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AS2.1-2 | Cardiopulmonary Resuscitation — Practice Quiz
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A 45-year-old male collapses in the hospital corridor. You approach, tap his shoulders firmly and shout — he is unresponsive. You look at his chest for 10 seconds — no chest rise, no breathing. What is your NEXT immediate action?
Correct. In adult BLS, after confirming unresponsiveness and absent normal breathing, you simultaneously call for help (activate EMS/code team) and begin 30 chest compressions — do not delay compressions to check pulse or wait for an AED.
BLS priority: compressions first, defibrillation second, airway third. Compressions before ventilation is the current AHA/ERC standard for adult cardiac arrest.
In adult BLS the sequence is: unresponsive + no normal breathing → activate emergency response AND begin 30 compressions. A lone healthcare provider may check the carotid pulse, but this check must not exceed 10 seconds; if uncertain, start compressions. Giving breaths first or waiting for an AED both delay life-saving compressions.
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You are performing single-rescuer adult CPR on a 60-year-old woman found in VF. Which combination of compression rate, depth, and compression-to-ventilation ratio is CORRECT?
Correct. Adult BLS uses 100–120 compressions/min, 5–6 cm depth (allowing full chest recoil), and a 30:2 ratio for both single and two-rescuer adult CPR. The 15:2 ratio applies only to two-rescuer paediatric CPR.
The 30:2 ratio for adults reflects the dominant role of compressions; excessive ventilation during CPR increases intrathoracic pressure and reduces coronary perfusion pressure.
Adult BLS parameters: rate 100–120/min (not faster — faster compromises recoil and cardiac output), depth 5–6 cm, ratio 30:2 for adults regardless of rescuer number. The 15:2 ratio is paediatric two-rescuer only.
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A paediatric code is called in the ward. A 4-year-old boy is found unresponsive and apnoeic. Two nurses are present. What is the CORRECT compression-to-ventilation ratio for two-rescuer paediatric BLS?
Correct. Two-rescuer paediatric BLS (infants and children) uses 15:2. The 3:1 ratio applies specifically to neonatal resuscitation. Single-rescuer paediatric BLS uses 30:2.
Paediatric arrests are usually hypoxic (airway/respiratory origin), so ventilation is weighted more heavily than in adult (cardiac-origin) arrests — hence 15:2 with two rescuers.
Paediatric CPR ratios differ by number of rescuers: single rescuer 30:2, two rescuers 15:2. Neonatal resuscitation uses 3:1 (compression:ventilation). The higher ventilation fraction in paediatrics reflects the fact that most paediatric arrests are primarily respiratory in origin.
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You are alone and come across a neonate who has not breathed since delivery. After drying and stimulating, the infant remains apnoeic with a heart rate of 60/min. Which initial resuscitation sequence is correct for neonatal BLS?
Correct. Neonatal resuscitation starts with airway opening and 5 sustained inflation breaths (each 2–3 seconds). Chest compressions at 3:1 are added only if the heart rate remains < 60/min after effective ventilation is established.
The 3:1 ratio in neonates (90 compressions + 30 breaths/min) maximises ventilation. Compressions begin only after lung aeration is confirmed because compression without lung aeration is ineffective.
Neonatal resuscitation is ventilation-first because neonatal arrest is almost always respiratory. The sequence: dry/stimulate → open airway → 5 inflation breaths → reassess heart rate → if HR <60/min despite adequate ventilation, begin 3:1 compression:ventilation. Defibrillation has virtually no role in neonatal resuscitation.
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During an in-hospital cardiac arrest, the monitor shows a wide-complex tachycardia with no palpable pulse. The team leader identifies this as pulseless ventricular tachycardia. What is the IMMEDIATE first step in the ALS algorithm?
Correct. Shockable rhythms (VF and pulseless VT) require immediate defibrillation. For pulseless VT/VF, the shock is unsynchronised (asynchronous defibrillation). Adrenaline and amiodarone are administered after the first shock + 2-minute CPR cycle, not as the first action.
