ACLS question & Answer According to AHA 2025 guideline

 1. What is the first step when an adult patient is found unresponsive?

Answer: Check responsiveness, activate emergency response system, check breathing and pulse simultaneously.

2. What is the recommended pulse check duration?

Answer: At least 5 seconds but no more than 10 seconds.

3. What compression rate is recommended during CPR?

Answer: 100–120 compressions per minute.

4. What compression depth is recommended for adults?

Answer: At least 2 inches (5 cm) but not more than 2.4 inches (6 cm).

5. What is the compression-to-ventilation ratio without an advanced airway?

Answer: 30:2.

6. How often should rescuers switch compressors?

Answer: Every 2 minutes.

7. What rhythm requires immediate defibrillation?

Answer: Ventricular fibrillation (VF) & Pulseless ventricular tachycardia (pVT).

8. Which rhythm is shockable?

Answer: Pulseless ventricular tachycardia (pVT).

9. Which rhythms are non-shockable?

Answer: Asystole and pulseless electrical activity (PEA).

10. What is the first medication for VF/pVT arrest?

Answer: Epinephrine 1 mg IV/IO every 3–5 minutes.

11. When should epinephrine be given in non-shockable rhythms?

Answer: As soon as IV/IO access is established.

12. What is the epinephrine dose during cardiac arrest?

Answer: 1 mg IV/IO every 3–5 minutes.

13. What antiarrhythmic is preferred for refractory VF/pVT?

Answer: Amiodarone.

14. What is the first amiodarone dose?

Answer:1st dose amiodarone 300 mg IV/IO bolus  during cardiac arrest only .

15. What is the second amiodarone dose?

Answer: 150 mg IV/IO.

16. What is an alternative to amiodarone?

Answer: Lidocaine.

17. What is the first lidocaine dose?

Answer: 1–1.5 mg/kg IV/IO.

18. What is the maximum total lidocaine dose?

Answer: 3 mg/kg.

19. What is ROSC?

Answer: Return of spontaneous circulation.

20. What ETCO₂ value suggests high-quality CPR?

Answer: ≥10 mmHg.

21. Sudden increase in ETCO₂ may indicate what?

Answer: ROSC.

22. What is the preferred route for ACLS medications?

Answer: IV or IO.

23. Which vasopressor is routinely recommended during cardiac arrest?

Answer: Epinephrine.

24. Is atropine recommended for asystole?

Answer: No.

25. What are the H's and T's used for?

Answer: Identifying reversible causes of cardiac arrest.

26. Name the H's.

Answer: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia.

27. Name the T's.

Answer: Tension pneumothorax, Tamponade, Toxins, Thrombosis coronary, Thrombosis pulmonary.

28. What is the preferred airway strategy initially?

Answer: Bag-mask ventilation with high-quality CPR.

29. What ventilation rate is used after advanced airway placement?

Answer: 10 breaths/minute.

30. Should chest compressions pause during advanced airway ventilation?

Answer: No.

31. What rhythm is treated with synchronized cardioversion?

Answer: Unstable tachycardia with a pulse.

32. What is the first-line drug for stable narrow-complex SVT?

Answer: Adenosine.

33. What is the first adenosine dose?

Answer: 6 mg rapid IV push.

34. What is the second adenosine dose?

Answer: 12 mg rapid IV push.

35. What is symptomatic bradycardia?

Answer: Bradycardia causing hypotension, shock, altered mental status, ischemia, or heart failure.

36. First drug for symptomatic bradycardia?

Answer: Atropine.

37. Atropine dose for bradycardia?

Answer: 1 mg IV every 3–5 minutes.

38. Maximum atropine dose?

Answer: 3 mg.

39. If atropine fails, what is next?

Answer: Transcutaneous pacing.

40. Dopamine infusion dose?

Answer: 5–20 mcg/kg/min.

41. Epinephrine infusion dose for bradycardia?

Answer: 2–10 mcg/min.

42. What is unstable tachycardia?

Answer: Tachycardia causing hypotension, shock, chest pain, altered mental status, or heart failure.

