BLS & ACLS Exam Flashcards

Q: What is the difference between BLS and ACLS?

BLS (Basic Life Support) covers: high-quality CPR, AED use, choking relief, rescue breathing. Required for all healthcare providers. ACLS (Advanced Cardiovascular Life Support) builds on BLS and adds: cardiac arrest algorithms, medication administration, advanced airway management, ECG rhythm interpretation, team leadership. ACLS is required for RNs, MDs, paramedics, and other advanced providers.

Q: How often do BLS and ACLS need to be renewed?

Both BLS and ACLS certifications expire every 2 years. Renewal courses are shorter than initial certification: BLS renewal takes about 3 hours, ACLS renewal takes about 6-8 hours. AHA now offers blended learning options (online portion + in-person skills session). Some employers require annual competency verification even though certification is biennial.

Q: What are the CPR compression guidelines for adults?

AHA adult CPR guidelines: Rate: 100-120 compressions per minute. Depth: at least 2 inches (5 cm) but no more than 2.4 inches (6 cm). Allow full chest recoil between compressions. Minimize interruptions (aim for >80% chest compression fraction). Compression-to-ventilation ratio: 30:2 without advanced airway. Switch compressors every 2 minutes.

Q: What are the shockable cardiac arrest rhythms?

The two shockable rhythms are: Ventricular Fibrillation (V-Fib) and Pulseless Ventricular Tachycardia (V-Tach). Both are treated with defibrillation + CPR + epinephrine + amiodarone. The two non-shockable rhythms are: Asystole (flatline) and PEA (Pulseless Electrical Activity)—treated with CPR + epinephrine + treating reversible causes (H's and T's).

Q: What medications are used in ACLS?

Key ACLS medications: Epinephrine 1mg IV/IO q3-5 min (all arrest rhythms). Amiodarone 300mg then 150mg (refractory V-fib/V-tach). Atropine 1mg IV q3-5min max 3mg (symptomatic bradycardia). Adenosine 6mg then 12mg rapid IV push (stable SVT). Dopamine 5-20 mcg/kg/min (bradycardia/hypotension). Magnesium 1-2g IV (Torsades de Pointes).

Q: Who needs BLS certification?

BLS is required for: all healthcare professionals (nurses, doctors, PAs, NPs, dentists), EMTs and paramedics, medical/nursing/dental students, physical therapists, respiratory therapists, medical assistants, and many non-clinical hospital employees. Many employers require BLS for any patient-facing role. AHA BLS for Healthcare Providers is the most widely accepted certification.

Question 1

BLS Survey: CAB Sequence

Accepted Answer

C = Compressions (start immediately), A = Airway (head-tilt chin-lift or jaw thrust), B = Breathing (rescue breaths). For cardiac arrest: compressions first (C-A-B). Changed from A-B-C in 2010 guidelines because early compressions improve survival. Check for responsiveness and pulse before starting.

Question 2

Adult CPR: Compression Guidelines

Accepted Answer

Rate: 100-120 compressions/min. Depth: at least 2 inches (5 cm), no more than 2.4 inches (6 cm). Allow full chest recoil between compressions. Minimize interruptions (<10 sec). Compression-to-ventilation ratio: 30:2 (1 or 2 rescuers without advanced airway). Switch compressors every 2 minutes to prevent fatigue.

Question 3

Hands-Only CPR

Accepted Answer

Continuous chest compressions without rescue breaths. Recommended for untrained bystanders or those unwilling/unable to provide breaths. Push hard and fast (100-120/min) in the center of the chest. Nearly as effective as conventional CPR for witnessed adult cardiac arrest in the first few minutes.

Question 4

Rescue Breathing (No Cardiac Arrest)

Accepted Answer

For patients with a pulse but inadequate breathing. Adult: 1 breath every 5-6 seconds (10-12 breaths/min). Child/Infant: 1 breath every 2-3 seconds (20-30 breaths/min). Each breath delivered over 1 second, visible chest rise. Recheck pulse every 2 minutes.

Question 5

AED (Automated External Defibrillator) Steps

Accepted Answer

1) Power on AED. 2) Attach pads (right clavicle, left lateral chest/axilla). 3) Analyze rhythm—clear the patient. 4) If shock advised, ensure no one touching patient, deliver shock. 5) Immediately resume CPR for 2 minutes. 6) Reanalyze. AED detects V-fib and pulseless V-tach (shockable rhythms).

