Free BLS & ACLS Exam Flashcards

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.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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).

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).

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.

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).

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.

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.

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.

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.

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.

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.

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.

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).

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.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.