ALS non-shockable loop (asystole/PEA): adrenaline 1 mg immediately, then every alternate 2-min cycle. ALS shockable loop: defibrillate → 2 min CPR → reassess; adrenaline after 2nd shock, amiodarone 300 mg after 3rd shock.
In pulseless VT/VF, defibrillation is the definitive treatment and must not be delayed. Synchronised cardioversion is used for haemodynamically unstable PULSED VT, not pulseless VT. Adrenaline 1 mg IV is given after the first 2-minute CPR cycle (i.e., after the second shock); amiodarone 300 mg IV is given after the third shock.
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A cardiac arrest patient's rhythm shows a flat line (asystole) on two leads. Compressions are ongoing. What is the CORRECT drug protocol?
Correct. Asystole is a non-shockable rhythm. ALS management: high-quality CPR + IV access + adrenaline 1 mg IV as soon as IV/IO access obtained, repeated every 3–5 minutes. Defibrillation is NOT indicated. Atropine was removed from resuscitation guidelines in 2010; amiodarone is for shockable rhythms only.
The 4 Hs: hypoxia, hypovolaemia, hypo/hyperkalaemia (metabolic), hypothermia. The 4 Ts: tension pneumothorax, tamponade, toxins, thrombosis (pulmonary or coronary). These reversible causes must be actively sought in every non-shockable arrest.
Asystole and PEA are non-shockable rhythms. The backbone of treatment is uninterrupted CPR + reversible causes (4 Hs, 4 Ts) + adrenaline 1 mg IV every 3–5 min. Amiodarone is restricted to shockable rhythms (after 3rd shock). Atropine for asystole was removed from guidelines.
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During CPR on a 55-year-old woman with witnessed VF arrest, the team achieves ROSC after three shocks. She remains unconscious, GCS 5, with a blood pressure of 80/50 mmHg. Which post-resuscitation measure is MOST strongly associated with improved neurological outcome?
Correct. Post-resuscitation care targets the post-cardiac arrest syndrome. Targeted temperature management (TTM) at 32–36°C for at least 24 h is the intervention most strongly linked to improved neurological outcome in comatose survivors. Haemodynamic stabilisation (MAP >65 mmHg, SaO2 94–98%, normocarbia) is equally essential.
Post-cardiac arrest syndrome = myocardial dysfunction + neurological injury + systemic ischaemia-reperfusion injury. TTM reduces cerebral metabolic demand during the vulnerable reperfusion phase and is the cornerstone of neuroprotection.
Post-ROSC priorities: TTM 32–36°C (neuroprotection), MAP >65 mmHg (avoid hypoperfusion), SaO2 94–98% (avoid hyperoxia), PaCO2 35–45 mmHg (avoid hypo- and hyper-carbia), 12-lead ECG for STEMI (emergent cath). Sodium bicarbonate and hyperventilation are not first-line and carry harm.
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A first-year intern finds a 30-year-old man slumped in the bathroom. She calls for help and confirms unresponsiveness. She looks at his chest for 10 seconds and sees occasional irregular gasping — one gasp every 5–6 seconds. What should she do?
Correct. Agonal breathing (occasional gasps, irregular, laboured) is a brainstem reflex occurring in the early minutes after cardiac arrest. It must NOT be mistaken for normal breathing. The correct action is to treat this as a cardiac arrest and begin CPR immediately.
The 'occasional gasp' rule: any doubt about normal breathing = treat as cardiac arrest. Agonal breathing stops within a few minutes of arrest; waiting costs irreversible brain time.
Agonal respirations are a recognised trap: they occur in up to 40% of witnessed cardiac arrests and lead to delayed CPR if misidentified. The rule is simple — if breathing is not normal (regular, adequate, effortless), treat as absent. Recovery position is for unconscious patients with normal breathing and a pulse.
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