ACLS Bradycardia Quiz #2 focuses on the bradycardia algorithm of the ACLS Protocol.
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Question 1 of 10
1. Question
The correct dose of dopamine given in the bradycardia algorithm is:
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Question 2 of 10
2. Question
The key clinical question when determining steps to take for the patient with symptomatic bradycardia is:
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Question 3 of 10
3. Question
The treatment sequence for bradycardia with poor perfusion is:
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Question 4 of 10
4. Question
Transcutaneous pacing should be started immediately if:
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Question 5 of 10
5. Question
If transcutaneous pacing is ineffective for symptomatic bradycardia, the next step would be to prepare for:
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Question 6 of 10
6. Question
(True or False)
Atropine doses of less than 0.5mg may paradoxically result in further slowing of the heart rate.CorrectIncorrect -
Question 7 of 10
7. Question
For bradycardia unresponsive to atropine, what other drug should be considered?
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Question 8 of 10
8. Question
If atropine fails, the treatment of choice for symptomatic bradycardia with signs of poor perfusion is ____________.
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Question 9 of 10
9. Question
The correct dose of epinephrine given in the bradycardia algorithm is:
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Question 10 of 10
10. Question
The correct dose of atropine given in the bradycardia algorithm is:
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Jeffrey Bomber says
Doesn’t the ACLS Algoithm still call for Atropine first in this scenario?
Jeff with admin. says
“In the 2010 up date it said initial treatment of bradycardia is Atropine.”
On page 111 of the AHA Provider Manual it states:
“Atropine administration should not delay the implementation of external pacing for patients with poor perfusion.”
Also on page 111 it states:
“Do not rely on atropine in Mobitz Type II and also 3rd degree block or in patients with third-degree AV block with a new wide QRS complex.”
The above would be the main reason for skipping over the atropine and going straight to TCP if it is ready for use.
Kind regards,
Jeff
gganne says
If the patient is DNR, are you still going to treat the patient whether the Brady is caused by another illness/problem or the heart slowing down?
Jeff with admin. says
A DNR patient’s bradycardia can and should be treated. Once the patient has moved from having symptoms and being unstable to being pulseless then the DNR would take affect. DNR is “Do Not Resuscitate.” Any problem while the patient has a pulse should be treated.
Kind regards,
Jeff
ACLS recert says
Provide comfort measures only
rs2390 says
This wasn’t a question that was asked but rather a concept stated in the manual which confuses me a little. WHEN exactly would you use TCP or chemical pacers (Epi, Dopamine) over Atropine in the bradycardic patient? As stated on the manual in page 111 it says “Do not rely on atropine in Mobitz type II or third degree AV block”, so I’m not sure how that concept also goes with using pacers as opposed to Atropine. Thanks for the help Jeff!
Jeff with admin. says
For unstable bradycardia in the presence of Mobitz II and 3rd degree block, I would not hesitate to use electrical pacing. If electrical pacing was not available then I would go for chemical pacing. Depending on the situation, I may or may not attempt atropine. Atropine will probably not do anything in this case, but in the case of MI induced bradycardia, atropine could be detrimental. If I suspect MI (12 lead EKG) then I would skip any atropine.
For most other situations, atropine would be appropriate, and I would use this first. In most cases excepting the above mentioned, I would choose electrical TCP over chemical pacing if electrical pacing is available or if electrical pacing failed to capture and stabilize the patient. It seems to me that electrical pacing is easier to manage with minimal side effects to manage, and it can always be shut off.
I hope this answers your question.
Kind regards,
Jeff
Joel Parker Overton says
This site is the best. I took the may 17th exam, didn’t know about the website until two weeks prior. Because of this site I was able to pass!!!!! Thank you. recommending this site to my fellow nurses!
jramo2008 says
Hi Jeff,
atropine doses of less than 0.5mg may paradoxically result in further slowing of the heart rate.
Can this also happen if the atropine is pushed to slow.
Jeff with admin. says
Yes, if atropine is pushed to slow, this could elicit the same paradoxical effect as if you were giving a lower dose. This is because the delivery of the atropine to the body would not be in bolus form and therefore the dose could vary depending on the rapidity with which it is delivered.
Kind regards,
Jeff
Karenau says
I have a 2010 acls manual. Is there a newer version? Karen
Jeff with admin. says
The version you have will provide you with the information that you need. There is a newer addition, but it is basically the same. The guidelines changed in 2010 and they will be in effect through 2015. In 2015, AHA meets again and reevaluates the guidelines and makes changes.
Kind regards,
Jeff
klyball says
I have not been ACLS certified since 1997. I have the 2010 ACLS provider manual and I am working through your site. To take the written exam (50 questions?) what percentage on the quizzes/tests should I be getting to be confident I will pass the first time?
Jeff with admin. says
Since you have time to study, I would shoot for getting a 100% on quizzes here on the site. If you miss a question, use the “slide open” rational to check your answers in the provider manual to get an understanding. If this fully does not answer your question, you can comment at the site and I will reply to you.
I am fully confident that if you go through everything on the site, you will be fully prepared for both the written exam and the megacode skills station.
Use the checklist in the download library to help you cover everything on the site.
Kind regards,
Jeff
kmillerflightrn says
2) correct answer says epi that is NOT weight based. But in the post arrest it says weight based. Why must they confuse us with different calcs?
