ADVANCED LIFE SUPPORT QUESTIONS
AND ANSWERS WITH COMPLETE
SOLUTIONS (GRADED A+)
Fundamentals of High-Quality CPR ✔️✔️
To maximize the chances of survival, chest compressions must be performed with
precision:
Optimal Depth: Press down at least 2 inches (5 cm), but avoid exceeding
2.4 inches (6 cm).
Recoil: Ensure the chest returns fully to its normal position between
compressions to allow the heart to refill with blood.
Pacing: Maintain a consistent speed of 100 to 120 compressions per minute.
Continuity: Keep any gaps in compressions to less than 10 seconds.
Ventilation: Deliver breaths just until the chest rises; avoid excessive air.
Airway Management Procedures ✔️✔️
Oropharyngeal Airway (OPA) Insertion
1. Measure: From the corner of the mouth to the earlobe.
2. Insert: Point the tip toward the roof of the mouth (hard palate) as you enter.
3. Rotate: Once halfway in, rotate the device 180° so the curve follows the
tongue.
4. Confirm: The flange should rest against the patient's lips. Use only on
unconscious patients without a gag reflex.
Nasopharyngeal Airway (NPA) Insertion
1. Measure: From the tip of the nose to the earlobe.
2. Lubricate: Use a water-soluble lubricant.
, 3. Insert: Aim the bevel toward the septum and slide it straight back along the
floor of the nasal passage.
4. Check: Ensure it reaches the back of the throat without causing trauma.
Advanced Airway Considerations
Continuous Compressions: Once an ET tube or supraglottic airway is in,
do not pause for breaths.
Respiratory Rate: Provide 1 breath every 6 seconds (10 breaths per
minute).
Verification: Use waveform capnography ($PETCO_2$) to confirm the
tube remains in the trachea.
Electrical Interventions ✔️✔️
Electrode Placement (ECG)
Standard Monitoring: White on right, smoke (black) over fire (red) on the
left.
12-Lead: Specifically placed across the precordium (V1–V6) and limbs to
view the heart from 12 different angles.
Defibrillation (Unsynchronized)
1. Power: Turn on the defibrillator and select the energy level (200J biphasic
or 360J monophasic).
2. Pad Placement: Apply pads to the bare upper right chest and lower left ribs.
3. Clear: Ensure no one is touching the patient.
4. Shock: Press the shock button immediately following the analysis of a
shockable rhythm (VF/pVT).
Synchronized Cardioversion
1. Sync Mode: Press the "Sync" button to ensure the shock lands on the R-
wave.
2. Sedation: Consider sedating the patient if they are conscious.
, 3. Shock: Hold the shock button until the machine delivers the energy at the
peak of the QRS complex.
Transcutaneous Pacing (TCP)
1. Pacing Mode: Select the "Pacer" function on the monitor.
2. Rate: Set the desired heart rate (usually 60–80 bpm).
3. Current (mAmps): Increase the output until "electrical capture" (a pacer
spike followed by a wide QRS) is seen, then check for a mechanical pulse.
Intraosseous (IO) Access Procedure ✔️✔️
Used when IV access is unavailable during emergencies:
1. Site Selection: Usually the proximal tibia (just below the knee) or proximal
humerus (shoulder).
2. Preparation: Clean the site with an antiseptic.
3. Insertion: Use an IO driver to drill the needle through the bone cortex until
a "give" or "pop" is felt.
4. Verification: Remove the trochar, aspirate for bone marrow, and flush with
saline. If the patient is conscious, administer Lidocaine for pain before the
flush.
How to interpret EtCO2 during resuscitation ventilation?
30-45 what it is normally
15-20 during a resuscitation
Below 10 could be a problem with rate or quality of compressions
Spike is often the first sign of ROSC
Four components of communication
Sender, message, receiver, feedback (closed loop communication)
, Debriefing
Review, Analyze, Reflect, Summarize
Team leader responsibilities
- Assigns team roles
- Sets expectations
- Prioritizes, directs, acts decisively
- Encourages and allows team input and interaction
- Focuses on big picture
- Monitors performance while providing support
- Acts as a role model
- Coaches the team
- Re-evaluates and summarizes progress
- Leads a debriefing session
Team member responsibilities
- Have the knowledge and skills to perform their assigned role
- Communicate with the team leader if they feel they are lacking the above,
identify something the team leader may have overlooked, recognize a dangerous
situation or need for urgent action
- Stay in their assigned role but assist others as needed, as long as they are able to
maintain their own responsibilities
AND ANSWERS WITH COMPLETE
SOLUTIONS (GRADED A+)
Fundamentals of High-Quality CPR ✔️✔️
To maximize the chances of survival, chest compressions must be performed with
precision:
Optimal Depth: Press down at least 2 inches (5 cm), but avoid exceeding
2.4 inches (6 cm).
