycardia at a rate of 30/min. What intervention has the highest priority? What is the appropriate procedure for endotracheal tube Suction during withdrawal but for no longer than 10 seconds. suctioning after the appropriate catheter is selected? While treating a patient with dizziness, a blood pressure of Atropine 0.5mg 68/30 mm Hg, and cool, clammy skin, you see this lead II ECG rhythm:What is the first intervention ? A 68-year-old woman experienced a sudden onset of right Cincinnati Prehospital Stroke Scale assessment arm weakness. EMS personnel measure a blood pressure of 140/90 mm Hg, a heart rate of 78/min, a nonlabored respiratory rate of 14 breaths/min, and a pulse oximetry reading of 97%. The lead II ECG displays sinus rhythm. What is the most appropriate action for the EMS team to perform next? EMS is transporting a patient with a positive prehospital Head CT scan stroke assessment. Upon arrival in the emergency department, the initial blood pressure is 138/78 mm Hg, the pulse rate is 80/min, the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95% on room air. The lead II ECG displays sinus rhythm. The blood glucose level is within normal limits. What intervention should you perform next? What is the proper ventilation rate for a patient in cardiac 8-10 breaths per minute arrest who has an advanced airway in place? A 62-year-old man in the emergency department says that Obtain a 12 lead ECG. his heart is beating fast. He says he has no chest pain or shortness of breath. The blood pressure is 142/98 mm Hg, the pulse is 200/min, the respiratory rate is 14 breaths/min, and pulse oximetry is 95% on room air. What intervention should you perform next? You are evaluating a 48-year-old man with crushing Synchronized cardioversion substernal chest pain. The patient is pale, diaphoretic, cool to the touch, and slow to respond to your questions. The blood pressure is 58/32 mm Hg, the heart rate is 190/min, the respiratory rate is 18 breaths/min, and the pulse oximeter is unable to obtain a reading because there is no radial pulse. The lead II ECG displays a regular wide- complex tachycardia. What intervention should you perform next? What is the initial priority for an unconscious patient with Determine whether pulses are present. any tachycardia on the monitor? Which rhythm requires synchronized cardioversion? Unstable supraventricular tachycardia What is the recommended second dose of adenosine for 12m g patients in refractory but stable narrow-complex tachycardia? What is the usual post-cardiac arrest target range for 35-40mm Hg PETCO2 when ventilating a patient who achieves return of spontaneous circulation (ROSC)? Which condition is a contraindication to therapeutic Responding to verbal commands hypothermia during the post-cardiac arrest period for patients who achieve return of spontaneous circulation ROSC? What is the potential danger of using ties that pass Obstruction of venous return from the brain circumferentially around the patient's neck when securing an advanced airway? What is the most reliable method of confirming and Continuous waveform capnography monitoring correct placement of an endotracheal tube? 4 /8 hat is the recommended IV fluid (normal saline or Ringer's 1 to 2 Liters lactate) bolus dose for a patient who achieves ROSC but is hypotensive during the post-cardiac arrest period? What is the minimum systolic blood pressure one should 90mm Hg attempt to achieve with fluid, inotropic, or vasopressor administration in a hypotensive post-cardiac arrest patient who achieves ROSC? What is the first treatment priority for a patient who Optimizing ventilation and oxygenation. achieves ROSC? What should be done to minimize interruptions in chest Continue CPR while the defibrillator is charging. compressions during CPR? Which condition is an indication to stop or withhold Safety threat to providers resuscitative efforts? After verifying the absence of a pulse, you initiate CPR IV or IO access with adequate bag-mask ventilation. The patient's lead II ECG appears below. What is your next action? After verifying unresponsiveness and abnormal breathing, Check for a pulse. you activate the emergency response team. What is your next action? What is the recommendation on the use of cricoid pressure Not recommended for routine use to prevent aspiration during cardiac arrest? What survival advantages does CPR provide to a patient inProduces a small amount of blood flow to the heart ventricular fibrillation? What is the recommended compression rate for performing At least 100 per minute CPR? EMS personnel arrive to find a patient in cardiac arrest. defibrillati on Bystanders are performing CPR. After attaching a cardiac monitor, the responder observes the following rhythm strip. What is the most important early intervention? A patient remains in ventricular fibrillation despite 1 shock administer a second shock. and 2 minutes of continuous CPR. The next intervention is to What is the recommended next step after a defibrillation Begin CPR, starting with chest compressions. attempt? Which of the following is the recommended first choice for Antecubital vein establishing intravenous access during the attempted resuscitation of a patient in cardiac arrest? Which finding is a sign of ineffective CPR? PETCO2 10 mm Hg How often should the team leader switch chest . Every 2 minutes compressors during a resuscitation attempt? IV/IO drug administration during CPR should be given rapidly during compressions What is the recommended first intravenous dose of 300 mg amiodarone for a patient with refractory ventricular fibrillation? 