43. What should be done for unstable tachycardia?

Answer: Immediate synchronized cardioversion.

44. What energy is used for narrow regular tachycardia?

Answer: 50–100 J synchronized.

45. What energy is used for atrial fibrillation cardioversion?

Answer: 120–200 J biphasic.

46. What energy is used for monomorphic VT with pulse?

Answer: 100 J synchronized.

47. What is torsades de pointes?

Answer: Polymorphic ventricular tachycardia associated with prolonged QT interval.

48. Drug of choice for torsades de pointes?

Answer: Magnesium sulfate.

49. Magnesium sulfate dose?

Answer: 1–2 g IV/IO.

50. What is the most important determinant of survival from cardiac arrest?

Answer: Early recognition, high-quality CPR, and rapid defibrillation.

51. What is the primary goal of post–cardiac arrest care?

Answer: Optimize ventilation, oxygenation, hemodynamics, and neurological recovery.

52. What oxygen saturation should generally be targeted after ROSC?

Answer: Maintain oxygen saturation in the normal range, typically 92–98%, avoiding hyperoxia.

53. What PaCO₂ goal is generally recommended after ROSC?

Answer: Maintain normocapnia.

54. What blood pressure target is important after ROSC?

Answer: Avoid hypotension and maintain adequate organ perfusion.

55. What is targeted temperature management (TTM)?

Answer: Active temperature control to improve neurological outcomes after cardiac arrest.

56. Why should fever be avoided after ROSC?

Answer: Fever may worsen neurological injury.

57. What is the preferred method for confirming endotracheal tube placement?

Answer: Continuous waveform capnography.

58. What ETCO₂ finding strongly suggests proper tube placement?

Answer: Persistent waveform capnography with appropriate ETCO₂ values.

59. What is pulseless electrical activity (PEA)?

Answer: Organized electrical activity without a palpable pulse.

60. Can PEA be defibrillated?

Answer: No.

61. What should be done immediately after a defibrillation shock?

Answer: Resume CPR immediately.

62. How long should CPR continue before rhythm reassessment?

Answer: About 2 minutes.

63. What is the purpose of minimizing interruptions in chest compressions?

Answer: To maintain coronary and cerebral perfusion.

64. What is the preferred compression fraction during CPR?

Answer: Greater than 60%, ideally above 80%.

65. What is compression fraction?

Answer: The percentage of resuscitation time during which compressions are performed.

66. What does ETCO₂ less than 10 mmHg during CPR suggest?

Answer: Inadequate perfusion or poor-quality CPR.

67. What is the role of point-of-care ultrasound during arrest?

Answer: Assist in identifying reversible causes without delaying CPR.

68. What medication is not routinely recommended during PEA?

Answer: Atropine.

69. What reversible cause should be suspected in a dialysis patient with arrest?

Answer: Hyperkalemia.

70. What ECG change is commonly associated with hyperkalemia?

Answer: Peaked T waves.

71. What medication stabilizes the myocardium in severe hyperkalemia?

Answer: Calcium chloride or calcium gluconate.

72. What treatment shifts potassium into cells?

Answer: Insulin with glucose.

73. What is a common cause of PEA after major trauma?

Answer: Hypovolemia.

74. What reversible cause should be considered after chest trauma with absent breath sounds?

Answer: Tension pneumothorax.

75. What is the definitive treatment for tension pneumothorax?

Answer: Immediate decompression.

76. What condition should be suspected in sudden arrest with jugular venous distension and muffled heart sounds?

Answer: Cardiac tamponade.

77. What is the treatment for cardiac tamponade?

Answer: Pericardiocentesis.

78. What reversible cause should be suspected in sudden arrest after prolonged immobility?

Answer: Pulmonary embolism.

79. What is coronary thrombosis?

Answer: Acute coronary artery occlusion causing myocardial infarction.

80. What should be considered after ROSC in STEMI patients?

Answer: Emergent coronary reperfusion therapy.

81. What is the first step in managing stable tachycardia?

Answer: Assess QRS width and patient stability.

