5. Adult Resus

Question 1

Cardiac arrest with rhythm of VF or pVT often from what source?

Answer 1

heart

Question 2

Nontraumatic cardiac arrest: List 4 cardiac causes

Answer 2

cad
cardiomyopathy
structural abnormality
valve dysfunction

Question 3

Nontraumatic cardiac arrest: List 8 respiratory causes

Answer 3

Hypoventilation: cns dysfunc, nm disease, toxic and metabolic encephalopathies

upper airway: cns dysf, fb, infection, trauma, neoplasm

pulmonary dysf: asthma, copd, pulmonary edema, pe, pneumonia

Question 4

Nontraumatic cardiac arrest: List 7 circulatory

Answer 4

mechanical obs: tension pneumo, tamponade, pe

hypovolemia: hemorrhage

vascular tone: sepsis, neurogenic

Question 5

Nontraumatic cardiac arrest: List 4 metabolic causes

Answer 5

lyte abnorm: hypo or. hyperk, hypermag, hypo mag, hypoca

Question 6

Nontraumatic cardiac arrest: List 8 toxic causes

Answer 6

1. prescription meds: anti dysrh, digoxin, beta blockers, ccb, tca
2. drug use: cocaine, heroin
3. toxins: co, cyanide

Question 7

Nontraumatic cardiac arrest: List 4 environmental causes

Answer 7

lightning
electrocution
hypothermia or hyperthermia
drowning or near drowning

Question 8

Key hx of cardiac arrest - bystander q:

Answer 8

event
pt doing
drug ingestion
cpr
initial cpr
ecg
interventions

pmhx SAMPLE

Question 9

PE of cardiac arrest

Answer 9

General, airway, neck, chest, lung, heart, abdo, rectal, extremities, skin

Question 10

Goal of CPR

Answer 10

maintain perfusion until ROSC achieved

Question 11

CPR important qualities adults

Answer 11

100-120 comp per min, depth 5-6cm, chest compression fracture at least 80% ie performed 80 out of 100 of pulseless interval
full recoil between

in hosp 30:2 ventilation

Question 12

PEA 2 further characterizations:
1)
2)

Answer 12

1) electromechanical dissoc (no Myoc activity)
2) pseudo EMD (myoc contraction occurs but is inadequate, no pulse palpable)

distinguish by echo

Question 13

Causes of pseudo EMD

Answer 13

cardiac: pap m and myocardial wall rupture
hypovol, PE, PTX, tamponade

Question 14

A mnemonic “4 H’s and 4 T’s” is often referenced to aid in rapidly identifying reversible etiologies of PEA arrest: hypoxia, hypovolemia, hypo/hyperkalemia, hypother- mia, thrombosis (pulmonary embolism), tamponade (cardiac), toxins, and tension pneumothorax.

Answer 14

**

Question 15

vF or pVT refractory to defib 2 meds and doses

Answer 15

(first dose: 300 mg IV/IO; second dose: 150 mg IV/IO) or lidocaine (first dose: 1 to 1.5 mg/kg IV/IO; second dose: 0.5 to 0.75 mg/kg IV/IO)

Question 16

Magnesium sulfate dose in Torsades

Answer 16

2-4g IV

Question 17

NaBicarb in TCA OD

Answer 17

1-2mEq/kg

Question 18

List 5 indicators of inadequate blood flow during CPR

Answer 18

1. carotid/fe pulse not palpable
2. coronary perfusion pressure <15mmhg
3. arterial relax/diastolic press ,20-25
4. PETco2 <10
5. CVO2 <40%

Question 19

At what etco2 should compressors work harder?

Answer 19

<10 = bad

Question 20

What is SVO2?

Answer 20

oxygen remaining in blood after systemic extraction

Question 21

Because oxygen consumption remains relatively constant during CPR, as does arterial oxygen saturation (Sao2) and hemoglobin, changes in Scvo2 reflect changes in oxygen delivery by means of changes in __ __

Answer 21

cardiac output.

Question 22

Common complications of ECMO

Answer 22

coagulopathy, hemorrhage, limb ischemia, vascular injury, renal replacement therapy, and stroke

Question 23

Pt with STEMI findings post ROSC?

Answer 23

asa, antiplt
cath

Question 24

Goals post ROSC from cardiac arrest

Answer 24

ecg
maintain o2 - 94-98%
maintain bp - map 70-100, cvp 10-15
hbg >/70
lact <2
temp 36
u/o

Question 25

1. Which of the following statements regarding the epidemiology of out-of-hospital cardiac arrest is true?
   a. Most patients have an automated external defibrillator applied
   prior to emergency medical services (EMS) arrival.
   b. Most patients receive bystander CPR.
   c. Most surviving to hospital discharge will not have major per-
   sistent neurologic deficits.
   d. Only 2% of EMS-treated out-of-hospital cardiac arrests survive
   to hospital discharge.

Answer 25

c
. It is estimated that 180,000 patients are treated for out-of-hospital cardiac arrest each year in the United States. The number of patients receiv- ing bystander cardiopulmonary resuscitation (CPR) remains low, averag- ing 40%. The proportion of emergency medical services (EMS)–treated cardiac arrest patients with an initial shockable rhythm has declined over time to 18% in recent US studies. Automated external defibrillators are applied in a minority of cases prior to EMS arrival. Recent epidemiologic data from cardiac arrest registries indicate the survival rate to hospital dis- charge for EMS-treated, out-of-hospital cardiac arrest is about 10%. Of patients surviving to hospital discharge, independent of neurologic status on presentation, 79% have good neurologic function.

Question 26

Which of the following statements regarding hypothermic targeted temperature management (HTTM) in comatose survivors of car- diac arrest is true?
a. Gradual rewarming should occur over 4 hours.
b. Pregnancy is an absolute contraindication.
c. Prolonged pharmacologically induced paralysis without seda-
tion is often required to control shivering.
d. Target core body temperature should be 32° to 36°C.

Answer 26

d

Question 27

2. A 75-year-old man presents with return of spontaneous circulation
   (ROSC) after 2 minutes of ventricular fibrillation and successful defibrillation by EMS. The patient is unresponsive to verbal and pain- ful stimuli. Vital signs on arrival are pulse, 120 beats/min; blood pres- sure, 130/70 mm Hg; respiratory rate, 10 breaths/min; temperature, 36°C (96.8°F); and oxygen saturation, 94%. The patient has intrave- nous access. The next most appropriate examination or procedure is: a. Anteroposterior (AP) chest radiograph
   b. Arterial blood gas (ABG)
   c. Comprehensive neurologic examination d. Electrocardiography

Answer 27

d

Question 28

5. For end-tidal pressure of carbon dioxide (PETco2) to be a reliable indicator of cardiac output during cardiac arrest, which of the fol- lowing must be present?
   a. Mechanical chest compressions must be performed.
   b. The patient must be in asystole.
   c. The patient must be normothermic
   d. The patient must have relatively constant minute ventilation

Answer 28

d

Question 29

3. Which chest compression/ventilation ratio is recommended during adult resuscitation efforts performed by health care professionals before placement of an advanced airway?
   a. 10:1
   b. 20:1 c. 20:2 d. 30:2

Answer 29

d