AHA ACLS Provider Course: Adult Emergency Decisions Study Guide

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A patient collapses in a waiting area and makes occasional snorting breaths. After activating help, you cannot definitely identify a pulse within 10 seconds. Start compressions while another responder brings the AED.

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An unresponsive adult has no effective breaths but a definite carotid pulse of 64/min. Provide assisted breaths at 10/min, observe chest rise and reassess circulation. Begin CPR if the pulse subsequently disappears.

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During a focused history for chest discomfort, a patient becomes unresponsive and stops breathing normally. Interrupt the history, reassess breathing and pulse, activate the arrest response and begin the indicated BLS interventions immediately.

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A ward patient becomes progressively confused, breathes faster and needs increasing oxygen. The pulse is present. Activate the rapid-response system and begin immediate physiological assessment rather than waiting for the next scheduled observations.

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A patient with a rapid sustained rhythm remains able to generate a measurable blood pressure but develops new confusion and pulmonary edema. Treat these findings as evidence of instability while determining whether the tachyarrhythmia is causal.

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A patient with ongoing bleeding has a regular sinus rhythm at 132/min, cool skin and falling pressure. Prioritize hemorrhage and perfusion management while monitoring the rhythm rather than assuming the rate itself requires cardioversion.

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Feedback shows compressions at 138/min with a depth of 3.8 cm. Coach the rescuer to slow into the recommended range and increase depth, then verify both measurements improve during the next compression interval.

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A compressor reaches the correct depth and rate but rests body weight on the sternum between pushes. Ask for full release of pressure and use the feedback device to confirm recoil improves without losing hand position.

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The next compressor moves into position before the planned rhythm check. Pads and airway equipment are already ready. The team completes the check, delivers an indicated shock and restarts compressions without a separate equipment-preparation pause.

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During a 120-second interval, compressions occur for 96 seconds. The fraction is 96 divided by 120, or 80%. Review the remaining 24 seconds to distinguish necessary treatment pauses from avoidable workflow delays.

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A single rescuer struggles to obtain chest rise despite repeated bag squeezes. A second responder takes over the bag while the first uses both hands to improve jaw lift and the mask seal, then reassesses ventilation.

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An airway responder rapidly empties a large bag with each breath. Coach smaller, controlled breaths that produce visible chest rise, and verify the rate matches whether the patient has an advanced airway or a pulse.

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Two responders provide CPR using a bag-mask device with no supraglottic airway or endotracheal tube. Continue 30 compressions followed by 2 coordinated breaths, keeping the ventilation pause brief and checking that the chest rises.

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After a supraglottic airway is placed during CPR, the team continues compressions without pausing for breaths. The airway responder delivers 10 controlled breaths each minute and checks chest movement and device function throughout the cycle.

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A patient remains in VF while bag-mask ventilation produces visible chest rise. The defibrillator is ready, but intubation equipment is still being assembled. Deliver the indicated shock and continue CPR while airway preparation proceeds.

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A previously consistent capnography waveform disappears after the patient is moved. Check circuit connections, tube position and ventilation immediately while another responder maintains indicated resuscitation, rather than relying on the original confirmation of tube placement.

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A monitor shows organized complexes at 48/min, but no pulse is definitely present. Continue CPR, administer indicated epinephrine and investigate reversible causes. Do not deliver a shock solely because the patient is pulseless.

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A witnessed arrest patient has VF and attached pads. A colleague proposes waiting for an IV before shocking. Deliver the shock as soon as the team is clear, then resume CPR while vascular access is established.

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After a shock for VF, the team looks toward the monitor and hesitates. Direct immediate compressions and resume ventilation. Organize the next rhythm check and compressor change during the ensuing 2-minute CPR interval instead.

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An unfamiliar biphasic defibrillator is ready for a patient in VF, but its recommended initial dose cannot be identified promptly. Use its maximum available energy, clear the team, deliver the shock and resume compressions.

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A pulseless patient has PEA, and vascular access is already available. Give epinephrine promptly during ongoing CPR while the team evaluates hypoxia, hypovolemia and other causes rather than preparing an empiric defibrillation shock first.

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VF persists after the second shock, and CPR has restarted. With access available, administer epinephrine and record its time. Prepare subsequent treatments while compressions continue, without delaying the next rhythm assessment or indicated defibrillation.

