ADVANCED CARDIOVASCULAR LIFE
SUPPORT CERTIFICATION SCRIPT 2026
QUESTIONS WITH SOLUTIONS GRADED A+
◍ Tamponade.
Answer: Fluid buildup in the pericardium results in ineffective pumping of
the blood, which can lead to pulseless activity. - ECG symptoms such as
narrowing QRS and rapid HR- Physical signs include JVD, no pulse or
difficulty palpating pulse, and muffled heart sounds** Perform
pericardiocentesis to reverse
◍ Adenosine.
Answer: SVT ADENOSINE- Slows heart rate temporarily to allow better
visualization of rhythm - 6 mg initial dose - 20 mL flush - Wait 1-2 min- 12
mg second dose if indicated - 12 mg third dose if indicated
◍ Hypothermia.
Answer: If the patient has been exposed to cold, warming measures should
be taken - Core temperature should be raised above 86 degrees F/ 30 C
ASAP- Patient may not respond to drug or electrical therapy while
hypothermic
◍ What are the shockable rhythms?.
Answer: V Fib and V Tach without a pulse
◍ Pulseless Electrical Activity (PEA).
Answer: Electrical conduction in the heart is functional but the muscles are
not responsivePEA will appear as NSR with a wide QRS complex
◍ Dopamine.
Answer: 1) AlgorithmsBradycardia with a pulse2) Dose2 to 20 mcg/kg/min
by IV3) MechanismAlpha and beta adrenergic actions increase inotropic
, activity & cause vasoconstriction at higher doses
◍ How do we give Amiodarone?.
Answer: - Strong antidysrhythmic and slows the heart rate WITHOUT A
PULSE- 300 mg initial dose- 150 mg second dose if indicated WITH A
PULSE- 150 mg initial dose- 300 mg second dose
◍ What do we do if the rhythm is not shockable?.
Answer: - Maintain IV/IO access if none already exists- Begin epinephrine
administration every 3-5 min- Capnography w/ advanced airway if
indicated- If rhythm still not shockable continue CPR - Identify treatable
causes and continue
◍ What rhythm is MJ in?a) Asystoleb) Bradycardiac) Torsades de Pointesd)
Pulseless Ventricular Tachycardia.
Answer: d) Pulseless Ventricular Tachycardia
◍ Amiodarone.
Answer: 1) Algorithmsa) Pulseless ventricular tachycardia/ventricular
fibrillationb) Stable ventricular tachycardia = have a pulse2) Dosea) 300 mg
by IV or intraosseous x 1 dose (Pulseless ventricular tachycardia/ventricular
fibrillation)1. 150 mg by IV or intraosseous x 1 if pulseless ventricular
tachycardia/ventricular fibrillation persists (after initial 300 mg dose) = max
total dose is 450 mg by IV or intraosseousb) 150 mg IV bolus over 10
minutes (Stable ventricular tachycardia)1. Continuous IV infusion 1 mg/min
for 6 hours or 0.5 mg/min for 18 hours2. Common drip = 450 mg in 250 mL
D5W3) MechanismPrevents the development or recurrence of ventricular
fibrillation and pulseless ventricular tachycardia by raising the defibrillation
threshold
◍ Atropine.
Answer: 1) AlgorithmsBradycardia = avoid in type II second degree & third
degree AV blockWith a pulse2) Dose0.5 mg by IV every 3 to 5 minutesMax
total dose = 3 mg-----means 6 doses of 0.5 mg3) MechanismDecreases
parasympathetic tone by blocking depressant effect of acetylcholine on heart
rate and AV nodal conduction
, ◍ Access for Medication AdministrationIntraosseous (IO).
Answer: 1) Spongy, cancellous bone of the epiphysis and the medullary
cavity of the diaphysis2) Intraosseous access can be obtained quicker than
central or peripheral access3) Medications and fluids can be admin the same
as IV
◍ Access for Medication AdministrationEndotracheal (ET).
Answer: 1) Not preferred in setting of cardiac arrest d/t variable drug
delivery2) Can be used to admin certain drugs if IV and intraosseous access
cannot be establishedNaloxoneAtropineVasopressin = not in Guidelines
anymoreEpinephrineLidocaine3) 2 to 2.5 times IV or intraosseous dose = d/t
going into lungs
◍ How do we manage Symtomatic Bradycardia?.
Answer: Get them on the monitor/AEDEnsure IV accessAtropine 1 mg
every 3-5 min, max 3xCont'd: Transcutaneous PacingTurn AED to
pacingSet rate at 60-80/minTurn milliamps up until captureDrop milliamps
until lose captureTurn up 1-2 milliampsIf unstable, flip to monitor to see
rhythm
◍ Hydrogen Ion (Acidosis).
Answer: - Obtain ABG to determine respiratory acidosis- Provide adequate
ventilation- Use sodium bicarbonate to prevent metabolic acidosis if
necessary
◍ Torsades de PointesPolymorphic Ventricular Tachycardia.
Answer: Want to give magnesium if see thisRate 150 to 300 beats/minQT
Prolongation"Twisting of the Points"
◍ The medical resident asks you to prepare atropine for MJ's bradycardia, but
she cannot remember how to admin the medication.What do you tell
them?a) 0.5 mg by IV/intraosseous every 3 to 5 minutesb) 1 mg by
IV/intraosseous every 3 to 5 minutesc) 1 mg/min IV x 6 hours, followed by
0.5 mg/min for 18 hoursd) 2 to 10 mcg/min by IVe) 2 to 20 mcg/kg/min by
IV.
