Ready to sharpen your skills with the latest pa als protocols? Our free interactive pa als protocols quiz invites physician assistants to test their mastery of cardiac rhythms, respiratory support strategies, and emergency care decision-making in line with pa als protocols 2023 updates. From identifying ventricular fibrillation to mastering advanced airway techniques and ventilation management, this als protocols pa quiz sharpens critical thinking under pressure. Whether you're brushing up for recertification or on-shift readiness, you'll get instant feedback to pinpoint strengths and gaps. Dive deeper with our practical pa als protocols reference , then tackle life-saving scenarios in our immersive resuscitation challenge . Take the challenge now - boost your confidence, prove your expertise, and ace every protocol!
At what depth should chest compressions be delivered during adult CPR according to PA ALS guidelines?
Approximately 3 inches (7.5 cm)
Approximately 2 inches (5 cm)
Approximately 4 inches (10 cm)
Approximately 1 inch (2.5 cm)
Adult chest compressions should be at least 2 inches (5 cm) in depth to ensure adequate perfusion without causing excessive injury. Compressions deeper than guidelines risk trauma to the heart and lungs, while shallower compressions reduce forward blood flow. Maintaining proper depth optimizes cardiac output during arrest. See AHA CPR Guidelines for more details.
What is the recommended compression-to-ventilation ratio for a single rescuer performing CPR on an adult patient?
15 compressions to 2 breaths
30 compressions to 2 breaths
20 compressions to 2 breaths
40 compressions to 2 breaths
The AHA recommends a 30:2 compression-to-ventilation ratio for single rescuers in adult CPR to maximize circulation while ensuring adequate ventilation. This ratio balances the need for uninterrupted chest compressions with necessary breaths. Deviations can compromise either perfusion or oxygenation. For further reference, see AHA CPR Guidelines.
Which of the following is NOT one of the 'Hs' in the reversible causes of cardiac arrest?
Hypertension
Hypothermia
Hyperkalemia
Hypoxia
The 'Hs' of reversible causes include Hypoxia, Hypovolemia, Hydrogen ion (acidosis), Hyper-/Hypokalemia, and Hypothermia, but not Hypertension. Recognizing and treating these causes can restore circulation in arrest states. Hypertension is not part of this mnemonic. For more details, visit AHA Hs and Ts.
During basic life support for an adult patient in cardiac arrest, which action takes highest priority?
High-quality chest compressions
Airway intubation
Administering epinephrine
Establishing IV access
High-quality chest compressions are the cornerstone of BLS because they maintain vital blood flow during cardiac arrest. Early airway management and drug administration are secondary to continuous, effective compressions. Interruptions should be minimized to optimize survival outcomes. See AHA BLS Priorities.
What is the primary airway opening maneuver for an unconscious adult without suspected spinal injury?
Head-tilt chin-lift
Cricoid pressure
Jaw-thrust
Neck extension
The head-tilt chin-lift maneuver is the preferred initial technique to open the airway in unconscious patients without spinal injury suspicion. It extends the neck and lifts the tongue away from the posterior pharynx. The jaw-thrust is reserved for trauma patients. Further details are available at AHA Airway Management.
When using a bag-valve-mask (BVM) for rescue breathing in adults, what approximate oxygen concentration can be delivered?
Approximately 80-100%
Approximately 50%
Approximately 21%
Approximately 40%
A bag-valve-mask attached to supplemental oxygen can deliver 80-100% FiO2 when a tight mask seal and high flow are maintained. Room air alone is 21%. Proper technique ensures maximal oxygenation during rescue breaths. For technical guidance, see AHA BVM Use.
What is the target rate of chest compressions per minute during adult CPR?
120-140 compressions per minute
60-80 compressions per minute
80-100 compressions per minute
100-120 compressions per minute
Current guidelines recommend a compression rate of 100-120 per minute for adults to optimize cardiac output without causing fatigue or inadequate recoil. Rates below or above this range can reduce perfusion or increase rescuer fatigue. For more, refer to AHA Compression Rate.
