ACLS megacode practice: run the case yourself

1. Card 01 / 08Cardiac arrest

   Which of the following is the most appropriate management for a patient with a wide-complex tachycardia at 180 bpm who is unresponsive with no palpable pulse?

   1. AAmiodarone 300 mg IV bolus before electrical therapy
   2. BDefibrillation at the manufacturer-recommended energy
   3. CSynchronized cardioversion at 100J
   4. DAdenosine 6 mg rapid IV push

   Explanation

   Keyed answerB. Defibrillation at the manufacturer-recommended energy

   Your pickA. Amiodarone 300 mg IV bolus before electrical therapy ww

   A patient with a wide-complex tachycardia and no pulse is in cardiac arrest from pulseless ventricular tachycardia. The treatment is immediate unsynchronized defibrillation at the energy the device manufacturer recommends, then 2 minutes of CPR and the shockable-rhythm arm of the cardiac arrest algorithm. Synchronized cardioversion and adenosine are for patients who still have a pulse.

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2. Card 02 / 08Cardiac arrest

   What is the correct sequence for managing a patient with PEA (Pulseless Electrical Activity)?

   1. AStart high-quality CPR, establish IV/IO access, administer epinephrine every 3-5 minutes, identify and treat possible causes
   2. BAdminister amiodarone 300 mg IV/IO, defibrillate at 200 J biphasic, then start CPR and give epinephrine only if there is no response
   3. CAdminister atropine, begin pacing, then start CPR if no response
   4. DDefibrillate immediately, then start CPR if no response

   Explanation

   Keyed answerA. Start high-quality CPR, establish IV/IO access, administer epinephrine every 3-5 minutes, identify and treat possible causes

   Your pickB. Administer amiodarone 300 mg IV/IO, defibrillate at 200 J biphasic, then start CPR and give epinephrine only if there is no response ww

   The correct sequence for managing PEA is: start high-quality CPR, establish IV/IO access, administer epinephrine every 3-5 minutes, and identify and treat possible reversible causes (the H's and T's) including hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia, toxins, tamponade (cardiac), tension pneumothorax, and thrombosis (coronary or pulmonary).

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3. Card 03 / 08CPR & airway

   When using an AED, when should CPR be resumed after a shock is delivered?

   1. AImmediately after the shock is delivered
   2. BAfter waiting 2 minutes
   3. CAfter reassessing breathing
   4. DAfter checking for a pulse

   Explanation

   Keyed answerA. Immediately after the shock is delivered

   Your pickC. After reassessing breathing ww

   After an AED delivers a shock, CPR should be resumed immediately, starting with compressions. This helps circulate blood while the heart tries to establish an effective rhythm.

   Next cardTurn back to the question

4. Card 04 / 08Brady & tachy

   What is the most appropriate management for a patient with a regular narrow-complex tachycardia at 180 bpm who becomes hypotensive after adenosine fails to convert the rhythm?

   1. AAdminister a higher dose of adenosine
   2. BBegin verapamil administration
   3. CStart an amiodarone infusion
   4. DProceed to synchronized cardioversion

   Explanation

   Keyed answerD. Proceed to synchronized cardioversion

   Your pickA. Administer a higher dose of adenosine ww

   For a patient with narrow-complex tachycardia who becomes hypotensive (indicating instability) after adenosine fails, synchronized cardioversion is the appropriate next step to rapidly restore a normal rhythm and hemodynamic stability.

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5. Card 05 / 08Brady & tachy

   What is the correct sequence for treating a patient with polymorphic ventricular tachycardia (Torsades de Pointes) with a pulse?

   1. ADefibrillate immediately, administer epinephrine, perform CPR
   2. BAdminister amiodarone, perform synchronized cardioversion, administer lidocaine
   3. CCorrect electrolyte abnormalities, administer magnesium sulfate, consider overdrive pacing
   4. DAdminister adenosine, perform carotid sinus massage, administer beta-blockers

   Explanation

   Keyed answerC. Correct electrolyte abnormalities, administer magnesium sulfate, consider overdrive pacing

   Your pickB. Administer amiodarone, perform synchronized cardioversion, administer lidocaine ww

   For Torsades de Pointes with a pulse, the treatment sequence involves correcting underlying causes (especially electrolyte abnormalities), administering magnesium sulfate, and considering overdrive pacing for refractory cases.