Recoil: Ensure the chest returns fully to its normal position between
compressions to allow the heart to refill with blood.
Pacing: Maintain a consistent speed of 100 to 120 compressions per minute.
Continuity: Keep any gaps in compressions to less than 10 seconds.
Ventilation: Deliver breaths just until the chest rises; avoid excessive air.
Airway Management Procedures ✔️✔️
Oropharyngeal Airway (OPA) Insertion
1. Measure: From the corner of the mouth to the earlobe.
2. Insert: Point the tip toward the roof of the mouth (hard palate) as you enter.
3. Rotate: Once halfway in, rotate the device 180° so the curve follows the
tongue.
4. Confirm: The flange should rest against the patient's lips. Use only on
unconscious patients without a gag reflex.
Nasopharyngeal Airway (NPA) Insertion
1. Measure: From the tip of the nose to the earlobe.
2. Lubricate: Use a water-soluble lubricant.
, 3. Insert: Aim the bevel toward the septum and slide it straight back along the
floor of the nasal passage.
4. Check: Ensure it reaches the back of the throat without causing trauma.
Advanced Airway Considerations
Continuous Compressions: Once an ET tube or supraglottic airway is in,
do not pause for breaths.
Respiratory Rate: Provide 1 breath every 6 seconds (10 breaths per
minute).
Verification: Use waveform capnography ($PETCO_2$) to confirm the
tube remains in the trachea.
Electrical Interventions ✔️✔️
Electrode Placement (ECG)
Standard Monitoring: White on right, smoke (black) over fire (red) on the
left.
12-Lead: Specifically placed across the precordium (V1–V6) and limbs to
view the heart from 12 different angles.
Defibrillation (Unsynchronized)
1. Power: Turn on the defibrillator and select the energy level (200J biphasic
or 360J monophasic).
2. Pad Placement: Apply pads to the bare upper right chest and lower left ribs.
3. Clear: Ensure no one is touching the patient.
4. Shock: Press the shock button immediately following the analysis of a
shockable rhythm (VF/pVT).
Synchronized Cardioversion
1. Sync Mode: Press the "Sync" button to ensure the shock lands on the R-
wave.
2. Sedation: Consider sedating the patient if they are conscious.
, 3. Shock: Hold the shock button until the machine delivers the energy at the
peak of the QRS complex.
Transcutaneous Pacing (TCP)
1. Pacing Mode: Select the "Pacer" function on the monitor.
2. Rate: Set the desired heart rate (usually 60–80 bpm).
3. Current (mAmps): Increase the output until "electrical capture" (a pacer
spike followed by a wide QRS) is seen, then check for a mechanical pulse.
Intraosseous (IO) Access Procedure ✔️✔️
Used when IV access is unavailable during emergencies:
1. Site Selection: Usually the proximal tibia (just below the knee) or proximal
humerus (shoulder).
2. Preparation: Clean the site with an antiseptic.
3. Insertion: Use an IO driver to drill the needle through the bone cortex until
a "give" or "pop" is felt.
4. Verification: Remove the trochar, aspirate for bone marrow, and flush with
saline. If the patient is conscious, administer Lidocaine for pain before the
flush.
How to interpret EtCO2 during resuscitation ventilation?
30-45 what it is normally
15-20 during a resuscitation
Below 10 could be a problem with rate or quality of compressions
Spike is often the first sign of ROSC
Four components of communication
Sender, message, receiver, feedback (closed loop communication)
, Debriefing
Review, Analyze, Reflect, Summarize
Team leader responsibilities
- Assigns team roles
- Sets expectations
- Prioritizes, directs, acts decisively
- Encourages and allows team input and interaction
- Focuses on big picture
- Monitors performance while providing support
- Acts as a role model
- Coaches the team
- Re-evaluates and summarizes progress
- Leads a debriefing session
Team member responsibilities
- Have the knowledge and skills to perform their assigned role
- Communicate with the team leader if they feel they are lacking the above,
identify something the team leader may have overlooked, recognize a dangerous
situation or need for urgent action
- Stay in their assigned role but assist others as needed, as long as they are able to
maintain their own responsibilities
