327 Cardiovascular Collapse, Cardiac arrest, Sudden Cardiac Death

Question 1

Natural death due to cardiac causes in a person who may or may not have previously heart disease - unexpected.

Answer 1

Sudden cardiac death

Question 2

Previously most common electrical mechanism for cardiac arrest

Answer 2

Ventricular fibrillation or PVT

Question 3

Most common mechanism recorded at initial contact (45-50%)

Answer 3

Asystole

Question 4

Most common structural abnormality associated with SCD in middle aged or older adults

Answer 4

Coronary artherosclerotic heart disease

Question 5

Refers to attemt to identify individual patients at specific risk for SCD and institute preventive strategies

Answer 5

Primary prevention

Question 6

Refers to measures taken to prevent recurrence

Answer 6

Secondary prevention

Question 7

Most powerful long term risk factors include:

Answer 7

age, smoking elevated cholesterol, DM, HPN, LVH, non specific ecg abnormalities, elevated CRP

Question 8

Marker of inflammation that may predict plaque destabilization

Answer 8

C reactive protein

Question 9

Most common cause of SCD in US

Answer 9

Hypertrophic CM

Question 10

Mechanism in which outcome is best

Answer 10

pulseless VT, next is VF

Question 11

Pulse check is no longer recommended beacause it is unreliable - where should you check for pulse in patients suspected to have cardiac arrest?

Answer 11

Femoral and Carotid

Question 12

Right technique for CPR

Answer 12

Sternum depressed, arms straight, rate of 100 per minute, force to depress sternum 4-5cm and relaxation is abrupt.

Question 13

Once diagnosis of VF or VT is established, how do you shock the patient?

Answer 13

150-200 J in biphasic waveform

360 J if monophasic waform

Question 14

After 2 to 3 unsuccessful defibrillation attempts, what do you give?

Answer 14

Epinephrine 1mg IV

Question 15

Recommended for confirmation and monitoring of endotracheal tube placement

Answer 15

Quantitative waveform capnography

Question 16

After initial unsuccessful defibrillation, antiarrythmic therapy should be given. What do you give?

Answer 16

IV amniodarone 150mg over 10 minutes, followed by 1mg/min for 6 hours and 0.5mg/min thereafter

Question 17

VF in early phase of ACS, this can be given as alternative

Answer 17

Boluse of 1mg/kg lidocaine

Question 18

Four components of post-cardiac arrest syndrome

Answer 18

1) Brain injury
2) myocardial dysfunction
3) Systemic ischemia/reperfusion
4) control of precipitating factors

Question 19

Strong predictor of in hospital death and post arrest disability

Answer 19

Anoxic Encephalaopathy

Question 20

Post- MI patients with EF <35%, with other risk factors, heart failure are candidates for ICDs __ days or more after MI.

Answer 20

40 days after MI.

Very low EFs <20% may recieve less benefit.

Question 21

Newly diagnosed heart failure patients with EF <35%, required delay between diagnosis and medical therapy and implantation of ICD is __ days.

Answer 21

90 days.

Very low EFs <20% may recieve less benefit.