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A patient remains in VF after three shocks. CPR is underway and epinephrine timing is documented. Prepare an indicated antiarrhythmic while another team member checks reversible causes and the defibrillator remains ready for the next rhythm check.

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A responder cannot promptly establish IV access during a nonshockable arrest. The team continues CPR and proceeds with IO access so indicated medication can be administered, rather than repeatedly stopping to attempt another difficult peripheral vein.

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A patient with major gastrointestinal bleeding develops PEA. While CPR and indicated medication continue, prioritize evaluation and treatment of hypovolemia. The bleeding history makes volume loss a stronger immediate causal hypothesis than an unrelated electrolyte abnormality.

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A patient deteriorates abruptly after a chest procedure and develops PEA. The team continues resuscitation while evaluating an obstructive cause. Any bedside ultrasound assessment is organized to avoid extending pauses in compressions or delaying necessary treatment.

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One patient arrests after ischemic chest discomfort; another collapses after sudden dyspnea with major thromboembolic risk. Both need immediate resuscitation, but the different histories guide parallel evaluation for coronary versus pulmonary vascular obstruction during subsequent management.

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End-tidal carbon dioxide falls while compression depth also declines. Replace the fatigued compressor and reassess airway function and ventilation. If the value later rises abruptly, coordinate evaluation for ROSC rather than assuming the monitor alone proves recovery.

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An adult develops abrupt regular tachycardia at 190/min, new confusion and hypotension with a pulse. Prepare synchronized cardioversion while supporting airway and circulation, using feasible sedation without allowing preparation to postpone treatment of the unstable rhythm.

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A tracing has QRS duration 0.08 second, markedly varying R-R intervals and no consistent discrete P waves. Recognize atrial fibrillation rather than regular reentrant SVT. Assess perfusion immediately: rhythm-caused shock requires urgent synchronized cardioversion, while stability permits further assessment and appropriate rate or rhythm management.

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An alert adult has abrupt palpitations and a regular narrow rhythm at 180/min with preserved perfusion. Attempt an appropriate vagal maneuver and screen for asthma before considering adenosine. If transient AV block exposes continuing sawtooth atrial waves, recognize flutter rather than assuming another adenosine dose will terminate its atrial circuit.

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A perfusing wide-complex tachycardia has markedly variable intervals. Although the patient is currently alert, do not select adenosine from the regular monomorphic branch. Continue monitored assessment and obtain appropriate rhythm-specific treatment and expert assistance.

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An unstable monomorphic tachycardia persists after synchronized cardioversion. Recheck synchronization mode and QRS markers before another attempt. If reliable synchronization cannot be achieved promptly and the patient critically deteriorates, deliver an immediate unsynchronized shock rather than repeatedly adjusting sensing while perfusion fails.

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A patient becomes poorly responsive during a sustained wide-complex rhythm whose amplitude and axis change continuously. A weak pulse is briefly felt. Prepare immediate unsynchronized defibrillation rather than waiting for the device to obtain stable synchronization markers.

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A resting patient has a pulse of 46/min, normal mentation, stable blood pressure and no ischemic or heart-failure symptoms. Monitor and evaluate causes rather than initiating emergency rate acceleration solely because the number is below 50.

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A confused, hypotensive patient has P waves at 90/min and wide QRS complexes at 30/min, each rhythm regular but with changing PR relationships. Recognize complete AV block with an escape rhythm. Prepare pacing promptly while supporting circulation; do not delay escalation for repeated ineffective atropine attempts.

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Pacing spikes and apparent wide complexes appear, but the patient's blood pressure remains very low and no corresponding pulse is identified. Reassess capture, equipment and pacing effectiveness rather than documenting success from the monitor appearance alone.

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A patient develops a slow pulse and hypotension after taking an uncertain quantity of a rate-slowing medication. Begin bradycardia support and seek toxicologic expertise while evaluating the exposure, rather than treating the event as an isolated electrical abnormality.

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After ROSC, a reliable oximeter reads 100% on maximal oxygen and an arterial sample confirms excessive oxygenation. Reduce inspired oxygen while monitoring toward the post-arrest target, maintaining adequate ventilation and avoiding a fall into hypoxemia.

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A ventilated post-arrest patient has a PaCO2 of 27 mm Hg without severe acidemia. Reduce excessive minute ventilation and reassess blood gases, rather than increasing the respiratory rate because the patient remains unresponsive after circulation returns.