Automated external defibrillators (AEDs) most commonly deliver which type of waveform for adult defibrillation?
Triphasic waveform
DC cardioversion
Biphasic waveform
Monophasic waveform
Modern AEDs use a biphasic waveform because it requires less energy to achieve successful defibrillation and reduces myocardial injury compared to monophasic shocks. Monophasic devices are largely outdated. Biphasic defibrillation is standard in PA ALS protocols. See AHA Defibrillation.
What is the recommended dose of epinephrine for adult patients in cardiac arrest?
1 mg IV/IO every 3-5 minutes
0.1 mg IV/IO every 3-5 minutes
0.5 mg IV/IO every 3-5 minutes
5 mg IV/IO once
Adults in cardiac arrest should receive 1 mg of epinephrine IV/IO every 3-5 minutes during resuscitation. Lower or higher routine doses are not supported by guidelines. Epinephrine improves coronary and cerebral perfusion pressure. Reference: AHA ACLS Drugs.
What is the initial recommended dose of amiodarone for refractory ventricular fibrillation or pulseless ventricular tachycardia?
400 mg IV/IO bolus
300 mg IV/IO bolus
150 mg IV/IO bolus
100 mg IV/IO bolus
The first bolus of amiodarone for refractory VF/pVT is 300 mg IV/IO. If the rhythm persists, a secondary 150 mg dose may be given. This dosing improves the chance of ROSC in refractory arrhythmias. See AHA ACLS Guidelines for more.
Which end-tidal CO2 (ETCO2) value during CPR is generally associated with a higher likelihood of return of spontaneous circulation (ROSC)?
ETCO2 above 35 mmHg
ETCO2 between 20 - 25 mmHg
ETCO2 below 10 mmHg
ETCO2 at 15 mmHg
A sudden sustained rise in ETCO2 above 35 mmHg during CPR often indicates ROSC, as increased pulmonary blood flow carries more CO2 to the sensor. Values below 10 mmHg suggest poor perfusion. Continuous capnography guides CPR quality and ROSC detection. For details, see AHA Capnography.
What is the initial IV/IO dose of atropine for symptomatic bradycardia in adults?
1 mg, repeat every 3 - 5 minutes up to 6 mg
0.5 mg, repeat every 3 - 5 minutes up to 3 mg
0.1 mg, single dose only
2 mg, repeat once after 5 minutes
Atropine 0.5 mg IV/IO is given for symptomatic bradycardia and may be repeated every 3 - 5 minutes, up to a total of 3 mg. Higher initial doses or single-dose protocols are not guideline-based. Appropriate dosing can improve heart rate and perfusion. See AHA Bradycardia Management.
Which energy level is recommended for the first attempt at synchronized cardioversion in narrow-complex regular supraventricular tachycardia (SVT)?
50 joules
100 joules
200 joules
25 joules
For synchronized cardioversion of narrow-regular SVT, begin with 50 joules. If unsuccessful, energy can be escalated. Starting too high may risk unnecessary myocardial injury. This recommendation is supported by ACLS guidelines. More information at AHA Cardioversion.
What is the first-line pharmacologic treatment for Torsades de Pointes in the setting of prolonged QT?
Amiodarone
Procainamide
Magnesium sulfate
Lidocaine
Magnesium sulfate is the treatment of choice for Torsades de Pointes, even if serum magnesium is normal, as it stabilizes the myocardial membrane and suppresses early afterdepolarizations. Other antiarrhythmics are less effective and may worsen QT prolongation. See AHA Arrhythmia Treatment.
What is the target mean arterial pressure (MAP) after return of spontaneous circulation (ROSC) in adult patients to ensure adequate end-organ perfusion?
At least 45 mmHg
At least 85 mmHg
At least 65 mmHg
At least 55 mmHg
A target MAP ?65 mmHg post-ROSC is recommended to ensure sufficient cerebral and coronary perfusion without causing excessive afterload. Lower targets risk hypoperfusion; higher targets may increase cardiac work. Hemodynamic monitoring guides vasopressor therapy. For guidelines, see AHA Post-ROSC Care.