5 /8 A team leader orders 1 mg of epinephrine, and a team Closed-loop communication member verbally acknowledges when the medication is administered. What element of effective resuscitation team dynamics does this represent? How long should it take to perform a pulse check during 5 to 10 seconds the BLS Survey? Your rescue team arrives to find a 59-year-old man lying Check the patient's pulse. on the kitchen floor. You determine that he is unresponsive and notice that he is taking agonal breaths. What is the next step in your assessment and management of this patient? An AED advises a shock for a pulseless patient lying in Administer the shock immediately and continue as directed by the AED. snow. What is the next action? Which treatment or medication is appropriate for the Epinephri ne treatment of a patient in asystole? What is the minimum depth of chest compressions for an 2 inches adult in cardiac arrest? A patient with pulseless ventricular tachycardia is Start chest compressions at a rate of at least 100/min. defibrillated. What is the next action? You have completed your first 2-minute period of CPR. You Have a team member attempt to palpate a carotid pulse. see an organized, nonshockable rhythm on the ECG monitor. What is the next action? Emergency medical responders are unable to obtain a Intraosseous (IO) peripheral IV for a patient in cardiac arrest. What is the next most preferred route for drug administration? What is the appropriate rate of chest compressions for an At least 100/min adult in cardiac arrest? You are receiving a radio report from an EMS team en Divert the patient to a hospital 15 minutes away with CT capabilities. route with a patient who may be having an acute stroke. The hospital CT scanner is not working at this time. What should you do in this situation? A 53-year-old man has shortness of breath, chest Vagal maneuvers discomfort, and weakness. The patient's blood pressure is 102/59 mm Hg, the heart rate is 230/min, the respiratory rate is 16 breaths/min, and the pulse oximetry reading is 96%. The lead II ECG is displayed below. A patent peripheral IV is in place. What is the next action? A 49-year-old man has retrosternal chest pain radiating Administer 2 to 4 mg of morphine by slow IV bolus. into the left arm. The patient is diaphoretic, with associated shortness of breath. The blood pressure is 130/88 mm Hg, the heart rate is 110/min, the respiratory rate is 22 breaths/min, and the pulse oximetry value is 95%. The patient's 12-lead ECG shows ST segment elevation in the anterior leads. First responders administered 160 mg of aspirin, and there is a patent peripheral IV. The pain is described as an 8 on a scale of 1 to 10 and is unrelieved after 3 doses of nitroglycerin. What is the next action? A 56-year-old man reports that he has palpitations but not Seeking expert consultation chest pain or difficulty breathing. The blood pressure is 132/68 mm Hg, the pulse is 130/min and regular, the respiratory rate is 12 breaths/min, and the pulse oximetry reading is 95%. The lead II ECG displays a wide-complex tachycardia. What is the next action after establishing an IV and obtaining a 12-lead ECG? A postoperative patient in the ICU reports new chest pain. Obtain a 12-lead ECG and administer aspirin if not contraindicated. What actions have the highest priority? 6 /8 An 80-year-old woman presents to the emergency Conduct a problem-focused history and physical examination. department with dizziness. She now states she is asymptomatic after walking around. Her blood pressure is 102/72 mm Hg. She is alert and oriented. Her lead II ECG is below. After you start an IV, what is the next action? What is the recommended oral dose of aspirin for patients 160 to 325 mg suspected of having one of the acute coronary syndromes? A responder is caring for a patient with a history of stable supraventricular tachycardia congestive heart failure. The patient is experiencing shortness of breath, a blood pressure of 68/50 mm Hg, and a heart rate of 190/min. The patient's lead II ECG is displayed below. What is the most appropriate intervention for a rapidly Synchronized cardioversion deteriorating patient who has this lead II ECG? What is the purpose of a medical emergency team (MET) Improving patient outcomes by identifying and treating early clinical deterioration or rapid response team (RRT)? What is the recommended assisted ventilation rate for 10 to 12 breaths per minute patients in respiratory arrest with a perfusing rhythm? Family members found a 45-year-old woman unresponsive Performing a head tilt chin lift maneuver in bed. The patient is unconscious and in respiratory arrest. What is the recommended initial airway management technique? A patient in respiratory distress and with a blood pressure Synchronized cardioversion of 70/50 mm Hg presents with the following lead II ECG rhythm: What is the appropriate next intervention? A patient has a witnessed loss of consciousness. The lead Defibrillati on II ECG reveals this rhythm: What is the appropriate next intervention? What is the recommended energy dose for biphasic 120to20 0J synchronized cardioversion of atrial fibrillation? Which of the following is an acceptable