82. What defines a wide-complex tachycardia?

Answer: QRS duration ≥0.12 seconds.

83. What defines a narrow-complex tachycardia?

Answer: QRS duration <0.12 seconds.

84. Can adenosine be considered for regular monomorphic wide-complex tachycardia?

Answer: Yes, if rhythm is regular and monomorphic.

85. What should be avoided in irregular polymorphic wide-complex tachycardia?

Answer: Adenosine.

86. What is the treatment for unstable ventricular tachycardia with a pulse?

Answer: Immediate synchronized cardioversion.

87. If synchronization is not possible in unstable VT, what should be done?

Answer: Deliver an unsynchronized shock (defibrillation).

88. What is the hallmark ECG finding of atrial fibrillation?

Answer: Irregularly irregular rhythm without distinct P waves.

89. What is the hallmark ECG finding of atrial flutter?

Answer: Sawtooth flutter waves.

90. What is monomorphic ventricular tachycardia?

Answer: VT with uniform QRS morphology.

91. What is polymorphic ventricular tachycardia?

Answer: VT with varying QRS morphology.

92. What medication may be used for stable monomorphic VT?

Answer: Amiodarone.

93. What is a common loading dose of amiodarone for stable VT?

Answer: 150 mg IV over 10 minutes.

94. What is a major goal during ACLS resuscitation?

Answer: Identify and treat reversible causes while providing high-quality CPR.

95. Why is excessive ventilation harmful during CPR?

Answer: It increases intrathoracic pressure and decreases venous return.

96. What ventilation rate is recommended without an advanced airway?

Answer: Two breaths after every 30 compressions.

97. What should rescuers do if they are unsure whether a pulse is present?

Answer: Begin chest compressions.

98. What is the purpose of waveform capnography during CPR?

Answer: Monitor CPR quality and detect ROSC.

99. Which intervention has the greatest impact on survival from VF arrest?

Answer: Early defibrillation.

100. What are the three priorities in every ACLS cardiac arrest?

Answer: High-quality CPR, rapid defibrillation when indicated, and treatment of reversible causes.

101. What is the first priority when managing any cardiac arrest?

Answer: High-quality CPR.

102. What is the recommended chest recoil during CPR?

Answer: Complete chest recoil after each compression.

103. Why is complete chest recoil important?

Answer: It allows adequate venous return to the heart.

104. What should be minimized during CPR?

Answer: Interruptions in chest compressions.

105. What is the preferred action when a shockable rhythm is identified?

Answer: Deliver a shock as soon as possible.

106. What should occur immediately after defibrillation?

Answer: Resume CPR without checking the pulse.

107. What is ventricular fibrillation (VF)?

Answer: Chaotic ventricular electrical activity without effective cardiac output.

108. What is pulseless ventricular tachycardia (pVT)?

Answer: Ventricular tachycardia without a detectable pulse.

109. Which rhythm appears as a flat line on ECG?

Answer: Asystole.

110. Is asystole a shockable rhythm?

Answer: No.

111. What medication is routinely administered in asystole?

Answer: Epinephrine.

112. How often should rhythm checks occur during cardiac arrest?

Answer: Every 2 minutes.

113. What is the purpose of rhythm checks?

Answer: Determine whether a shock is indicated and assess for ROSC.

114. What does ROSC stand for?

Answer: Return of spontaneous circulation.

115. What clinical signs suggest ROSC?

Answer: Pulse, blood pressure, spontaneous breathing, and abrupt ETCO₂ rise.

116. What ETCO₂ increase may indicate ROSC?

Answer: A sudden sustained increase, often above 35–40 mmHg.

117. Which airway adjunct may be used before intubation?

Answer: Oropharyngeal airway (OPA).

118. When is an OPA contraindicated?

Answer: In a conscious patient with a gag reflex.

119. What airway adjunct can be used in semi-conscious patients?

Answer: Nasopharyngeal airway (NPA).

120. What is the most reliable method to monitor CPR quality?

Answer: Quantitative waveform capnography.

121. What is the purpose of an AED?

Answer: Analyze rhythm and deliver defibrillation if needed.