Which intervention is indicated first in a patient with pulseless electrical activity (PEA) during ALS care?
Sodium bicarbonate infusion
High-quality CPR and epinephrine administration
Atropine bolus
Immediate defibrillation
PEA management focuses on high-quality CPR and epinephrine every 3 - 5 minutes because there is no shockable rhythm. Identifying and treating reversible causes (Hs and Ts) also occurs concurrently. Defibrillation and atropine are not indicated initially in true PEA. See AHA PEA Algorithm.
During advanced airway placement in cardiac arrest, which method is recommended to confirm correct endotracheal tube placement?
Chest rise observation only
Listening for bilateral breath sounds only
Esophageal detector device alone
Continuous waveform capnography
Continuous waveform capnography is the gold standard for confirming and continuously monitoring correct endotracheal tube placement during cardiac arrest. Other methods are adjuncts but less reliable. Early detection of esophageal intubation prevents hypoxia. Further reading: AHA Airway Confirmation.
What temperature target range is recommended for targeted temperature management (TTM) after cardiac arrest in comatose adults?
32 - 36°C
28 - 30°C
36 - 38°C
30 - 32°C
Targeted temperature management of 32 - 36°C for at least 24 hours is recommended to improve neurologic outcomes in comatose adults post-arrest. Lower or higher ranges have not shown additional benefit and may increase complications. Consistency in temperature maintenance is crucial. See AHA TTM Guidelines.
Which vasopressor is preferred for managing post-cardiac arrest hypotension in the ICU after initial stabilization?
Dopamine
Phenylephrine
Norepinephrine
Isoproterenol
Norepinephrine is preferred for post-arrest hypotension because it provides alpha-adrenergic vasoconstriction with minimal tachycardia, optimizing perfusion. Dopamine has more arrhythmogenic potential and is no longer first-line. Phenylephrine may reduce heart rate too much. For more, see AHA Post-ROSC Hemodynamics.
In pediatric advanced life support during cardiac arrest, what is the recommended energy dose for defibrillation of ventricular fibrillation?
4 J/kg for the first shock
1 J/kg for the first shock
2 J/kg for the first shock
5 J/kg for the first shock
In pediatric VF/pVT, the initial defibrillation dose is 2 J/kg. If unsuccessful, subsequent shocks may be increased to 4 J/kg. Adult fixed-energy protocols do not apply to children. See AHA Pediatric ACLS.
What arterial oxygen saturation target should be avoided to reduce the risk of hyperoxia after ROSC?
SpO2 > 98%
SpO2 90 - 92%
SpO2 94 - 96%
SpO2 88 - 90%
Post-ROSC hyperoxia (SpO2 > 98%) can exacerbate oxidative injury and worsen neurologic outcomes. Targeting 94 - 96% balances oxygen delivery without hyperoxic harm. Lower saturations risk hypoxia. For full recommendations, see AHA Oxygenation Targets.
Which advanced extracorporeal therapy may be considered in refractory cardiac arrest when conventional ALS fails and immediate ROSC is not achieved?
Therapeutic plasma exchange
Intra-aortic balloon pump alone
High-volume hemofiltration
Extracorporeal CPR (ECPR)
Extracorporeal CPR (ECPR) uses venoarterial ECMO to provide circulatory support in refractory arrest when traditional ALS fails. It can maintain perfusion until definitive treatment. Other therapies like hemofiltration are not first-line in arrest. See AHA ECPR Considerations.
Which of the following best defines inclusion criteria for initiating extracorporeal CPR (ECPR) in an adult out-of-hospital cardiac arrest?
