Chapter 21 | Resuscitation

Question 1

Fill in the blank:

The [BLANK] and [BLANK] functions of the heart must work together for the heart to pump blood.

Answer 1

The electrical and mechanical functions of the heart must work together for the heart to pump blood.

Question 2

Fill in the blank:

Electrical stimulation causes the cardiac muscle to [BLANK].

Answer 2

Electrical stimulation causes the cardiac muscle to contract.

Question 3

Fill in the blank:

[BLANK] causes the cardiac muscle to contract.

(as it should)

Answer 3

Electrical stimulation causes the cardiac muscle to contract.

Question 4

Fill in the blank:

The heart-pumping muscle requires [BLANK] to function.

Answer 4

The heart-pumping muscle requires oxygenated blood to function.

Question 5

List:

causes of mechanical failure of the heart

3 points (things that could make heart stop working)

Answer 5

• loss of normal heart muscle structure
• loss of normal heart valve function
• direct trauma

Question 6

Fill in the blank:

[BLANK] indicates mechanical failure of the heart.

Answer 6

PEA indicates mechanical failure of the heart.

PEA is pulseless electrical activity

Question 7

Define:

pulseless electrical activity (PEA)

Answer 7

condition where heart stops because electrical activity in heart is too weak to produce beat

Question 8

Define:

PEA

(abbreviation)

Answer 8

pulseless elecrical activity

Question 9

Define:

asystole

(ay-SIS-toe-lee)

Answer 9

complete failure of heart’s electrical system

(i.e. flat-lining)

Question 10

Define:

sudden cardiac arrest

Answer 10

abrupt onset of heart malfunction, apnea, and unconsciousness

Question 11

Define:

asphyxial cardiac arrest

Answer 11

inability of heart to pump due to systemic hypoxia

Question 12

Explain:

difference in causes of sudden cardiac arrest and asphyxial cardiac arrest

Answer 12

sudden cardiac arrest: acute blunt trauma to chest

asphyxial cardiac arrest: result of low oxygen levels in blood

Question 13

Fill in the blank:

In treating asphyxial cardiac arrest, [BLANK] are important during CPR.

Answer 13

In treating asphyxial cardiac arrest, high-quality ventilations are important during CPR.

Question 14

Fill in the blank:

[BLANK] occur as a primal reflex during cardiac arrest.

Answer 14

Agonal respirations occur as a primal reflex during cardiac arrest.

Question 15

List (in order):

process of cardiac arrest

5 points (how cardiac arrest causes death)

Answer 15

• heart fails to pump
• blood stops moving
• cells lack essential oxygen
• organs get damaged (eventually fail)
• (if untreated) patient dies

Question 16

Define:

SUIDS

(abbreviation)

Answer 16

sudden unexpected infant death syndrome

Question 17

List:

common causes of SUIDS

3 points

Answer 17

• sudden infant death syndrome (SIDS)
• unknown cause
• accidental suffocation/strangulation in bed

Question 18

Explain:

average survival rate of out-of-hospital resuscitation attempts

Answer 18

5% to 10%

Question 19

Explain:

average survival rate of in-hospital resuscitation attempts

Answer 19

20%

Question 20

List:

5 elements of chain of survival

Answer 20

1. immediate recognition/activation
2. immediate high-quality CPR
3. rapid defibrillation
4. basic/advanced EMS (BLS)
5. ALS post-arrest care

Question 21

Define:

LUCAS device

Answer 21

electronic machine which provides automated CPR

Question 22

Define:

AED

(abbreviation)

Answer 22

automated external defibrillator

Question 23

Explain:

difference between semi-automatic and fully-automatic AEDs

Answer 23

semi-automatic: advises EMT to press button that causes machine to deliver shock through pads

fully-automatic: delivers shock without EMT taking any action

both AEDs identify shockable rhythm

Question 24

List:

components of “triangle of life”

you guess how many

Answer 24

• one provider delivers compressions
• one provider attaches the AED
• one provider manages the airway and delivers ventilations

Question 25

Fill in the blank:

You should treat a submersion-injury patient in cardiac arrest the same as [BLANK].

Answer 25

You should treat a submersion-injury patient in cardiac arrest the same as any other cardiac arrest patient.

(be extra agressive with airway and breathing)

Question 26

List:

conditions where you may stop resuscitation attempts

3 points

Answer 26

• occurrence of spontaneous circulation/breathing
• another trained rescuer can take over
• receiving a “cease resuscitation” order from physician

Question 27

Choose:

If you turn resuscitation efforts for a patient over to another rescuer, this person must be trained to which level of proficiency?