Question 6

Chain of Survival: In-Hospital (IHCA)

Accepted Answer

1) Surveillance and prevention, 2) Recognition and activation of emergency response, 3) Immediate high-quality CPR, 4) Rapid defibrillation, 5) Advanced cardiac life support, 6) Post-cardiac arrest care, 7) Recovery. Multidisciplinary team response critical.

Question 7

Chain of Survival: Out-of-Hospital (OHCA)

Accepted Answer

1) Recognition and activation of emergency response (call 911), 2) Immediate high-quality CPR, 3) Rapid defibrillation (AED), 4) Advanced EMS care, 5) Post-cardiac arrest care, 6) Recovery. Bystander CPR doubles or triples survival rates. Time to defibrillation is the most critical factor.

Question 8

Child CPR Modifications (Age 1 to Puberty)

Accepted Answer

Compression depth: about 2 inches (5 cm), or 1/3 AP diameter. One or two hands for compressions. Rate: 100-120/min. Ratio: 30:2 (lone rescuer), 15:2 (2 healthcare providers). AED: use pediatric pads/dose attenuator if available; use adult pads if not. Most pediatric arrests are respiratory in origin—ventilations critical.

Question 9

Infant CPR (Under Age 1)

Accepted Answer

Compression depth: about 1.5 inches (4 cm), or 1/3 AP diameter. Technique: 2-finger (lone rescuer) or 2-thumb encircling hands (2 rescuers—preferred). Rate: 100-120/min. Ratio: 30:2 (lone), 15:2 (2 providers). Brachial pulse check (not carotid). AED with infant pads if available.

Question 10

Neonatal Resuscitation Basics

Accepted Answer

Compression-to-ventilation ratio: 3:1 (unique to neonates). Rate: 120 events/min (90 compressions + 30 breaths). Two-thumb encircling technique. Compress lower 1/3 of sternum, depth 1/3 AP diameter. Most neonatal resuscitation requires only warming, drying, stimulating, and airway clearing.

Question 11

Adult/Child Choking (Conscious)

Accepted Answer

Mild obstruction (can cough/speak): encourage forceful coughing, do not interfere. Severe obstruction (cannot cough/speak/breathe): perform abdominal thrusts (Heimlich maneuver). Stand behind, fist above navel, quick upward thrusts. Continue until object expelled or patient becomes unconscious.

Question 12

Infant Choking (Conscious, Under 1)

Accepted Answer

5 back slaps (between shoulder blades, head lower than chest) alternating with 5 chest thrusts (2 fingers on sternum, same landmark as CPR). Do NOT use abdominal thrusts on infants (risk of organ damage). Continue until object expelled or infant becomes unconscious. If unconscious: begin CPR, look for object before breaths.

Question 13

Ventricular Fibrillation (V-Fib)

Accepted Answer

Chaotic, disorganized electrical activity in ventricles. No effective cardiac output. ECG: irregular, chaotic waveform with no identifiable P waves, QRS, or T waves. Treatment: defibrillation (shock) ASAP + CPR + epinephrine every 3-5 min + amiodarone. SHOCKABLE rhythm. Most common initial rhythm in adult cardiac arrest.

Question 14

Pulseless Ventricular Tachycardia (V-Tach)

Accepted Answer

Rapid ventricular rhythm (>150 bpm), wide QRS, regular, no pulse. No effective cardiac output. SHOCKABLE rhythm. Treatment: same as V-fib—defibrillation + CPR + epinephrine q3-5 min + amiodarone/lidocaine. With a pulse: cardioversion (synchronized shock) if unstable, medications if stable.

Question 15

Asystole

Accepted Answer

Complete absence of electrical activity in the heart—'flatline.' ECG: flat line (confirm in 2 leads, check connections). NON-SHOCKABLE. Treatment: CPR + epinephrine every 3-5 min. Do NOT defibrillate asystole. Identify and treat reversible causes (H's and T's). Poorest prognosis of all arrest rhythms.

Question 16

Pulseless Electrical Activity (PEA)

Accepted Answer

Organized electrical rhythm on monitor but NO palpable pulse. NON-SHOCKABLE. Treatment: CPR + epinephrine every 3-5 min + identify/treat reversible cause. PEA has the best prognosis of non-shockable rhythms if cause is found and treated. Think H's and T's.