122. What does AED stand for?

Answer: Automated External Defibrillator.

123. Should CPR be stopped while the AED is charging?

Answer: No, continue CPR until instructed otherwise.

124. What is synchronized cardioversion used for?

Answer: Unstable tachycardia with a pulse.

125. What is defibrillation used for?

Answer: VF and pulseless VT.

126. Why is synchronization important during cardioversion?

Answer: To avoid delivering a shock during ventricular repolarization.

127. What is the "R-on-T" phenomenon?

Answer: A shock delivered during the vulnerable period of repolarization causing VF.

128. What is the usual first intervention for symptomatic bradycardia?

Answer: Atropine.

129. What if atropine is ineffective?

Answer: Consider pacing, dopamine infusion, or epinephrine infusion.

130. What is transcutaneous pacing?

Answer: Electrical stimulation through the chest wall to increase heart rate.

131. Which patients require immediate pacing?

Answer: Those with severe symptomatic bradycardia not responding to atropine.

132. What rhythm commonly causes sudden cardiac arrest in adults?

Answer: Ventricular fibrillation.

133. What is the leading cause of VF?

Answer: Acute coronary syndrome.

134. What is the first-line treatment for opioid-associated respiratory arrest?

Answer: Ventilation support and naloxone.

135. What medication reverses opioid overdose?

Answer: Naloxone.

136. Can naloxone replace CPR in cardiac arrest?

Answer: No.

137. What is the importance of ventilation in opioid emergencies?

Answer: Hypoxia is the primary life-threatening problem.

138. What is the recommended ventilation rate for adults with a pulse but not breathing?

Answer: One breath every 6 seconds.

139. How often should the pulse be reassessed during rescue breathing?

Answer: Every 2 minutes.

140. What is coronary perfusion pressure?

Answer: Pressure gradient supplying blood flow to the heart during CPR.

141. Why are uninterrupted compressions important?

Answer: They improve coronary perfusion pressure.

142. What is cerebral perfusion?

Answer: Blood flow to the brain.

143. Why is cerebral perfusion critical during arrest?

Answer: It helps prevent neurological injury.

144. What is the purpose of post-arrest neurological assessment?

Answer: Evaluate brain recovery and guide treatment.

145. Why should hyperoxia be avoided after ROSC?

Answer: Excess oxygen may worsen oxidative injury.

146. What should be done if hypoglycemia is identified after ROSC?

Answer: Correct blood glucose appropriately.

147. Why is continuous ECG monitoring important after ROSC?

Answer: Detect arrhythmias and ischemia.

148. What is the preferred hospital destination after ROSC from suspected cardiac causes?

Answer: A facility capable of advanced cardiac and post-arrest care.

149. What is the role of a resuscitation team leader?

Answer: Coordinate care, assign tasks, and maintain ACLS algorithms.

150. What are the key components of effective team dynamics?

Answer: Clear roles, closed-loop communication, mutual respect, and shared mental model.

151. What is closed-loop communication?

Answer: The receiver repeats back the instruction to confirm understanding.

152. Why is closed-loop communication important?

Answer: It reduces errors during resuscitation.

153. What is constructive intervention?

Answer: Team members respectfully correcting potential errors.

154. What is mutual support in ACLS?

Answer: Team members assisting each other to improve performance.

155. What is a mega code ?

Answer: A simulated ACLS resuscitation scenario.

156. What is the first action when VF is recognized?

Answer: Defibrillate immediately.

157. After the second shock in VF/pVT, what medication is administered?

Answer: Epinephrine 1 mg IV/IO.

158. After the third shock in VF/pVT, what medication is considered?

Answer: Amiodarone 300 mg IV/IO.

159. What is refractory VF?

Answer: VF that persists despite multiple shocks.

160. What is the purpose of antiarrhythmic drugs during VF/pVT?

Answer: Increase the likelihood of successful defibrillation.

161. What is the recommended route if IV access cannot be obtained?

Answer: Intraosseous (IO) access.

162. What does IO stand for?

Answer: Intraosseous.

