HealthCare Training Service Advanced Life Support Exam Time: Perusal Time: 20 minutes 5 minutes Total Marks: 25 Instructions: Read each question carefully. Using a pencil, record your response to each question on the examination answer sheet. When answering each multiple-choice question place an X over the box containing the letter which corresponds to the most correct response for the question you are answering, as displayed below. Question 1 A B C D If you wish to change your response to a multiple-choice question erase the initial response and place an obvious X over the letter you have selected as the correct response. Question 1 A B C D Place your name on the top right hand corner of the examination answer sheet. Attempt all questions. The pass mark for this examination is 80%, this equates to 20/25 correct responses. Do not place any marks on this paper. Page 1 HealthCare Training Service 2017
Indicate your response to the following multiple-choice questions on the examination answer sheet by placing an X over the box containing the letter which corresponds to the most correct response for the question you are responding to. Section One Basic Life Support 1. A child has collapsed, you have established the area is safe and sent for help. The child is unresponsive to your verbal and tactile stimulation. What is the next priority for this child? A. Connecting the child to a monitor to assess rhythm. B. Immobilisation of the cervical spine to prevent damage. C. Clearing and opening the child s airway. D. Connecting oxygen and turning the flow meter fully on. 2. If after opening the airway, the infant/child starts breathing and is responsive, what should you do? A. Continue rescue breathing only. B. Maintain a clear open airway and continue to assess. C. Continue chest compressions only. D. Continue cardiopulmonary resuscitation (CPR). 3. What is the advanced CPR ratio (compressions to ventilations) performed by two trained health care professionals for an infant or child? A. 30 : 2 B. 5 : 2 C. 15 : 2 D. 15 : 1 4. How should you position an infant in order to maintain an open airway? A. Apply full head tilt and jaw support. B. Ensure the infant s chin rests on their chest. C. Quickly insert an oropharyngeal airway, as positioning is then not relevant. D. Place the head in a neutral position and support the jaw. 5. What is the correct site for chest compressions on a 2 year old child? A. Uppermost segment of the sternum. B. Centre of the chest. C. Directly over the xiphoid process. D. Chest compressions are not performed on children 2 years of age or younger due to the increased risk of damage to the abdominal organs. Page 2 HealthCare Training Service 2017
6. What is the correct rate for performing chest compressions for an infant or a child? A. 60 80 compressions per minute, to aid perfusion B. 80 100 compressions per minute C. 100 120 compressions per minute D. More than 140 compressions per minute, because of their fast heart rates Airway 7. What size self-inflating resuscitation bag is appropriate to provide bag-vale-mask ventilation for a six-month-old infant? A. Small (250 ml). B. Medium (450 500 ml). C. Large (1600 ml). D. Any of the above self-inflating resuscitation bags may be used, size does not matter. 8. When should a laryngeal mask airway (LMA) be considered for the infant/child in cardiac arrest? A. To provide effective ventilation when there are no personnel skilled in endotracheal intubation or endotracheal intubation by a highly skilled practitioner has failed. B. If the infant or child is semi-conscious, but there is a risk to airway patency. C. Laryngeal mask airways do not provide absolute airway protection and should not be considered at all in cardiac arrest. D. Laryngeal mask airways should be considered for drug administration when intravenous (IV) access cannot be obtained. Rhythms 9. What is the most common initial life-threatening arrhythmia seen in paediatric cardiorespiratory arrest? A. Ventricular Tachycardia. B. Ventricular Fibrillation. C. Severe bradycardia or Asystole. D. Sinus Tachycardia. Page 3 HealthCare Training Service 2017
Defibrillation 10. With regards to defibrillation, which of these statements is correct? A. Defibrillation produces simultaneous depolarisation of a mass of myocardial cells to terminate ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). B. Defibrillation is required in all situations resulting in cardiac arrest. C. Defibrillation is delivered to the infant/child without any interruption to chest compression. D. Defibrillation is not affected by transthoracic impedance. 11. What is the correct number of joules when defibrillating pulseless VT or VF for an infant/child using a biphasic defibrillator? A. 1 Joules/kg. B. 2 Joules/kg. C. 4 Joules/kg. D. 6 Joules/kg. Drugs 12. Which of the following statements is correct in relation to intravenous administration of drugs during cardiac arrest? A. IV administration requires effective chest compressions to circulate the drug to the myocardium. B. IV administration takes longer to circulate through a central venous line than through a peripheral cannula. C. IV administration requires interruption of chest compressions. D. IV administration is contraindicated when an endotracheal tube is insitu. 13. A bolus dose of IV/IO Adrenaline 10 mcg/kg will cause which of the following actions? A. Block the alpha and beta receptors B. Block the parasympathetic stimulation C. Stimulate the alpha receptors to cause vasoconstriction D. Raise the fibrillation threshold Page 4 HealthCare Training Service 2017