Witnessed arrest, initial shockable rhythm, low-flow time <60 minutes
Unwitnessed arrest, PEA, any low-flow duration
Unwitnessed arrest, any rhythm, low-flow time <90 minutes
Witnessed arrest, asystole only, low-flow time <30 minutes
Optimal ECPR candidates are witnessed arrests with an initial shockable rhythm and a low-flow time under 60 minutes. These factors correlate with better neurologic outcomes. Asystole and prolonged low-flow times predict poor recovery. For advanced criteria, see AHA ECPR Guidelines.
In cardiac arrest due to hyperkalemia, when is sodium bicarbonate administration indicated during ALS?
Never during cardiac arrest
Only if rhythm is refractory VF/pVT
Only after the third dose of epinephrine
Immediately after airway secured when hyperkalemia is suspected
Sodium bicarbonate is indicated early in arrests caused by hyperkalemia to shift potassium intracellularly and buffer acidosis. It should be given once the airway is secured. Waiting or omitting it delays correction of the underlying cause. For detailed guidance, see AHA Metabolic Arrest Management.
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AI Study Notes
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Study Outcomes
Understand PA ALS Protocols Structure -
Grasp the step-by-step flow and organization of Pennsylvania's advanced life support guidelines to streamline your clinical approach.
Apply Cardiac Arrest Interventions -
Use the pa als protocols 2023 to execute evidence-based management of cardiac arrest, including CPR, defibrillation, and medication administration.
Analyze Respiratory Emergency Responses -
Interpret ALS protocols PA for acute respiratory distress and airway management to optimize patient ventilation strategies.
Evaluate Clinical Decision-Making -
Assess your judgment in simulated scenarios, identifying when to escalate care or modify interventions based on real-world protocols.
Identify Knowledge Gaps -
Pinpoint areas needing improvement through instant quiz feedback, ensuring targeted review of key pa als protocols concepts.
Reinforce Certification Readiness -
Leverage the interactive quiz format to solidify your understanding and boost confidence ahead of formal ALS certification exams.
Cheat Sheet
Cardiac Arrest Algorithm Mastery -
Review the PA ALS protocols 2023 chain-of-survival steps from the American Heart Association: immediate high-quality CPR (30:2), early defibrillation for VF/pulseless VT, and timed epinephrine (1 mg IV every 3 - 5 minutes). Use the "CAB" mnemonic (Circulation, Airway, Breathing) to recall priority actions in a pulse-less arrest scenario. Understanding the algorithm nuances in als protocols pa can boost your quiz performance and real-world response.
Advanced Airway Management -
Know when to transition from bag-valve-mask to advanced airway devices, such as endotracheal tubes or supraglottic airways, per pa als protocols. Practice rapid sequence intubation steps - preoxygenation, induction, paralytic dosing - and confirm placement with waveform capnography (target ETCO₂ 35 - 45 mmHg). A quick mnemonic is "SOAP ME" (Suction, Oxygen, Airway, Positioning, Monitoring, End”tidal CO₂).
Medication Dosing & Timing -
Memorize weight-based emergency drug calculations: epinephrine 1:10,000 at 0.01 mg/kg (max 1 mg), amiodarone 5 mg/kg IV bolus (max 300 mg), and lidocaine 1 mg/kg. Use the formula "Weight (kg) × Dose (mg/kg)" to ensure accuracy under pressure. This quick math skill is critical for both the pa als protocols quiz and field scenarios.
Capnography & Monitoring Parameters -
ETCO₂ monitoring is a key quality indicator in pa als protocols; aim for values above 10 mmHg during CPR and watch for a sudden rise (to 35 - 40 mmHg) as an early ROSC sign. Continuous waveform capnography also helps detect tube dislodgement instantly. Familiarity with troubleshooting low traces will earn you points on the quiz and save lives in practice.
Pediatric ALS Adaptations -
Use pediatric-specific guidelines: Broselow tape or the "4×Age+4" formula to estimate endotracheal tube size (in mm) and emergency fluid bolus (20 mL/kg). Remember that compression depth is one-third of chest diameter and ventilation rate is 10 breaths/min for infants. Mastering these pediatric modifications in pa als protocols ensures you're ready for any age group challenge.
