Advanced Cardiovascular Life Support (ACLS) Practice Exam

What is the recommended initial intervention for managing hypotension after return of spontaneous circulation (ROSC)?

1. Administration of IV or IO fluid bolus

2. Immediate defibrillation

3. Intravenous medication administration

4. Oral fluid intake

The correct answer is: Administration of IV or IO fluid bolus

The recommended initial intervention for managing hypotension after return of spontaneous circulation (ROSC) is the administration of an intravenous (IV) or intraosseous (IO) fluid bolus. This approach is based on the understanding that hypotension following ROSC is often due to relative hypovolemia or decreased cardiac output. Providing volume through IV or IO fluids helps to increase the circulating blood volume, thus improving cardiac output and blood pressure. In the post-resuscitation phase, it is critical to reassess the patient's hemodynamic status and ensure adequate perfusion to vital organs. A fluid bolus can help quickly resolve low blood pressure without potentially delaying treatment that could occur with other interventions requiring more time to administer or evaluate, such as medications. Other options, like immediate defibrillation, are typically reserved for cases of arrhythmias rather than hypotension after ROSC. Intravenous medication administration can be necessary but usually follows fluid resuscitation and is based on the clinical picture and specific hemodynamic responses observed. Oral fluid intake is generally not appropriate in acutely unstable patients who may need rapid volume replacement and monitoring of their response.