Cardiac Arrest

Question 1

!!!BLS

Answer 1

Remember, assess then perform the appropriate action

Question 2

!!!With Defibrillation

Answer 2

Minimize any interruptions in chest compressions as this will rapidly decreased blood flow to the brain and heart.

Question 3

Someone has a shockable rhythm. Do you delay defibrillation to intubate or do you use defibrillation first?

Answer 3

Endotracheal intubation should not delay delivery of defibrillation in patients with a shockable rhythm

Question 4

Does a chest x-ray ensure intubation?

Answer 4

NO

Question 5

Several medications can be given via the endotracheal (ET) tube as well, if IV or IO access has not been established. The optimal dosing of drugs administered endotracheally has not been established, but ***

Answer 5

2-2 1/2 times the IV route is generally accepted.

Question 6

!!!NAVEL: ACLS Drugs Safe for Endotrachael Administration

Answer 6

Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine

Question 7

Successful resuscitation is dependent on ***

Answer 7

Successful resuscitation is dependent on rapid defibrillation. Improved survival is related to witnessed arrest with initiation of bystander CPR, initial shockable rhythm, and rapid defibrillation and initiation of ACLS by a trained professional within 10 minutes of onset.

Question 8

Once pulseless VT or VF is identified, the patient should be immediately defibrillated using *** J

Answer 8

Once pulseless VT or VF is identified, the patient should be immediately defibrillated using 200J on a biphasic defibrillator or 360J on a monophasic defibrillator.

Question 9

How many shocks?

Answer 9

ACLS currently recommends that only 1 shock is delivered which changed from their previous recommendations of 3 shocks. CPR starting with compressions should be immediately initiated after the shock without performing a pulse or rhythm check for 2 minutes (5 cycles) of CPR. In patients without an advanced airway, each cycle consists of 30 compressions and 2 ventilations. After 2 minutes of CPR, the rhythm should be rechecked, but the interruption in CPR should not exceed 10 seconds.

Question 10

What drug do you give for Torsades de Pointes

Answer 10

Magnesium

Question 11

When do you give Atropine during ACLS

Answer 11

Atropine 1mg IV/IO should be considered for asystole or slow PEA and may be repeated every 3 to 5 minutes for a total of 3 doses

Question 12

At what time do you cease resuscitation efforts?

Answer 12

Studies have shown that resuscitation efforts are unlikely to be successful after 20 minutes of combined BLS and ACLS. It is appropriate to consider cessation of resuscitation efforts at that time.

Question 13

How effective is induced Hypothermia?

Answer 13

Initiation of mild hypothermia (cooling to 32-34 C) has been demonstrated to decrease the 6 month mortality rate and lead to improved functional recovery at hospital discharge

Question 14

How long should patients with spontaneous return of circulation be cooled to 32-34 C for?

Answer 14

unconscious patients with return of spontaneous circulation should be cooled to 32-34 C for 12-24 hours when VF was the initial rhythm.

Question 15

Inclusion criteria for Therapeutic Hypothermia

Answer 15

Patients resuscitated after out-of-hospital witnessed arrest with VT/VF as initial rhythm
Resuscitation initiated by EMS within 5-15 minutes of arrest
No more than 60 minutes from collapse to return of spontaneous circulation (ROSC)
Persistent coma after ROSC
Adult age
Endotracheal intubation and mechanical ventilation

Question 16

Contraindications for Therapeutic Hypothermia

Answer 16

Severe cardiogenic shock (SBP<90 mmHg) despite fluids and inotropes
Cause of coma other than cardiac arrest (overdose, CVA)
Pregnancy
Known coagulopathy
Life-threatening arrhythmias
Initial temperature <30 C
Preexisting DNR status
Pediatric patients