163. How effective is IO medication delivery compared with IV?

Answer: It is considered equivalent in emergencies.

164. What is a common IO insertion site in adults?

Answer: Proximal tibia.

165. What is another common IO insertion site?

Answer: Proximal humerus.

166. Which electrolyte abnormality commonly causes torsades de pointes?

Answer: Hypomagnesemia.

167. Which medication treats torsades de pointes?

Answer: Magnesium sulfate.

168. What is a common cause of bradycardia after inferior MI?

Answer: AV nodal ischemia.

169. What is a third-degree AV block?

Answer: Complete dissociation between atrial and ventricular activity.

170. Which intervention is often required for complete heart block?

Answer: Transcutaneous pacing.

171. What is pulselessness?

Answer: Absence of a palpable central pulse.

172. Which pulse is preferred during adult cardiac arrest assessment?

Answer: Carotid pulse.

173. What is agonal breathing?

Answer: Abnormal gasping respirations seen during cardiac arrest.

174. Should agonal breathing be considered normal breathing?

Answer: No.

175. What is the significance of agonal respirations?

Answer: They may indicate cardiac arrest.

176. What is the purpose of defibrillation?

Answer: Terminate VF or pVT to allow normal rhythm restoration.

177. What is biphasic defibrillation?

Answer: Current flows in two directions between electrodes.

178. Why is biphasic defibrillation preferred?

Answer: It is more effective and requires less energy.

179. What should be checked before delivering a shock?

Answer: Ensure no one is touching the patient.

180. What command is given before shock delivery?

Answer: "Clear!"

181. What is the purpose of capnography after intubation?

Answer: Confirm tube placement and monitor ventilation.

182. What should be suspected if ETCO₂ suddenly falls after intubation?

Answer: Tube displacement or reduced perfusion.

183. What is a common reversible cause in drowning victims?

Answer: Hypoxia.

184. What is the primary treatment for hypoxia?

Answer: Oxygenation and ventilation.

185. What is the purpose of advanced airway placement?

Answer: Secure ventilation and oxygenation.

186. What is a supraglottic airway?

Answer: An airway device positioned above the vocal cords.

187. Give an example of a supraglottic airway.

Answer: Laryngeal mask airway (LMA).

188. Are supraglottic airways acceptable alternatives to intubation?

Answer: Yes.

189. What is the primary determinant of successful resuscitation?

Answer: Early recognition and effective CPR.

190. What is the Chain of Survival?

Answer: Sequence of actions that improve survival from cardiac arrest.

191. What is the first link in the Chain of Survival?

Answer: Early recognition and activation of emergency response.

192. What is the second link?

Answer: High-quality CPR.

193. What is the third link?

Answer: Rapid defibrillation.

194. What is the fourth link?

Answer: Advanced resuscitation.

195. What is the fifth link?

Answer: Post–cardiac arrest care.

196. Why is early defibrillation important?

Answer: Survival decreases with each minute of delay.

197. What is the most common initial rhythm in witnessed sudden cardiac arrest?

Answer: Ventricular fibrillation.

198. What is the goal of ACLS?

Answer: Improve survival and neurological outcomes.

199. What is the cornerstone of successful ACLS?

Answer: High-quality CPR.

200. What are the three most important ACLS principles?

Answer: High-quality CPR, early defibrillation, and Identify and treat reversible causes.

So,

High-quality CPR:

Start chest compressions immediately when indicated.

Compress hard and fast (100–120/min in adults).

Minimize interruptions.

Allow full chest recoil and avoid excessive ventilation.

Early defibrillation for shockable rhythms:

For rhythms such as ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT), rapid defibrillation is one of the most effective interventions.

Deliver shocks as soon as a defibrillator is available and resume CPR promptly afterward.

Identify and treat reversible causes:

ACLS emphasizes finding the underlying reason for the arrest or instability.

Clinicians systematically evaluate the “Hs and Ts” (e.g., hypoxia, hypovolemia, electrolyte abnormalities, tension pneumothorax, cardiac tamponade, toxins, thrombosis) and treat them when possible.