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Anestesiologia - Pontos ME1 ME2 + Miller > 16 Cardiopulmonary Resuscitation and Advanced Cardiac Life Support > Flashcards

16 Cardiopulmonary Resuscitation and Advanced Cardiac Life Support Flashcards

1
Q

For non-­shockable rhythms, the essential step will be early detection and ______.

A

Correction of potentially reversible underlying causes

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2
Q

Cardiac output during CPR with effective, uninterrupted
chest compression is at best ______ of the normal spontaneous circulation.

A

25% to 30%

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3
Q

In cardiac arrests without hypoxic causes (e.g., suffocation, drowning), oxygen content in the lungs at the time of cardiac arrest is usually sufficient for maintaining acceptable arterial oxygen content during the first several minutes of CPR.

  • V ou F
A

Verdadeiro

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4
Q

______ rather than arterial oxygen content is the limiting factor for oxygen delivery to coronary, cerebral, and systemic circulation during CPR. Thus, rescue breaths are less important than initiating effective chest compressions as soon as possible after SCA.

A

Blood flow

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5
Q

Primeiro passo do BLS

A

Segurança da cena

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6
Q

Como reconhecer Parada Cardiaca? (3)

A
  • Responsividade
  • Respiracao ou gasping
  • Pulso

(Breathing and pulse check can be performed simultaneously in less than 10 s)

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7
Q

Como ativar o sistema de resposta a emergências? (2)

A
  • Sozinho e sem telefone: deixar a vitima e ativar o sistema de resposta e trazer DEA antes de iniciar RCP
  • Caso contrario: enviar alguém e iniciar RCP imediatamente; usar DEA assim que disponivel
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8
Q

Como devem ser as compressões e ventilações em adultos? (4)

A
  • 30:2
  • Compressoes 100-120/min
  • 1vent q6seg
  • 5cm compressao

Compression depth should be no more than 2.4 inches (6 cm).

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9
Q

Compression-­ only CPR is easy for an untrained rescuer to perform and can be more effectively guided by dispatchers over the telephone. (…) However, for the trained lay rescuer who is able, the recommendation remains for the rescuer to perform both compressions and breaths, especially for victims with asphyxiation causes of cardiac arrest or prolonged CPR.

  • V ou F
A

Verdadeiro

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10
Q

Physiologically, in most cases of SCA, the need for assisted ventilation is a lower priority because of:

A
  • Availability of adequate arterial oxygen content at the
    time of an SCA.

The presence of this oxygen and its renewal through gasping and chest compressions (provided there is a patent airway) also supported the use of compression-only CPR and the use of passive oxygen delivery.

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11
Q

Shock First or Chest Compressions in adult witnessed cardiac arrest?

A
  • When an AED is immediately available, the defibrillator should be used as soon as possible.
  • Caso contrario, iniciar RCP e colocar DEA assim que disponivel
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12
Q

Por que desfibriladores bifásicos necessitam de menos Joules para choque?

A

Habilidade de compensar e ajustar a impedancia do paciente

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13
Q

Stacked defibrillation is considered only during: (2)

A
  • Cardiac surgery
  • Cardiac catheterization lab. where invasive monitoring and defibrillation pads are in place already.
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14
Q

Em que situacoes a ventilacao é prioridade em relacao a compressões cardíacas? (3)

A
  • Asfixia
  • Afogamento
  • Sufocamento
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15
Q

Qual o manejo de VA de escolha em PCR (2)

A
  • BVM
  • VA Avancada

The choice of bag–mask device versus advanced airway insertion is determined by the skill and experience of the provider.

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16
Q

Qual a FiO₂ que deve ser ofertada em PCR?

A

100%

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17
Q

What is the most reliable method of confirming and
monitoring correct placement of an ETT?

A

Capnografia

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18
Q

Em que situacoes a Capnografia pode dar falsos positivos ou negativos?

A
  • Positivo: intubacao esofágica (ventilacoes iniciais)
  • Negativos: TEP, ↓DC, doenca pulmonar obstrutiva grave
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19
Q

Por que é necessario cuidado para evitar excesso de ventilações na PCR?

