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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Msrikureja says
Transcutaneous Pacer is a temporary measure, not permanent. Therefore, It cannot be the ultimate Treatment of Choice!
cindycrouse says
I understand the logic in the way that you would do it in real time but the brady algorithm starts with atropine not TCP how will it be on the test.
cindycrouse says
I understand that a doctor would just whisk them off to the cathlab but as a nurse wouldn’t it be Atropine then TCP then second dose of atropine. what will be the answer on the test?
Jeff with admin. says
Technically, if you have time to administer atropine then it should be administered. This is correct unless you suspect the bradycardia is being caused by Acute Coronary Syndrome (MI).
Kind regards,
Jeff
Jeff with admin. says
In my experience with the AHA written exams, they expect for atropine to be attempted prior to TCP. You should expect a question in which the administration of atropine will be the first intervention for the treatment of bradycardia. I think that AHA makes this more confusing that it should be, but at this time, it is the way it is.
Kind regards,
Jeff
Robin Warburton says
The ACLS Bradycardia algorithm states to give Dopamine IV infusion 2-10 mcg per min. Is this wrong? Is there more variances?
Jeff with admin. says
Dopamine:
Dopamine in the bradycardia algorithm is 2-20 mcg/kg/min.
Dopamine for the post-cardiac arrest hypotension is 5-10 mcg/kg/min
The dose for a dopamine infusion in both cases is weight based.
Epinephrine:
Epinephrine is weight based for post-cardiac arrest care: 0.1-0.5 mcg/kg/min
Epinephrine IS NOT weight based for bradycardia: 2 to 10 mcg/min
In my humble opinion, AHA needs to simplify all of this for emergencies.
Kind regards,
Jeff
nancyfields@roadrunner.com says
I agree…from a 30+ year critical nurse 😉
Robin Warburton says
Jeff, I am confused. On page 109 on the Adult Bradycardia with pulse algorithm it has Dopmine IV infusionh 2-10 mcg/kg per min., not 2-20. Please forgive me, I did forget to add the wt. issue with my first question and thank you for answering me but I need more clarification.
Jeff with admin. says
Your manual is out of date. You are looking at a 2010 AHA ACLS provider manual. You need the 2015 AHA ACLS provider manual.
Kind regards,
Jeff
Rchaplea says
good source for preparation, but I have a question regarding quiz2, question 7, if transcutaneous pacing is ineffective for symptomatic bradycardia, the correct answer is:to prepare for transcutaneous pacing. is that correct? thanks
Jeff with admin. says
The answer is to prepare for transvenous pacing. Transvenous pacing is a technique that is used to insert the electrical simulation device directly into the venous system so that the current has a direct path to the heart.
Kind regards,
Jeff
lullrich says
Hi Jeff –
I found your website by accident. It has helped me so much. I need ACLS certification for a job I just took. I’ve been a nurse for 17 years – during all of this time, I’ve performed one ECG and have never had to read or know how to read an ECG strip because the primary physician has done this. Therefore, I don’t know the first step on how to read an ECG strip. I’m trying to teach myself through this website and I’ve also found another site that explains the measurements of the boxes and the P, QRS, etc. When I told my manager I have never needed to read an ECG strip before she told me not to worry and that I would “do fine” with the ACLS course. Needless to say, I am scared to death to take this course which is in two weeks. I only hope I can cram enough to get a passing grade – but that’s not the way I like to learn. Just venting – but thanks so much for this site!
Jeff with admin. says
It sounds like you are doing the right things to prepare. I can tell you that if you go through everything on the site using the interactive course guide or the checklist in the download library, you will be fully prepared and you will do great.
I have had students tell me that they felt like they knew it better than the instructor that was testing them.
Let me know how it goes.
Kind regards,
Jeff
JFerwerda says
Q5 Quiz 2 contradicts an answer in Quiz 1. In Q1, I answered “prepare for TCP” as the first step (which would be followed by admin Atropine while getting it set up). It is correct in this question, but was wrong in Q1.
Jeff with admin. says
Quiz 1 Question #1 states: “What is the drug of first choice for symptomatic bradycardia?” Quiz 2 Question #5 states: “The treatment sequence for bradycardia with poor perfusion is:” These are two entirely different questions. One is asking for a sequence and the other is asking for the correct first choice drug to be given with symptomatic bradycardia. Kind regards, Jeff
urszula1 says
Hi, in my hospital we usually use an Isuprel drip when the TCP is not effective insted of epi or dopamine drip.. Is there any mention of Isuprel in the AHA guidelines?
Thank you
Jeff with admin. says
Here is the AHA stance on Isoproterenol (Isuprel). “Although not first-line agents for treatment of symptomatic bradycardia, dopamine, epinephrine, and isoproterenol are alternatives when a bradyarrhythmia is unresponsive to or inappropriate for treatment with atropine, or as a temporizing measure while awaiting the availability of a pacemaker.
Alternative drugs may also be appropriate in special circumstances such as the overdose of a β-blocker or calcium channel blocker…..Isoproterenol is a β-adrenergic agent with β-1 and β-2 effects, resulting in an increase in heart rate and vasodilation. The recommended adult dose for Isoproterenol is 2 to 10 mcg/min by IV infusion, titrated according to heart rate and rhythm response.”