   Next cardTurn back to the question

6. Card 06 / 08Post-arrest care

   How should a resuscitation team modify post-cardiac arrest care when the patient exhibits hemodynamic deterioration along with recurrent arrhythmias?

   1. ATerminate resuscitation efforts due to recurrent arrhythmias
   2. BImmediately reassess for reversible causes, fine-tune vasoactive medications, and consider repeat defibrillation if indicated
   3. CIncrease ventilation rate to improve oxygenation solely
   4. DContinue the original post-arrest protocol without modifications, since recurrent arrhythmias are expected after ROSC and resolve on their own

   Explanation

   Keyed answerB. Immediately reassess for reversible causes, fine-tune vasoactive medications, and consider repeat defibrillation if indicated

   Your pickD. Continue the original post-arrest protocol without modifications, since recurrent arrhythmias are expected after ROSC and resolve on their own ww

   The team should promptly reassess for reversible causes, adjust inotropic and vasopressor support, and consider repeating defibrillation if a shockable rhythm recurs, while re-evaluating the overall hemodynamic status.

   Next cardTurn back to the question

7. Card 07 / 08ACS & stroke

   What is the appropriate management for a patient with acute ischemic stroke who presents with right-sided hemiparesis and a blood pressure of 210/110 mmHg, and is otherwise eligible for thrombolytic therapy?

   1. AAggressively lower blood pressure to <140/90 mmHg
   2. BAdminister thrombolytics immediately without treating hypertension
   3. CCarefully lower blood pressure to <185/110 mmHg with IV labetalol or nicardipine
   4. DWithhold thrombolytics because any blood pressure above 185/110 mmHg at arrival is an absolute exclusion, and give supportive care only

   Explanation

   Keyed answerC. Carefully lower blood pressure to <185/110 mmHg with IV labetalol or nicardipine

   Your pickD. Withhold thrombolytics because any blood pressure above 185/110 mmHg at arrival is an absolute exclusion, and give supportive care only ww

   For patients eligible for thrombolytic therapy, blood pressure must be <185/110 mmHg. If BP exceeds this threshold, careful lowering with IV labetalol or nicardipine is indicated to achieve the target while avoiding excessive reduction that could worsen cerebral ischemia.

   Next cardTurn back to the question

8. Card 08 / 08ACS & stroke

   What is the recommended management for a patient with acute ischemic stroke who arrives 5 hours after symptom onset with an NIHSS score of 12 and a large vessel occlusion confirmed on CTA?

   1. AAdminister intra-arterial thrombolytics directly
   2. BProvide supportive care only, because revascularization is no longer an option beyond the 4.5-hour window
   3. CAdminister IV thrombolytics regardless of time window
   4. DEvaluate for mechanical thrombectomy eligibility without IV thrombolytics

   Explanation

   Keyed answerD. Evaluate for mechanical thrombectomy eligibility without IV thrombolytics

   Your pickB. Provide supportive care only, because revascularization is no longer an option beyond the 4.5-hour window ww

   While this patient is outside the standard window for IV thrombolytics (4.5 hours), mechanical thrombectomy can be considered up to 24 hours in selected patients with confirmed large vessel occlusion and favorable imaging, particularly with significant neurological deficits (NIHSS ≥6).

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9. Score card

   0%

   Answer a few cards and come back to this one.

   • Cardiac arrestnot yet
   • CPR & airwaynot yet
   • Brady & tachynot yet
   • Post-arrest carenot yet
   • ACS & strokenot yet

   Reread a low topic: Algorithms

   The thin line on each bar marks 84%, the written-exam pass mark AHA Training Centers usually quote; your instructor confirms the exact rule.

   Shuffle back to card 1

Pick an answer and the card turns over to the explanation. Keys: A to D or 1 to 4, arrows to move, F to turn the card.