1You witness a middle-aged, obese male pedestrian collapse on an escalator in an airport.

He is
clutching his chest and slumps over on the person behind him. The bystander places him on the floor at
the end of the down-moving escalator track. As a first responder certified in ACLS, which of the following
is your first course of action?

A Move the man out of the way of pedestrian traffic on the escalator

B Do not move the man because there may be a cervical spine injury

C Check for a pulse

D Begin high-quality CPR

RATIONALE

The rescuer must secure the scene before attempting resuscitation. People coming down the escalator
behind the man may interrupt CPR at best or cause injury at worst.

2You have moved the man to a seating area near the bottom of the escalator. The man is gasping for
breath but does not appear to be effectively breathing. You yell at him "Are you alright?" but he does
not respond. What is your next action?

A Begin high-quality CPR

B Send someone to get an AED device

C Check for a pulse

D Secure the cervical spine

 RATIONALE

The next step is to get help. This includes sending someone for an AED, activating EMS, and calling
others to help.

3After sending for EMS and waiting for an AED to arrive, you continue to attend to the man. The man is
unresponsive and he is now only gasping. What is your next action?

A Begin high-quality CPR

B Obtain IV or IO access

C Check for a pulse

D Count his breaths per minute

RATIONALE

The next step is to get help. This includes sending someone for an AED, activating EMS, and calling
others to help.

4You find a definite pulse on his carotid artery. It is fast, but clearly present. What is your next action?

A Begin high-quality CPR (30 compressions and 2 breaths)

B Give one breath every 5-6 seconds

C Check for a pulse in the other carotid or in the radial artery

D Apply "watchful waiting" since the AED device will arrive soon

RATIONALE

The man has a pulse, so he needs rescue breathing, not chest compressions. One ventilation every 5-6
seconds is appropriate in an adult without an advanced airway in place.

5The AED device has not yet arrived. You have been delivering breaths for two minutes, spaced 5-6
seconds apart. He is not breathing spontaneously. What is your next action?

A Check for a pulse

B Continue giving one breath every 5-6 seconds until the AED or EMS arrives

C Apply "watchful waiting" since the AED device will arrive soon

D Begin high-quality CPR until the AED arrives

RATIONALE

You must determine if the victim’s situation has deteriorated. Respiratory arrest may lead to cardiac
arrest. Pulse checks should be done every two minutes in respiratory arrest.
6You pause rescue breathing to check for a pulse. You cannot feel a definite pulse after 10 seconds of
trying. What is your next action?

A Continue checking for a pulse for 10 more seconds because you may have missed it

B Check to see if the patient is breathing normally

C Apply "watchful waiting" since the AED device will arrive soon

D Begin chest compressions

RATIONALE

Since there is no pulse, the man is now in cardiac arrest. He needs CPR, including chest compressions.

7You start high-quality CPR at a rate of 100-120 compressions per minute. The AED arrives moments
later. You open the man's shirt to find a copious amount of thick hair covering his chest and he is damp
with sweat. The AED cannot get a good signal through the pads because of the hair, even though you
have pressed them down very hard. What is your next action?

A Do not use the AED and wait for EMS to bring better equipment

B Find a razor and neatly shave the man's chest hair

C Rip the pads off the man's chest and apply new pads in the same locations

D Apply the pads to less hairy portions of the body (e.g. inner arm and neck)

 RATIONALE

Chest hair can interfere with electrical contact through the AED pads. The adhesive on the pads can act
as a rapid depilatory (i.e. it rips the chest hair out). New pads can then be used on the bare skin.

8With hair removed and new pads placed, the AED gets a good signal from the patient. It reports that
there is a shockable rhythm. You clear everyone from the patient, announce the shock, and then deliver
one shock. What is your next action?

A Immediately check to see if another shock is needed; one is usually not enough

B Resume high-quality CPR immediately

C Check the carotid artery for a pulse

D Turn up the voltage for a second shock

RATIONALE

Regardless of patient response, resume high-quality CPR immediately and continue for two minutes.
Even if a pulse returns, it may not be adequate to pump blood for a few minutes. A pulse check at this
point is irrelevant. An AED automatically controls the level of energy delivered.

9After two minutes of CPR, what is your next action?

A Activate EMS again; clearly the first call has failed

B Maximize voltage for a third shock

C Check for a pulse

D Resume high-quality CPR immediately

RATIONALE

It is important to determine if the man has regained spontaneous circulation. This can be done with a
pulse check.

10The man has a strong, regular pulse. He is not responsive, but appears to be breathing. You feel air
movement through his mouth. What is your next action?

A Resume high-quality CPR for two additional minutes

B Deliver breaths every 5-6 seconds

C Continue to monitor pulse, breathing, and rhythm until EMS arrives

D Take off AED pads awaiting EMS arrival

CPR can stop at this point, as the man has had a return of spontaneous circulation (ROSC). He should be
monitored very closely until EMS arrives. It is unwise to remove the AED pads in case his condition
deteriorates.