Assessment: ALS Recertification (Legacy)

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Question 1 of 15

1. Question
According to the RECOVER CPR algorithm, which of the following would be the first step in initiating ALS in a patient that arrested due to an inadvertent overdose of fentanyl?
- Administer flumazenil
- Administer naloxone
- Defibrillate
- Attach the ECG leads
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Question 2 of 15

2. Question
During CPR, what is the minimum EtCO₂ associated with good quality chest compressions?
- 10 mmHg
- 15 mmHg
- 20 mmHg
- 25 mmHg
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Question 3 of 15

3. Question
A patient in the ICU arrests. After the first cycle of BLS, you diagnose asystole and decide to administer epinephrine. What is your best route of administration?
- Cephalic catheter
- Red rubber catheter through the endotracheal tube
- Jugular catheter
- Intracardiac injection
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Question 4 of 15

4. Question
A patient is premedicated for an enucleation and spay with midazolam and methadone. Surgery is complicated and takes 3 hours. One hour after extubation, the patient experiences CPA. Which of the following is true?
- Atipamezole and flumazenil are indicated.
- Flumazenil and naloxone are indicated.
- Atipamezole and naloxone are indicated.
- Because it has been 4 hours since administration of the premedication, reversal agents are unlikely to be effective.
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Question 5 of 15

5. Question
You admit a 35 kg Golden Retriever to the hospital for a pyometra surgery. When discussing options, the owner asks to have open-chest CPR (OCCPR) performed only if closed-chest CPR does not seem effective. What is the correct response?
- Because her dog is round-chested and better cardiac output can be achieved with closed-chest CPR than with open-chest CPR, you recommend not doing OCCPR.
- Because her dog is more likely to have a good outcome with immediate open-chest CPR than starting with closed-chest CPR and then switching later into OCCPR, you recommend starting OCCPR as soon as possible.
- Because of the morbidity associated with open-chest CPR, it is reasonable to start with closed-chest CPR and convert to open-chest if there is no response.
- Because her dog will likely be on the surgery table if an arrest occurs, performing closed-chest CPR with sternal compressions is the most ideal.
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Question 6 of 15

6. Question
A patient in your hospital collapses suddenly and becomes apneic. You initiate BLS and attach an ECG monitor. At the end of the first cycle of BLS, you pause chest compressions briefly and see a rhythm with repeating complexes lacking p-waves at a rate of 216 per minute, but you do not feel a pulse or apex beat. What is your rhythm diagnosis?
- VF
- Asystole
- PEA
- Perfusing Rhythm
- Pulseless VT
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Question 7 of 15

7. Question
What is the goal of vasopressor therapy during CPR?
- To correct metabolic acidosis
- To increase cardiac contractility
- To increase heart rate
- To redirect blood to the core organs
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Question 8 of 15

8. Question
After administering the first dose of a vasopressor during CPR in a dog with a non-shockable rhythm, if there is NO return of spontaneous circulation, how long should you wait before giving another dose?
- 2 minutes
- 4 minutes
- 6 minutes
- Vasopressors should not be repeated
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Question 9 of 15

9. Question
As you monitor a 5-year-old female spayed Labrador under anesthesia, she develops a ventricular tachycardia at a rate of 190/minute, which rapidly progresses to asystole with no palpable pulses. According to the RECOVER CPR guidelines, what is the first treatment priority?
- Administer lidocaine
- Start chest compressions
- Start manual ventilation at 10 breaths per minute
- Administer low-dose epinephrine
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Question 10 of 15

10. Question
Why is high-dose epinephrine recommended in patients with prolonged CPA only as a last-ditch effort?
- High-dose epinephrine has been associated with an increased rate of ROSC during CPR, but also with a lower rate of survival to discharge.
- High-dose epinephrine increases the energy required to successfully defibrillate the patient.
- Low-dose epinephrine causes higher cardiac output with chest compressions when compared to high-dose epinephrine.
- The recommendation is incorrect. High-dose epinephrine is recommended over low-dose epinephrine unless the patient is in CPA for a prolonged amount of time.
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Question 11 of 15

11. Question
If the team does not agree on the rhythm diagnosis during the pause in chest compressions at the end of a BLS cycle, how should they proceed?
- Delay resumption of chest compressions until all members of the team examine the ECG and agree upon a rhythm diagnosis.
- Halt all discussions and perform one more cycle of BLS and wait until the next pause before revisiting the ECG.
- Resume compressions while discussing the rhythm diagnosis and come to a consensus as quickly as possible.
- Perform 30 seconds of compressions to allow for blood flow, then pause briefly to re-evaluate the ECG to reach a diagnosis.
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Question 12 of 15

12. Question
Both pulseless VT and PEA are associated with consistent, repeating complexes on the ECG but no palpable pulse. PEA is most reliably associated with which of the following?
- Narrower QRS complexes
- The presence of P waves
- Tented T waves
- A rate of less than 200 beats per minute
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Question 13 of 15

13. Question
At the end of a cycle of BLS, you evaluate the ECG and diagnose ventricular fibrillation. You continue chest compressions while charging the defibrillator and then pause compressions to administer the shock. What is the correct next step?
- Immediately start the next cycle of BLS and defibrillate every other cycle as long as a shockable rhythm is present.
- Evaluate the ECG and shock 2 more times (“stacked shocks”). If the patient is still in VF, restart BLS after the third shock.
- Immediately resume chest compressions until 2 minutes from the time chest compressions were started before defibrillating (e.g., the beginning of the BLS cycle), then defibrillate again if the patient is still in VF.
- Immediately resume chest compressions, restarting the 2-minute timer from the delivery of the shock and then defibrillate again if the patient is still in VF.
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Question 14 of 15

14. Question
A patient has been in pulseless VT for five cycles of CPR, meeting the criteria for prolonged pulseless VT. You have been treating with good quality BLS and electrical defibrillation. Which of the following is a correct additional ALS intervention according to the RECOVER guidelines?
- Intravenous lidocaine
- A precordial thump
- Intravenous sodium bicarbonate
- Intracardiac amiodarone
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Question 15 of 15

15. Question
All of the following improve electrical defibrillator safety EXCEPT:
- Multiple team members holding the patient in dorsal recumbency during the shock
- Standing away from the treatment table, especially if it is metal
- Using electroconductive gel on ECG clips
- Calling out “Clear” and verifying that all personnel are away from the patient
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Assessment: ALS Recertification (Legacy)

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