method of Measure from the corner of the mouth to the angle of the mandible. selecting an appropriately sized oropharyngeal airway (OPA)? Which is a contraindication to nitroglycerin administration Right ventricular infarction and dysfunction in the management of acute coronary syndromes? What is the recommended initial intervention for managing Administration of IV or IO fluid bolus hypotension in the immediate period after return of spontaneous circulation (ROSC)? Which is an appropriate and important intervention to Transport the patient to a facility capable of performing PCI. perform for a patient who achieves ROSC during an out-of- hospital resuscitation? What is the immediate danger of excessive ventilation Decreased cerebral blood flow during the post-cardiac arrest period for patients who achieve ROSC? What is the recommended target temperature range for 32°C to 34°C achieving therapeutic hypothermia after cardiac arrest? What is the recommended duration of therapeutic 12 to 24 hours hypothermia after reaching the target temperature? What is the danger of routinely administering high Potential oxygen toxicity concentrations of oxygen during the post- cardiac arrest period for patients who achieve ROSC? 7 /8 What is the recommended dose of epinephrine for the 0.1 to 0.5 mcg/kg per minute IV infusion treatment of hypotension in a post- cardiac arrest patient who achieves ROSC? You have completed 2 min of CPR. The ECG monitor Administer 1mg of epinephrine displays the lead below (PEA) and the patient has no pulse. You partner resumes chest compressions and an IV is in place. What management step is your next priority? A patient is in refractory ventricular fibrillation and has 150 mg IV push received multiple appropriate defibrillation shocks, epinephrine 1 mg IV twice, and an initial dose of 300 mg amiodarone IV. The patient is intubated. A second dose of amiodarone is now called for. The recommend second dose of amiodarone is ? A patient is in refractory ventricular fibrillation. High CPR is second dose of epinephrine 1 mg in progress and shocks have been given. One dose of epinephrine was given after the second shock. An anti arrhythmic drug was given immediately after the the third shock. What drug should the team leader request to be prepared for administration next? A patient is in pulseless ventricular tachycardia. Two amiodarone 300 mg shocks and 1 dose of epinephrine has been given. Which is the next drug to anticipate to administer? You are monitoring a patient with chest discomfort who Give a single shock suddenly becomes unresponsive. You observe the following rhythm on the cardiac monitor. A defibrillator is present. What is your first action? what do you do after return of spontaneous circulation maintain O2 sat at 94% treat hypotension (fluids vasopressor) 12 lead EKG if in coma consider hypothermia if not in coma and ekg shows STEMI or AMI consider re-perfusion what are the 5 h's and 5 t's hypovole mia hypoxia hydrogen ion (acidosis) hypo/hyperkalemia hypothermia tension pneumothorax tamponade, cardiac toxins thrombosis, pulmonary thrombosis, coronary Bradycardia require treatment when? chest pain or shortness of breath is present how do you treat non-symptomatic bradycardia monitor and observe what constitutes symptomatic bradycardia hypotension altered mental status signs of shock chest pain acute heart failure A patient with sinus bradycardia and a heart rate of 42 has 0.5 mg diaphoresis and blood pressure of 80/60. What is the initial dose of atropine? how do you treat symptomatic bradycardia give 0.5mg atropine every 3-5 mins to max of 3mg if that doesn't work try one of the following: transcutaneous pacing 2-10mcg/kg / minute dopamine infusion 2-10mcg per minute epinephrine infusion what is considered a tachycardia requiring treatment over 150 per minute 8 /8 when do you consider cardioversion if persistent tachycardia is causing: hypotension altered mental status signs of shock chest pain acute heart failure if persistent tachycardia does not present with symptoms wide QRS? what do you need to consider greater than 0.12 seconds Your patient has been intubated. IV/IVO access is not Lidocaine, epinephrine, vasopressin available. Which combination of drugs can be administered by endotracheal route? reentry supraventricular tachycardia polymorphic ventricular tachycardia - aka torsades atrial fibrilation 1 /8 sinus tachycardia coarse ventricular fibrillation atrial flutter reentry supraventricular tachycardia sinus bradycardia monomorphic ventricular tachycardia fine ventricular fibrillation second degree AV block type 1 wenckenbach second degree AV block mobitz type 2 third degree AV block asystole normal sinus rhythm pulseless electrical activity agonal rhythm/asystole The five links in the adult Chain of Survival 1- Immediate activation of EMS 2- Early CPR 3- Rapid defibrillation (not in peds) 4- Effective advanced life support 5- Integrated post-cardiac arrest care Type of breaths (not normal) that may be present in the Agonal gasps first minutes after sudden cardiac arrest To place the pads on the victims bare chest, Place one to the side of the left nipple, with the top edge of the pad a few inches below the pad on the upper-right chest (below the collarbone) and armpit place the other pad If the heart muscle resets and initiates an organized ROSC return of spontaneous circulation rhythm this is called