A

↓Retorno venoso

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20
Q

Principais ddx de Assistolia (2)

A
  • Bradicardia agonal
  • FV fina
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21
Q

Qual o efeito de maior beneficio da Epinefrina na PCR

A
  • Alfa: aumenta pressao de perfusão coronariana durante PCR

The β-adrenergic effects of epinephrine are controversial because they may increase myocardial work and reduce subendocardial perfusion.

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22
Q

High-­ dose epinephrine is not recommended for routine use in cardiac arrest. The exceptions to this recommendation are (3)

A
  • overdose BBQ
  • Overdose BCCa
  • Epi titulada a parametros fisiologicos monitorizados em tempo real
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23
Q

Qual o momento ideal para Epinefrina na PCR? (2)

A
  • Asystolia / PEA: precoce
  • FV ou TVSP: apos Desf
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24
Q

Qual o efeito prognostico de antiarritimicos na PCR por ritmos chocaveis? (2)

A
  • ↑RCE
  • ↑Admissao hospitalar

Some antiarrhythmic drugs have been associated with increased rates of ROSC and hospital admission, but none have yet been proven to increase long-­ term survival or survival with good neurologic outcome.

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25
Qual o papel dos corticoides na PCR?
* Inconclusivo
26
Como abordar paciente com Dispositivo de Assistencia Ventricular Esquerda irresponsivo ou com alteracao do estado mental? (2)
* Verificar perfusao * Funcao do DAVE
27
Paciente com DAVE, sem perfusao adequada, dispositivo funcionante - o que avaliar? (2)
* PAM * PetCO₂ Se inadequadas, RCP.
28
Quais terapias sao futeis em pacientes com Coracao Artificial Total (3)
* Compressoes cardiacas * Dorgas antiarritimicas * Defib / CV
29
Por que Epinefrina e Vasopressina sao contraindicadas em pacientes com Coracao Artificial Total
* ↑Pos-Carga → Edema pulmonar
30
Conduta em PCR no paciente com Coracao Artificial Total (4)
* Restaurar a funcao mecanica * SF0.9% 1000ml * Ventilacao assistida * Encaminhar ao hospital.
31
Por que doses de atropina menores de 0.5mg podem causar bradicardia paradoxal?
Com o bloqueio dos receptores M2 pré-sinápticos, há um aumento na liberação de acetilcolina no nódulo sinoatrial.
32
Por que Atropina costuma ser inefectiva em pacientes com transplante cardiaco?
* nao ha inervacao vagal
33
Por que Atropina nao funciona para bloqueios de segundo ou terceiro grau?
* Localizacao do bloqueio é mais distal do que NS
34
Se uma bradicardia for nao-responsiva a Atropina, qual a conduta?
* estimulo β-adrenergico: *dopaminam, epinefrina, isoprotenerol*
35
a fibrilacao atrial e o flutter sao ritmos juncionais?
Nao * FA: ritmo caotico, geralmente atrio esquerdo * Flutter: circuito de reentrada, atrio D * Juncional: NAV ou tecido juncional proximo (condução retrógrada para os átrios ou anterógrada para os ventrículos)
36
Because hypoxemia is a common cause of tachycardia, initial evaluation of any patient with tachycardia, like those with bradycardia, should focus on identifying signs of increased work of breathing and oxygen saturation * **V ou F**
Verdaedeiro
37
The temperature range currently recommended for TTM is **___1___** in order to improve survival with good neurologic outcome after cardiac arrest (CA). In the pediatric patient population, TTM to **___2___** is recommended in order to improve neurologic outcome.
1. between 32°C and 36°C 2. maintain normothermia
38
Principais betabloqueadores β1 especificos (3)
Atenolol Esmolol Metoprolol
39
Qual classe de Antiarritmicos pertence a Procainamida e quais is efeitos?
* Classe Ia * Bloqueador de Na⁺ e K⁺
40
Quais as principais caracteristicas antiarritmicas do Magnésio?
Cofactor in variety of cell processes including control of Na⁺ and K⁺ transport
41
Quais as principais caracteristicas antiarritmicas do Sotalol?
K⁺ channel blocker and nonselective beta blocker
42
Principais fatores modificáveis que influenciam o prognostico da Sindrome Pos-PCR (3)