SUPPORT CERTIFICATION SCRIPT 2026
QUESTIONS WITH SOLUTIONS GRADED A+
◍ Tamponade.
Answer: Fluid buildup in the pericardium results in ineffective pumping of
the blood, which can lead to pulseless activity. - ECG symptoms such as
narrowing QRS and rapid HR- Physical signs include JVD, no pulse or
difficulty palpating pulse, and muffled heart sounds** Perform
pericardiocentesis to reverse
◍ Adenosine.
Answer: SVT ADENOSINE- Slows heart rate temporarily to allow better
visualization of rhythm - 6 mg initial dose - 20 mL flush - Wait 1-2 min- 12
mg second dose if indicated - 12 mg third dose if indicated
◍ Hypothermia.
Answer: If the patient has been exposed to cold, warming measures should
be taken - Core temperature should be raised above 86 degrees F/ 30 C
ASAP- Patient may not respond to drug or electrical therapy while
hypothermic
◍ What are the shockable rhythms?.
Answer: V Fib and V Tach without a pulse
◍ Pulseless Electrical Activity (PEA).
Answer: Electrical conduction in the heart is functional but the muscles are
not responsivePEA will appear as NSR with a wide QRS complex
◍ Dopamine.
Answer: 1) AlgorithmsBradycardia with a pulse2) Dose2 to 20 mcg/kg/min
by IV3) MechanismAlpha and beta adrenergic actions increase inotropic
, activity & cause vasoconstriction at higher doses
◍ How do we give Amiodarone?.
Answer: - Strong antidysrhythmic and slows the heart rate WITHOUT A
PULSE- 300 mg initial dose- 150 mg second dose if indicated WITH A
PULSE- 150 mg initial dose- 300 mg second dose
◍ What do we do if the rhythm is not shockable?.
Answer: - Maintain IV/IO access if none already exists- Begin epinephrine
administration every 3-5 min- Capnography w/ advanced airway if
indicated- If rhythm still not shockable continue CPR - Identify treatable
causes and continue
◍ What rhythm is MJ in?a) Asystoleb) Bradycardiac) Torsades de Pointesd)
Pulseless Ventricular Tachycardia.
Answer: d) Pulseless Ventricular Tachycardia
◍ Amiodarone.
Answer: 1) Algorithmsa) Pulseless ventricular tachycardia/ventricular
fibrillationb) Stable ventricular tachycardia = have a pulse2) Dosea) 300 mg
by IV or intraosseous x 1 dose (Pulseless ventricular tachycardia/ventricular
fibrillation)1. 150 mg by IV or intraosseous x 1 if pulseless ventricular
tachycardia/ventricular fibrillation persists (after initial 300 mg dose) = max
total dose is 450 mg by IV or intraosseousb) 150 mg IV bolus over 10
minutes (Stable ventricular tachycardia)1. Continuous IV infusion 1 mg/min
for 6 hours or 0.5 mg/min for 18 hours2. Common drip = 450 mg in 250 mL
D5W3) MechanismPrevents the development or recurrence of ventricular
fibrillation and pulseless ventricular tachycardia by raising the defibrillation
threshold
◍ Atropine.
Answer: 1) AlgorithmsBradycardia = avoid in type II second degree & third
degree AV blockWith a pulse2) Dose0.5 mg by IV every 3 to 5 minutesMax
total dose = 3 mg-----means 6 doses of 0.5 mg3) MechanismDecreases
parasympathetic tone by blocking depressant effect of acetylcholine on heart
rate and AV nodal conduction
, ◍ Access for Medication AdministrationIntraosseous (IO).
Answer: 1) Spongy, cancellous bone of the epiphysis and the medullary
cavity of the diaphysis2) Intraosseous access can be obtained quicker than
central or peripheral access3) Medications and fluids can be admin the same
as IV
◍ Access for Medication AdministrationEndotracheal (ET).
Answer: 1) Not preferred in setting of cardiac arrest d/t variable drug
delivery2) Can be used to admin certain drugs if IV and intraosseous access
cannot be establishedNaloxoneAtropineVasopressin = not in Guidelines
anymoreEpinephrineLidocaine3) 2 to 2.5 times IV or intraosseous dose = d/t
going into lungs
◍ How do we manage Symtomatic Bradycardia?.
Answer: Get them on the monitor/AEDEnsure IV accessAtropine 1 mg
every 3-5 min, max 3xCont'd: Transcutaneous PacingTurn AED to
pacingSet rate at 60-80/minTurn milliamps up until captureDrop milliamps
until lose captureTurn up 1-2 milliampsIf unstable, flip to monitor to see
rhythm
◍ Hydrogen Ion (Acidosis).
Answer: - Obtain ABG to determine respiratory acidosis- Provide adequate
ventilation- Use sodium bicarbonate to prevent metabolic acidosis if
necessary
◍ Torsades de PointesPolymorphic Ventricular Tachycardia.
Answer: Want to give magnesium if see thisRate 150 to 300 beats/minQT
Prolongation"Twisting of the Points"
◍ The medical resident asks you to prepare atropine for MJ's bradycardia, but
she cannot remember how to admin the medication.What do you tell
them?a) 0.5 mg by IV/intraosseous every 3 to 5 minutesb) 1 mg by
IV/intraosseous every 3 to 5 minutesc) 1 mg/min IV x 6 hours, followed by
0.5 mg/min for 18 hoursd) 2 to 10 mcg/min by IVe) 2 to 20 mcg/kg/min by
IV.