Section Two A 2 year old boy, weighing 13 kg, has been brought into the emergency department following drowning (submersion injury) in the family s pool. CPR is being performed on the child. The child is lifeless, unresponsive and is centrally cyanosed. 14. What is the above rhythm that is being displayed on the monitor/defibrillator? A. Ventricular Tachycardia B. Ventricular Fibrillation C. Idioventricular rhythm D. Asystole 15. The ALS Team Leader, having ascertained the child is unresponsive and pulseless, requests for CPR to be continued. What is the initial advanced life support management of this event? using a single shock protocol B. Defibrillate using a three stacked shock protocol C. Administer IV/IO Adrenaline 10 mcg/kg D. Administer IV/IO Atropine 20mcg/kg 16. What is the main cause of this child s arrest? A. Hypoxaemia B. Toxicity (water toxicity) C. Thrombosis (pulmonary thrombosis) D. Hypovolaemia 17. Considering the main cause of the child s arrest (as identified above), what is the primary treatment for this child (to correct the cause)? A. Administering diuretics to treat water toxicity B. Giving volume replacement with a fluid load at 20mL/kg (e.g. 0.9% NaCl) C. Administering fibrinolytic agents to open up the blood vessels D. Providing adequate oxygenation to the tissues (cells) Page 5 HealthCare Training Service 2017
Section Three A 3 year old girl, weighing 14 kg, has been brought into the emergency department following an accidental overdose of tricyclic antidepressants. The child is transferred to an acute care unit for further monitoring for 24 hours. 18. Four hours following admission, the above rhythm is being displayed on the child s monitor. What is this rhythm? A. Ventricular Fibrillation B. Ventricular Tachycardia C. Idioventricular rhythm with artefact D. Sinus tachycardia 19 The clinical team immediately initiate CPR. The ALS response team arrive with the defibrillator and on assessment the child remains unresponsive. Which of the following is the immediate management of this event? B. Request to continue CPR for a further full 2 minutes {a full 10 cycles of (15 compressions to 2 breaths)} C. Administer IV/IO Amiodarone 5mg/kg in 5% Dextrose D. Administer IV/IO Adrenaline 10 mcg/kg 20 Having completed the above action, the child remains unresponsive. What is the next action in the management of this event? B. Immediately resume CPR for 2 minutes {10 cycles of (15 compressions : 2 breaths)} C. Cannulate and administer IV/IO Magnesium Sulphate 0.1 0.2 mmol/kg D. Cannulate and administer IV/IO Adrenaline 10 mcg/kg 21. What amount of joules is used for defibrillating this child? A. 200 Joules B. The defibrillator always defaults to the energy setting required. C. 28 Joules selecting energy closest to this number (e.g. rounded to 30J) D. 56 Joules selecting energy closest to this number (e.g. 50J or 60J depending on the defibrillator) Page 6 HealthCare Training Service 2017
Section Four A 6 month old baby boy, weighing 8 kg, has been brought to the hospital by his mother with a history of profuse diarrhoea and vomiting for the past 3 days. The baby s mother states the baby has vomited at every feed and has had 15 watery stools each day. The baby has become progressively lethargic and has not taken any fluid for the past 8 hours. 22. The above rhythm is being displayed on the child s monitor. What is this rhythm? A. Sinus tachycardia B. Sinus bradycardia C. Sinus rhythm D. First degree heart block 23. Whilst admitting the baby, during the initial assessment, the child becomes unresponsive (and pulseless). What is the immediate action in the management of this event? B. Commence CPR C. Cannulate and administer IV Atropine 20 mcg/kg D. Set up for intubation 24. While this initial management is being instigated, the child remains unresponsive with the above rhythm displayed, what is the next action by the ALS team in the management of this event? B. Cannulate and administer 0.08 ml of IV Adrenaline 1:10 000 (1mg in 10mL) C. Cannulate and administer IV Atropine 20 mcg/kg D. Cannulate and administer 0.8 ml of IV Adrenaline 1:10 000 (1mg in 10mL) 25. Following the above management, the Team Leader performs a physical assessment on the child. It is noted the child has poor capillary refill (5 seconds) and poor skin turgor. The baby also has a sunken anterior fontanel and sunken eyes. What is the next treatment for this baby? A. Administer IV Adrenaline 10 mcg/kg B. IV Atropine 20 mcg/kg C. Administer an intravenous fluid replacement of 80 ml (e.g. 0.9% NaCl) D. Administer an intravenous fluid replacement of 160 ml (e.g. 0.9% NaCl) Page 7 HealthCare Training Service 2017