Question 17

H's and T's (Reversible Causes of Arrest)

Accepted Answer

H's: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia. T's: Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary embolism), Thrombosis (coronary/MI). Identifying and treating the underlying cause is key to ROSC in PEA and asystole.

Question 18

Epinephrine in Cardiac Arrest

Accepted Answer

Dose: 1 mg IV/IO every 3-5 minutes. Mechanism: alpha-adrenergic vasoconstriction increases coronary and cerebral perfusion pressure. Given for ALL cardiac arrest rhythms (V-fib, V-tach, PEA, asystole). For V-fib/V-tach: give after 2nd shock. For PEA/asystole: give as soon as IV/IO access established.

Question 19

Amiodarone in Cardiac Arrest

Accepted Answer

First-line antiarrhythmic for V-fib/pulseless V-tach. First dose: 300 mg IV/IO bolus. Second dose: 150 mg IV/IO. Given after defibrillation and epinephrine have failed. Alternative: lidocaine (1-1.5 mg/kg first dose, then 0.5-0.75 mg/kg). Do not use for PEA or asystole.

Question 20

Atropine

Accepted Answer

Parasympatholytic (blocks vagal tone). Used for symptomatic bradycardia. Dose: 1 mg IV every 3-5 minutes (max 3 mg). NOT used in cardiac arrest (removed from ACLS arrest algorithms). Ineffective in denervated transplanted hearts. First-line drug for symptomatic sinus bradycardia.

Question 21

Adenosine

Accepted Answer

Used for stable, regular, narrow-complex tachycardia (SVT). Dose: 6 mg rapid IV push (1-3 sec), followed by 20 mL NS flush. If no effect: 12 mg rapid push (may repeat once). Must be given rapidly through proximal IV. Causes brief asystole (warn patient). Half-life: <10 seconds.

Question 22

Vasopressin (in ACLS)

Accepted Answer

No longer recommended as a replacement for epinephrine in cardiac arrest (AHA 2020 guidelines). Previously given as alternative to first or second dose of epinephrine (40 units IV). May still be used in combination with corticosteroids for in-hospital cardiac arrest (emerging research).

Question 23

Cardiac Arrest Algorithm Overview

Accepted Answer

Check responsiveness → Call for help/code team → Start CPR → Attach monitor/defibrillator → Rhythm shockable? YES (V-fib/V-tach): shock → CPR 2 min → epinephrine/amiodarone → repeat. NO (PEA/asystole): CPR → epinephrine q3-5 min → treat H's and T's → recheck rhythm every 2 minutes.

Question 24

Tachycardia Algorithm (With Pulse)

Accepted Answer

Unstable (hypotension, altered mental status, chest pain, acute HF): synchronized cardioversion immediately. Stable narrow complex regular: vagal maneuvers → adenosine. Stable narrow complex irregular (A-fib): rate control (diltiazem, beta-blockers). Stable wide complex regular: amiodarone or consider adenosine. Wide irregular: avoid AV nodal blockers.

Question 25

Bradycardia Algorithm

Accepted Answer

Heart rate <50 with symptoms (hypotension, altered mental status, chest pain, shock). 1st line: atropine 1 mg IV (repeat q3-5 min, max 3 mg). If atropine ineffective: transcutaneous pacing OR dopamine infusion (5-20 mcg/kg/min) OR epinephrine infusion (2-10 mcg/min). Prepare for transvenous pacing.

Question 26

Synchronized Cardioversion vs. Defibrillation

Accepted Answer

Cardioversion: synchronized shock timed to QRS complex. Used for unstable tachycardia WITH a pulse (SVT, A-fib, V-tach with pulse). Lower energy. Defibrillation: unsynchronized shock. Used for V-fib and pulseless V-tach. Higher energy. Key: cardioversion has a pulse, defibrillation does not.

Question 27

ROSC (Return of Spontaneous Circulation)

Accepted Answer

Signs: palpable pulse, measurable blood pressure, arterial waveform, abrupt increase in ETCO2 (>40 mmHg), spontaneous breathing. After ROSC: optimize ventilation and oxygenation, treat hypotension, 12-lead ECG, targeted temperature management, identify and treat cause, PCI if STEMI.

Question 28

Targeted Temperature Management (TTM)

Accepted Answer

Cooling the patient to 32-36°C for at least 24 hours after cardiac arrest. Improves neurological outcomes. Indicated for all comatose adults with ROSC. Methods: cooling blankets, ice packs, IV cold saline, intravascular cooling catheters. Monitor for shivering, arrhythmias, coagulopathy. Rewarm slowly (0.25-0.5°C/hr).

