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Practice Quiz for ACLS PEA Case

Quiz Questions

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The patient is a 90-year-old man who was found slumped over on the sofa by his wife. She said he was alert and talkative when she went downstairs to fix lunch. He was left alone about 20 minutes. His son called 911. He is pale and unresponsive. His chest does not noticeably rise and fall. His airway is clear.

1. What do you do first?

You continue to assess the patient using the BLS Primary and Secondary Surveys.
You immediately start managing the patient following the ACLS Pulseless Arrest Algorithm.
You insert an advanced airway.
You administer epinephrine.
A team member administers CPR, and you instruct another team member to give the patient epinephrine (1 mg of 1:10,000 epinephrine IV push) every 3 to 5 minutes.

2. You know that vasopressors have NOT been shown to increase survival rates from asystole, but you request epinephrine for the patient anyway. Why?

3. If the patient does not resuscitate immediately, what are appropriate questions to ask his wife, given his age?

4. The patient has not returned to spontaneous circulation and remains in asystole. It has been 40 minutes since resuscitation efforts began. Can resuscitation efforts be discontinued now?

No. Existing protocol should be reviewed before making the decision to stop.
Yes. It has been longer than 20 minutes, so resuscitation efforts can stop.
Yes or no. Factors other than time should be considered in making this decision.
Yes or no. His wife should make the decision.
All of the above

Quiz Answers

Answer: A. You continue to assess the patient using the BLS Primary and Secondary Surveys. Once your assessment is complete, you immediately start implementing the steps in the algorithm.
Answer: Epinephrine can improve aortic diastolic blood pressure and coronary artery perfusion pressure.
Answer: Does your husband have a DNAR order in place? Would you like us to continue resuscitation?
Answer: E. All of the above. The general consensus is that resuscitation can be discontinued after 20 minutes with no return to spontaneous circulation, but other factors need to be considered. A, B, C, and D are all possible correct answers.