* Otimizacao hemodinamica * Controle glicemico * Ventilacao e Oxigenacao *O "persistent precipitating pathologic mechanism" refere-se à causa subjacente ou condição que inicialmente levou à parada cardíaca e que pode continuar a exercer efeitos negativos mesmo após a ressuscitação bem-sucedida (5H5T).*
43
Nos cuidados pos PCR, por que a Gasometria Arterial é superior a Oximetria de pulso?
* A vasoconstriccao intensa pode dificultar a oximetria de pulso
44
O que significa leucocitose pos-PCR?
* Demarginacao aguda *O aumento na contagem de leucócitos devido à demarginação não é resultado de uma resposta inflamatória ou infecciosa. É uma resposta fisiológica ao estresse agudo.*
45
Principais causas de ↑QTc (3)
* Brugada * QT longo congenito * Adquiridas: drogas, hipotermia, electrolitos, bradicardia
46
Quais as pp causas de PCR que podem ser identificadas com USG? (5)
* Tamponamento * IAM * TEP * Pneumotorax hipertensivo * Hipovolemia grave
47
Preditores de mau prognostico pos-PCR (3)
* Reflexos corneais ou pupilares ausentes bilaterais * Ausencia de ondas N20 bilat * Presenca de status myoclonus > 72h pos-RCO
48
The current recommendations are to wait until at least **______** post ROSC for neuroprognostic evaluation.
* 72 hours
49
Principais limitações da RNM para prognostico pos-PCR
* necessidade de sistemas de scores bem definicdos * as alteracoes podem nao se manifestar por ate 4-7 dias pos-PCR
50
Como ajustar as doses de drogas ACLS para a população pediátrica?
**Actual body weight** is recommended to calculate initial resuscitation drug doses.
51
No Algoritmo de BLS para pediatria, profissional sozinho, paciente sem respiração e com pulso sentido em 10s, qual a conduta?
* Ventilacoes de resgate a cada 2-3s * Se HR permanecer < 60s, iniciar RCP
52
Em que população pediatrica a ECMO com RCP é mais benéfica?
* Criancas com Doenca Cardiaca subjacente
53
Qual o alvo de temperatura no pos-PCR de criancas? (2)
* 5 dias de normotermia (36-37.5°C) ou * 2 dias de hipotermia 32-34°C seguido de 3 dias de normotermia. *Tratamento agressivo de febre > 38°C*
54
When a drowning infant or child is encountered by a single rescuer, how to proceed?
* RCP de 2min, 30:2 * Depois, chamar ajuda *Se dois socorristas, chamar ajuda imediatamente*
55
Por que a manobra de Heimlich nao é benéfica em caso de afogamento? (2)
Heimlich maneuver is not beneficial in the case of drowned patients because it potentially **increases time to intubation and the possibility of gastric aspiration**.
56
Qual TOT escolher em caso de afogamento: com ou sem cuff?
**Com Cuff** * *Cuffed ETTs are preferred due to decreased lung compliance secondary to submersion-induced lung injury*
57
The outcomes of survivors of cardiac arrest secondary to drowning are usually **______** compared with other respiratory etiologies
Better
58
Unexpected and unexplained deaths in infants and children can result from cardiac and noncardiac etiology. Cardiac etiology is often attributed to:
* Cardiac arrhythmia caused by cardiac ion-­channel dysfunction secondary to genetic variations or mutations, which may be undetectable in a conventional autopsy. *In 2% to 10% of infants or children and 14% to 20% of young adults who experience sudden cardiac death, channelopathies are found on autopsy.*
59
Several post-­ ROSC factors have been studied as possible predictors of survival and neurologic outcome after pediatric cardiac arrest. These include: (3)
* Hipotensao * Biomarcadores neurológicos * Lactato *Although these factors are associated with better or worse outcomes, no single factor predicts outcome with sufficient accuracy to recommend termination or continuation of CPR*
60
Em que pacientes considerar a hipotermia por pelo menos 24h?
* Sobreviventes de PCR em coma
61
Em que momento é possivel fazer o prognostico do paciente apos RCE?
* 72h apos RCE * 72h apos completar tratamento de hipotermia-alvo
62
With the evolution of ECPR, nevertheless, there has been a resurgence of studies aimed at identifying effective neuroprotective agents. Examples include **___1___** agonists and **___2___**
1. Adenosine 2A receptor (A2AR) 2. inhaled Nitric Oxide (iNO)

Anestesiologia - Pontos ME1 ME2 + Miller (121 decks)

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