Here is the reference in the ECC/CPR Guidelines: Reference
Kind regards, Jeff
abosuyonov says
Love your site man!
Just a question .
If transcutaneous pacing is ineffective for symptomatic bradycardia, and atropine has been ineffective also , may I give Epi or dopamine first or do we first do transvenous pacing?
Jeff with admin. says
Yes, you can definitely start an epinephrine or dopamine infusion before attempting transvenous pacing.
Kind regards,
Jeff
Kim Hannan says
Again I have Dopamine for Brady at 2-10 mcg/kg/min and titrate. This is the second place I have found the answer to say 2-20 mcg/kg/min.
Jeff with admin. says
See page 125 of the 2016 AHA ACLS provider manual. This is the section on the bradycardia algorithm. It states that as an alternative to transcutaneous pacing dopamine can be used. The dosing is Dopamine 2-20 mcg/kg/min. This is the dosing for heart rate control.
The only other place within ACLS where dopamine is used is in the post-cadiac arrest care algorithm for control of hypotension. The dosing for this is Dopamine 5-10 mcg/kg/min.
You either have an old provider maual that using the 2010 guidelines or some other materaial that is using the 2010 guidelines which listed dopamine for bradycardia at 2-10 mcg/kg/min.
Kind regards,
Jeff
Sarfaraz says
Dear jeff really appreciate your work and marvelous presentation but still i am not convinced with dopamine doses for bradycardia you mentioned ie 2 to 20. Even in new manual its 2 to 10. Thanks please review and copy paste if you have the course material.
Jeff with admin. says
Please see page 125 of the 2015 AHA ACLS provider manual: “Dopamine 2 to 20 mcg/kg per minute (chronotropic or heart rate dose)”
Also, here is the online reference in the AHA ECC/CPR guidelines
Kind regards,
Jeff
calster says
Symptomatic bradycardia with signs of poor perfusion AND pacing. Does that mean the guidelines suggest anyone could pace 1st and Wenchebach av block besides formal indication of Mobitz II and 3rd degree? Seriously??
Jeff with admin. says
You would assess H and T. If the bradycardia is the cause of poor perfusion then you would pace. Otherwise you would use interventions that are appropriate for the cause of the poor perfusion and unstable condition. Kind regards, Jeff
DavetheMD says
In my hospitalist practice, I often go to transvenous pacing at the point where TCP would be indicated. Don’t answer tests this way, but it’s the real world. You place an internal jugular Cordis catheter and then float a balloon pacing catheter through it like a a Swan Ganz catheter. It paces through the right ventricle and is controlled through an external pacing control box. If anyone has ever seen TCP, it is very uncomfortable and the patients must be sedated.
I think there are basically two kinds of bradycardia… The dying heart, PEA type and the cardiac block type. It’s the cardiac block types you can help, and they generally have a stable enough ventricular rate to hold on till you can get the transvenous in.
jgreen2015 says
In question#7 the patient is bring paced. The question states if it is ineffective what is your next step? The answer is transvenous pacing. He is already being paced. That question is confusing.
Jeff with admin. says
Transvenous pacing is the next step and requires an in room surgical procedure to place an electrode into the patients venous system. I have provided a link that explains a little more about transvenous pacing.
You are basically placing a central line in a patient and then floating a electrode wire in that will send a pacer impulse directly through the blood to the heart. This eliminates the impedance caused by skin, bone, and fat.
Kind regards,
Jeff
alleas says
Is epinephrine weight based? Please check on this. Thank you!
Jeff with admin. says
The treatment of bradycardia is epinephrine infusion 2-10 mcg/min and the treatment of hypotension is 0.1-0.5 mcg/kg/minute (7-35 mcg/min). With epinephrine, the scale is not that important. What would be important would the to titrate the epinephrine to achieve the desired effect.
Kind regards,
Jeff
swalthall says
Hi Jeff, thanks so much for your site. It has been very helpful. Would you please check on Question 3 in the brady test? It is about treatment of bradycardia with epi or dopamine. The doses listed there are all weight based and the ranges listed do not include the response of 2-10 mcg/min, which I believe is the correct dose. Thanks for checking on this.
Jeff with admin. says
Dopamine is weight based when treating bradycardia. Prior to 2015, the dosing recommended was 2-10 mcg/kg/min. Now the recommendation is 2-20 mcg/kg/min. See page 125 of the 2016 AHA ACLS Provider manual.
Epinephrine is not weight based in the bradycardia algorithm and the dosing is 2-10 mcg/min.
Kind regards,
Jeff
vparif says
page 166 profound bradycardia or hypotension- 2 to 10 mcg per minute, only for cardiac arrest per kg dose is mentioned
regards
vpa
daisyrose says
Hi, In Q #2, the book says 2-10 mcg/kg/minute infusion, is this different from your 2-10 mcg/minute, isn’t the scale important?
Jeff with admin. says
The treatment of bradycardia is epinephrine infusion 2-10 mcg/min and the treatment of hypotension is 0.1-0.5 mcg/kg/minute (7-35 mcg/min). With epinephrine, the scale is not that important. What would be important would the to titrate the epinephrine to achieve the desired effect.
Kind regards,
Jeff