Question 29

Advanced Airway: Endotracheal Intubation

Accepted Answer

Definitive airway—tube placed through vocal cords into trachea. Confirm placement: waveform capnography (gold standard), auscultation (bilateral breath sounds, no epigastric sounds), chest rise, SpO2. After placement: ventilate at 10 breaths/min (1 every 6 sec). Continuous compressions (no 30:2 pauses).

Question 30

Supraglottic Airways (SGA)

Accepted Answer

Alternatives to endotracheal intubation: LMA (laryngeal mask airway), King LT, i-gel. Inserted blindly without direct visualization of vocal cords. Faster insertion, less training required. After placement: continuous compressions with ventilation every 6 seconds. Waveform capnography to confirm placement.

Question 31

Waveform Capnography (ETCO2)

Accepted Answer

Measures exhaled CO2. Gold standard for confirming ETT placement and monitoring CPR quality. Normal ETCO2: 35-45 mmHg. During CPR: target ETCO2 ≥10 mmHg (indicates adequate compressions). If <10: improve compression quality. Abrupt rise to ≥40: likely ROSC. Also detects esophageal intubation (no CO2 waveform).

Question 32

Normal Sinus Rhythm

Accepted Answer

Rate: 60-100 bpm. Regular rhythm. P wave before every QRS, QRS after every P. PR interval: 0.12-0.20 sec. QRS duration: <0.12 sec. All criteria must be met. This is the baseline 'normal' rhythm to compare all others against.

Question 33

Sinus Bradycardia

Accepted Answer

Rate: <60 bpm. Regular rhythm. Normal P waves and QRS complexes, just slow. Can be normal in athletes and during sleep. Treat only if symptomatic (hypotension, dizziness, altered mental status, chest pain). Treatment: atropine, pacing, dopamine/epinephrine drip.

Question 34

Sinus Tachycardia

Accepted Answer

Rate: >100 bpm (usually 100-150). Regular rhythm. Normal P waves, narrow QRS. Sinus tachycardia is a RESPONSE, not a primary arrhythmia. Causes: pain, fever, anxiety, hypovolemia, anemia, hypoxia, PE, sepsis. Treat the underlying cause, NOT the rhythm itself.

Question 35

Atrial Fibrillation (A-Fib)

Accepted Answer

Most common sustained arrhythmia. Irregularly irregular rhythm. No identifiable P waves (chaotic atrial activity). Narrow QRS (usually). Rate can be rapid (>100), controlled (60-100), or slow (<60). Risks: stroke (stagnant blood → clots), hemodynamic instability. Treatment: rate control, anticoagulation, possible cardioversion.

Question 36

Third-Degree (Complete) Heart Block

Accepted Answer

Complete AV dissociation—no atrial impulses reach the ventricles. P waves march at their own rate, QRS at a different rate (no relationship). Ventricular rate usually 20-40 bpm (junctional or ventricular escape). Often symptomatic. Treatment: transcutaneous pacing immediately, transvenous pacing. Atropine may be tried but often ineffective.

Question 37

High-Performance CPR Team Roles

Accepted Answer

Team Leader: directs resuscitation, makes decisions. Compressor: high-quality compressions, switches every 2 minutes. Airway Manager: BVM ventilation, advanced airway. IV/IO/Medications: establishes access, pushes drugs. Monitor/Defibrillator: attaches monitor, charges/delivers shocks. Recorder/Timer: tracks time, interventions, medications.

Question 38

Closed-Loop Communication

Accepted Answer

Team Leader gives order → Team Member repeats order back → Team Member performs task → Team Member reports completion. Example: 'Give 1 mg epinephrine IV.' → 'Giving 1 mg epinephrine IV.' → (administers) → '1 mg epinephrine given.' Reduces errors and ensures clear communication during high-stress situations.

Question 39

Acute Stroke Assessment and Management

Accepted Answer

Recognize symptoms (FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 911). Note time of onset. Assess with NIH Stroke Scale. CT scan to differentiate ischemic vs. hemorrhagic. Ischemic (87%): tPA within 4.5 hours of onset. Do NOT lower BP aggressively unless >220/120 (ischemic) or >180/110 (if tPA candidate).