Jeff with admin. says
Epinephrine is not weight based for both because the dosing for treatment of hypotension with epinephrine is a much higher dose than that used for pacing in symptomatic bradycardia.
For instance, if you are treating a 70 kg adult for hypotension post arrest the dose of 0.1-0.5 mcg/kg/min will be 7-35 mcg per minute.
If you are treating any adult for symptomatic bradycardia with epinephrine your dose will be 2-10 mcg/min.
This is a big difference in dosing especially at the higher end.
Kind regards,
Jeff
orangele says
On the question: “The treatment of choice for symptomatic bradycardia with signs of poor perfusion is___________” the correct answer is show as transcutaneous pacing in the quiz. I thought that atropine was the first treatment, and THEN transcutaneous pacing is used IF atropine is ineffective.
Jeff with admin. says
2010 AHA ACLS Manual pg. 113. Transcutaneous pacing should not be delayed for patients who are unstable due to a slow heart rate. It is noninvasive and has a high rate of success for improving the clinical condition of patients with symptomatic bradycardia.
Kind regards,
Jeff
BetsyB says
Agree manual indicates atropine as first line treatment for symptomatic bradycardia with poor perfusion. p110 Decision point: “If the patient has poor perfusion, proceed to box 5”
P 109 algorithm: box 5 “If atropine ineffective: transcutaneous pacing OR..”
P109 FYI guidelines: the initial treatment of bradycardia is atropine. If bradycardia unresponsive…”
P110 treatment sequence summary: “If the patient has poor perfusion secondary to bradycardia, the treatment sequence is as follows: Give atropine as first-line treatment. If atropine is ineffective”
P111 “In the absence of immediately reversible causes, atropine remains the first-line drug for acute symptomatic bradycardia”
Agree : There is room for modifying order of treatment based on specific extenuating circumstances, absence of IV, hi-degree block, etc and TCP should not be delayed if IV not yet in place.
P111 “..sequence determined by severity of pt clinical presentation”
P111 “Do not rely on atropine in Mobitz type II……”
P113 “Atropine may increase heart rate, improve hemodynamics, and eliminate the need for pacing. If atropine is ineffective or likely to be ineffective or IV access or atropine administration is delayed, begin pacing as soon as it is available. ”
Maybe reword the question???
Amy Rendleman says
Hi I requested this but dont know if it got on the right site. Is there a site where it shows on the
defibulator which buttons to push to sync, pace etc. AND how to use them? Thanks, amy
Jeff with admin. says
Each defibrillator/pacer is different. You should be given a chance to become familiar with the use of the defibrillator/pacer during your ACLS certification class.
Kind regards,
Jeff
lynn1 says
Jeff I would like to take a moment to thank you for this site. It’s pretty helpful and much better than the provided material to study for a 2 day certification class.
As I keep looking at the strips and medications, I am getting confused on how to read the ECG and the medication dosing. I am trying to gather as much info as I can because I am taking my exam on tuesday. Any suggestions or ideas will be highly appreciated. Thank again Jeff for this wonderful site and God bless.
Jeff with admin. says
As far as ECG rhythm strip id goes, you should only have to do quick identification that is on a monitor during the megacode. You may have to identify a couple of rhythms on the written test, but this should be very basic. Review the information and links on this page.
Know these medications and how to use them: Epinephrine, Vasopressin, Amiodarone, and Atropine
These can be reviewed from this page.
Let me know if you have any specific questions.
Kind regards,
Jeff
butch says
where did you get the information that less than 0.5 mg of IV atropine may result in slowing the heart rate?
Jeff with admin. says
From the ACLS provider manual pg. 111. It states: “Atropine doses of <0.5mg may paradoxically result in further slowing of the heart rate.”
Kind regards,
Jeff
Code-hanadi says
Confused
Wat’s meaning is pt a DNR
Jeff with admin. says
Do Not Resuscitate.
RNAriel98 says
In relation to rationale of Q#9
2010 AHA ACLS Manual pg. 112. Epinephrine along with dopamine can be considered for the treatment of bradycardia within the bradycardia algorithm.
Can you consider Vasopressin as well for treatment of bradycardia? Since Epi1mg can be replaced with Vaso 40u. 🙂
Jeff with admin. says
AHA guidelines does not included the use of a vasopressin drip as a replacement for the epinephrine/dopamine drip. I believe the main reason would be that vasopressin does not have a positive chronotropic effect as epinephrine does. Meaning that vasopressin does not increase the heart rate the way that epinephrine or dopamine does.
The use of epinephrine 1mg or vasopressin 40U in the pulseless arrest algorithms is primarily for the vasopressor (blood pressure) effects.
Kind regards,
Jeff
jtrit1 says
I’m a respiratory therapist, any advice on how to remember the amount of all the drug doses quickly? I’m cramming, have to take this tommorrow, I should have been looking at this info. a couple weeks ago, by the way this is 10x better than the class they offer
Jeff with admin. says
Here are a couple of things that help me:
(Pulsless Arrest Algorithm)
E1 = Epinephrine 1mg
V40=Vasopressin 40 Units
A300 and A150= Amiodarone 300 mg and then 150 mg
(Bradycardia Algorithm)
AB ½ = Atropine 0.5mg for Bradycardia
These would be the main medications that I would focus on if I were cramming.
Also it will be good to know that dopamine and epinephrine infusions are an adequate replacement if TCP is not available.
Kind regards and good luck,
Jeff
Nicole Dunbar says
Nice to know!