Cardio/ cerebral

Question 1

As you walk into the resuscitation bay, what initial steps should be taken to evaluate and manage this cardiac arrest victim?

Answer 1

1- BLS primary survey
2- Obtain finger stick blood sugar
3- ACLS secondary survey

Question 2

Dentures and airway

Answer 2

• Dentures may be left while bagging–> better seal/ prevent airway occlusion
• should be removed prior to intubation.

Question 3

Check carotid pulse for ________ time

Answer 3

at least 5 seconds, but not longer than 10 seconds.

Question 4

Intubation vs circulation

Answer 4

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

Question 5

A ________ does not ensure endotracheal intubation.

Answer 5

chest x-ray

Question 6

endotracheal (ET) tube NAVEL dosing

Answer 6

The optimal dosing has not been established

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

Question 7

NAVEL: ACLS Drugs Safe for Endotrachael Administration

Answer 7

Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine

Question 8

More than 1/2 of arrests in the US are ________ in origin

Answer 8

cardiac

EKG can offer evidence of cardiac ischemia, various toxin exposure, or hyperkalemia.

Question 9

Almost all episodes of sudden cardiac death initiate from a ___________

Answer 9

ventricular tachydysrhythmia

Successful resuscitation is dependent on rapid defibrillation.

Question 10

Improved survival with ventricular tachydysrhythmia is related to ___________ within 10 minutes of onset.

Answer 10

bystander CPR
initial shockable rhythm–> rapid defibrillation
initiation of ACLS

within 10 minutes of onset

Question 11

Once pulseless VT or VF is identified, the patient should be immediately defibrillated using ___________ (strength of shock)

Answer 11

200J on a biphasic defibrillator

360J on a monophasic defibrillator

Question 12

ACLS recommends chest compressions should be interrupted only for

Answer 12

ventilation
rhythm checks
shock delivery

Question 13

After 2 minutes of CPR, _________ should be rechecked

*interruption in CPR less than 10 seconds.

Answer 13

the rhythm should be rechecked

*interruption in CPR less than 10 seconds.

Question 14

__________ may be given for torsades de pointes.

Answer 14

Magnesium

Question 15

With PEA, give epin 1mg every 3-5 minutes, but __________ can be substituted for the 1 or 2 dose

Answer 15

Vasopressin 40 U can be substituted for the first or second dose of epinephrine.

Question 16

___________ should be considered for asystole or slow PEA .

Answer 16

Atropine 1mg IV/IO

may be repeated every 3- 5 min f
max of 3 doses

Question 17

Studies have shown that resuscitation efforts are unlikely to be successful after ___________ of combined BLS and ACLS

Answer 17

20 minutes

Question 18

Of pts with return of spontaneous circulation after cardiac arrest, _________ will survive until hospital discharge.

Answer 18

less than one-half will survive until hospital discharge.

Question 19

ACLS recommends unconscious pts with return of spontaneous circulation should be cooled to ___________ when VF was the initial rhythm.

Answer 19

32-34 C for 12-24 hours

*mild hypothermia has shown ↓ 6 month mortality rate with improved recovery at discharge

Question 20

Inclusion Criteria for Therapeutic Hypothermia

Answer 20

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

Question 21

Contraindications to Therapeutic Hypothermia

Answer 21

• Severe cardiogenic shock (SBP<90 mmHg) despite fluids and inotropes
• coma not cardiac arrest (overdose, CVA)
• Known coagulopathy
• Life-threatening arrhythmias
• Initial temperature <30 C
• Pediatric/ Pregnancy

Question 22

costochondritis

Answer 22

inflammatory process of costochondral / sternal joints

–> localized pain and tenderness

Question 23

Hyperkalemia cardiac Rx

Answer 23

• unstable cardiac rhythm–> Calcium (gluconate/ chloride)

- no ECG abnormalities–> potassium binding resins (Kayexalate)

Question 24

Absolute contraindications to TPA include

Answer 24

• Previous hemorrhagic stroke
• Known intracranial neoplasm
• Active internal bleeding (excluding menses)
• Suspected aortic dissection or pericarditis

Question 25

Troponin level vs time

Answer 25

• rise 3-6 hours of CP onset
• peak 12-24 hours,
• remain elevated for 7-10 days

Question 26

pericarditis classic s/s

Answer 26

-chest pain, a pericardial friction rub, and diffuse
ST-segment elevation

-pain relieved by sitting forward and worsened by lying down or swallowing