Question 40

Drowning Resuscitation

Accepted Answer

Priority: rescue breathing (drowning is primarily a respiratory arrest). 5 rescue breaths initially. If no pulse: start CPR (C-A-B). Continue standard CPR. Do NOT attempt to drain water from lungs (Heimlich is not recommended for drowning). Hypothermia may provide neuroprotection—aggressive resuscitation warranted.

Question 41

Opioid Overdose (BLS/ACLS)

Accepted Answer

Signs: unresponsiveness, slow/absent breathing, pinpoint pupils. BLS: call 911, check breathing/pulse, start CPR if needed, give naloxone (Narcan) 2 mg IN or 0.4 mg IM/IV. May repeat every 2-3 minutes. Continue rescue breathing/CPR as needed. Naloxone wears off in 30-90 min—monitor for recurrence. Transport all patients.

Question 42

Cardiac Arrest in Pregnancy

Accepted Answer

Manual left uterine displacement (LUD) to relieve aortocaval compression. Standard ACLS medications and defibrillation safe in pregnancy. IV access above the diaphragm. If no ROSC by 4-5 minutes: perimortem cesarean delivery to improve maternal resuscitation. Do NOT delay defibrillation for any reason.

Question 43

Hyperkalemia-Induced Cardiac Arrest

Accepted Answer

ECG: peaked T waves → widened QRS → sine wave → V-fib/asystole. Treatment: calcium chloride 10% (10 mL IV) for cardiac membrane stabilization, sodium bicarbonate (50 mEq IV), insulin + glucose (shifts K+ into cells), albuterol (nebulized), kayexalate, emergent dialysis. Treat the potassium to treat the arrest.

Question 44

Intraosseous (IO) Access

Accepted Answer

Alternative to IV when vascular access cannot be established within 90 seconds. Sites: proximal tibia (preferred), humeral head, distal tibia, sternum (adults). Onset of action equivalent to central IV. Can infuse any ACLS medication and fluids. Complications: fracture, compartment syndrome, osteomyelitis (rare).

Question 45

CPR Quality Metrics

Accepted Answer

Compression rate: 100-120/min. Depth: 2-2.4 inches. Full recoil: no leaning. Chest compression fraction (CCF): >80% (minimizing pauses). Ventilation: avoid excessive rates. ETCO2 >10 mmHg during CPR. Use real-time feedback devices when available. These metrics directly correlate with survival.

Question 46

Defibrillation Energy Levels

Accepted Answer

Biphasic (most modern devices): initial shock 120-200 J (device-specific), subsequent shocks same or higher. Monophasic: 360 J for all shocks. Pediatric: 2 J/kg first shock, 4 J/kg subsequent. Synchronized cardioversion for SVT/A-fib: 100-200 J. For A-flutter: 50-100 J. For V-tach with pulse: 100 J.

Question 47

Dopamine Infusion

Accepted Answer

Used for symptomatic bradycardia unresponsive to atropine or as vasopressor. Dose-dependent effects: Low (1-5 mcg/kg/min): renal vasodilation. Moderate (5-10 mcg/kg/min): beta-1 effects (increased HR, contractility). High (10-20 mcg/kg/min): alpha effects (vasoconstriction). Mix in D5W, use infusion pump.

Question 48

Magnesium Sulfate in ACLS

Accepted Answer

Indicated for: Torsades de Pointes (polymorphic V-tach with long QT), known hypomagnesemia, refractory V-fib. Dose: 1-2 g IV over 5-20 minutes (or push in cardiac arrest). Dilute in D5W. Side effects: hypotension, respiratory depression, loss of deep tendon reflexes. Monitor closely.

Question 49

Termination of Resuscitation Guidelines

Accepted Answer

Consider if: unwitnessed arrest, no bystander CPR, no ROSC after full ALS efforts, no shockable rhythm at any time, ETCO2 <10 after 20 minutes. BLS rule of termination: not witnessed, no AED shock, no ROSC before transport. Decision made by team leader/medical director. Document thoroughly.

Question 50

Post-Resuscitation Debriefing

Accepted Answer

Structured team review after every resuscitation attempt. Discuss what went well, what could improve, and emotional impact. Uses: improve future performance, identify system issues, support team well-being. Should be blame-free and conducted soon after the event. Both 'hot' (immediate) and 'cold' (delayed, data-reviewed) debriefings are valuable.

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