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A post-arrest patient has a measured MAP of 58 mm Hg despite a palpable pulse. Reassess cardiac function and volume status and initiate or adjust appropriate circulatory support to reach at least 65 mm Hg.

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After ROSC, a patient has persistent ST elevation and recurrent ventricular arrhythmias. Activate the appropriate emergency coronary pathway while maintaining ventilation and blood-pressure support, rather than waiting for the patient to awaken before assessing coronary intervention.

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A post-arrest patient does not follow commands after an appropriate assessment of medication effects. Begin a protocolized temperature-control strategy and continuous monitoring while other post-arrest treatments proceed, rather than assuming one specific cooling temperature is mandatory for everyone.

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An unresponsive survivor develops intermittent jerking. Arrange EEG evaluation and clinical assessment rather than assuming the movements either prove an untreatable outcome or automatically justify suppression without understanding the associated electrical activity and the patient's wider neurological findings.

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A patient is rewarmed to normothermia on day 2 after ROSC and sedatives are discontinued then. Collect indicated neurological information throughout care, but ordinarily consolidate prognosis no earlier than day 5, and later if drug effects or other confounders remain.

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A post-arrest patient's glucose falls from 126 to 66 mg/dL during an infusion. Treat the hypoglycemia and reassess the treatment plan with repeat measurements, rather than continuing unchanged because a low glucose was considered desirable.

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An adult develops new upper-body pressure, nausea and sweating during exertion but describes little chest pain. Initiate an ACS assessment and early ECG rather than excluding ischemia because the discomfort does not match a familiar textbook description.

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A patient with ongoing ischemic discomfort arrives at emergency care. Obtain and interpret the 12-lead ECG promptly while the team assesses stability, then activate the appropriate reperfusion pathway if the findings support it rather than awaiting troponin.

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A patient's first ECG is nondiagnostic, but chest pressure intensifies during observation. Repeat the ECG immediately and continue the indicated serial biomarker assessment rather than relying on the earlier tracing to justify reassurance or discharge.

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A comfortable patient with suspected ACS has a reliable room-air saturation of 97% and no separate respiratory indication. Continue monitoring and urgent coronary evaluation without automatically applying high-flow oxygen merely because chest discomfort is present.

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During handover, a patient is described as receiving aspirin and an anticoagulant. Clarify the exact agents and indications; this combination should not be documented as dual antiplatelet therapy because only one platelet-targeting medication has been identified.

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A patient wakes with new unilateral weakness at 07:00 and was last observed normal at 22:00. Document both times, activate stroke evaluation and assess imaging-based options rather than treating awakening as a proven 07:00 symptom onset.

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A patient presents 2 hours after onset of disabling aphasia. Check glucose promptly, exclude hemorrhage on emergency brain imaging and complete eligibility assessment. A blood pressure of 190/112 mm Hg requires treatment and confirmation below both pretreatment thresholds before thrombolysis; being inside the time window alone is insufficient.

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An adult with a disabling deficit presents 6 hours after known onset. Instead of declaring all reperfusion evaluation finished, activate specialist assessment for an advanced-imaging selection pathway and assess whether its specific criteria are met.

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A patient with confirmed basilar artery occlusion presents 12 hours after onset with NIHSS 14. Arrange urgent thrombectomy-capable evaluation rather than excluding intervention solely because the standard 4.5-hour IV thrombolysis window has passed for this presentation.

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A regional network has reliable local thrombolysis and rapid transfer agreements. Use its coordinated destination pathway rather than automatically adding a long bypass journey. If thrombectomy is indicated, initiate the established transfer process promptly with clear communication.

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Two responders reach for airway equipment while nobody prepares the defibrillator. The leader assigns one airway role and one monitor-defibrillator role, confirms who is compressing and identifies a recorder so the next rhythm decision can occur without delay.

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The leader assigns a medication to a named responder. The responder repeats the instruction, prepares and administers it, then reports the exact administration time. The recorder documents completion and the leader plans subsequent dosing from that time.

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The feedback display shows declining depth near the end of a compression cycle. The coach requests a prepared compressor change and verifies the next rescuer restores depth and recoil, while the leader continues planning rhythm assessment and treatment.

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A review identifies a long pause caused by searching for replacement pads. The team checks equipment availability and assigns a pre-event readiness change, then plans to review pause duration in later events to assess whether the change helped.