A. The level of an ALS provider

B. The highest possible level

C. The same level as or a greater level than you

D. The level of a physician

Answer 27

C

Question 28

Choose:

ALS personnel have just placed an advanced airway in an adult cardiac arrest patient. What should you do?

A. deliver positive pressure ventilations at 10-12 breaths per minute.

B. ventilate the patient twice after every 15 compressions.

C. deliver two breaths after every 30 compressions.

D. ventilate the patient at 12-20 breaths per minute

Answer 28

A

Question 29

Choose:

Your patient is a 66-year-old female who has regained a pulse after a shock with an AED; however, she remains unresponsive and is not breathing adequately.

Which of the following should be done next?

A. Remove the AED, assist the patient’s ventilations with a bag-valve mask and supplemental​ oxygen, and keep reassessing the pulse.

B. Apply a nonrebreather mask with high-concentration oxygen and keep reassessing the pulse.

C. Deliver a fourth shock to improve the patient’s respiratory status.

D. Ventilate the patient with high-concentration oxygen and transport immediately.

Answer 29

D

Question 30

Choose:

Your patient was pulseless but had a return of spontaneous pulses after one shock from the AED. Before transport, you notice that the patient is again unresponsive.

What should you do next?

A. check the pulse.

B. transport the patient.

C. assess the blood pressure.

D. continue ventilations.

Answer 30

A

Question 31

Choose:

Your patient is a 44-year-old female who has collapsed while jogging. She has been unresponsive for 4 to 5 minutes by the time you arrive. Her husband appears to be performing high-quality CPR.

Which of the following should be your first action?

A: Stop CPR and check for a pulse

B: Insert an oropharyngeal airway and begin ventilations

C: Load the patient into the ambulance for further assessment

D: Apply the AED

Answer 31

D

Question 32

Answer:

You are preparing a patient in cardiac arrest for an AED when you palpate a small lump below the patient’s right clavicle.

How should this modify your placement of the AED?

Answer 32

While placing the pads in the general area you need them, keep them several inches away from the lump.

Question 33

Choose:

When using an AED, which of the following people is responsible for calling to “clear” the patient before delivering a shock?

A: EMT supervising bystanders

B: EMT managing the airway

C: EMT doing chest compressions

D: EMT operating the defibrillator

Answer 33

D

Question 34

True or false:

Not all cardiac arrests are due to problems that respond to defibrillation.

Answer 34

true

Question 35

True or false:

Before attempting defibrillation, it may be necessary to obtain a 12-lead ECG on the patient.

Answer 35

false

Question 36

Choose:

Which of the following people is allowed to continue providing patient care when the patient is to be “cleared” for delivery of a shock via the defibrillator?

A: The EMT performing bag-valve mask ventilations

B: The provider who is ventilating the patient, so long as the patient has been intubated by a paramedic so that the provider does not directly touch the patient

C: Anyone in contact with the patient below the level of the patient’s knees

D: None of the above

Answer 36

D

Question 37

Choose:

Which of the following patients should have an automated external defibrillator applied?

A. A 19-year-old college athlete who collapsed during football practice and is pulseless and apneic

B. A 40-year-old female in cardiac arrest due to chest injuries sustained in a motor vehicle crash

C. A 6-month-old in severe respiratory distress

D. A 67-year-old man with​ severe, crushing chest pain that is not relieved by nitroglycerin

Answer 37

A

Question 38

Choose:

EMTs arrive at the scene of a cardiac arrest to see a police officer beginning to defibrillate the patient. At what point should the EMTs take over?

A. After a “no shock indicated” message is received but otherwise not until the patient is resuscitated

B. Only if the EMTs feel the police office is incompetent to administer the AED correctly

C. Immediately, even if interrupting the police office in the middle of shocking the patient

D. After the shock is delivered or a “no shock indicated” message is received

Answer 38

D

Question 39

Choose:

You are performing CPR on an 11-year-old patient who went into arrest while exercising. You called 911 and have been doing CPR for 3 minutes when a bystander who knows CPR rushes over asking how they can help.

What is the best response?

A. “Take over compressions while I perform rescue breaths”

B. “Take over CPR while I go search for help”

C. “Go search for an AED while I perform CPR”

D. “Take over compressions while I check a pulse”

Answer 39

C

Question 40

Choose:

You are on the scene of a pulseless and apneic patient and have completed your first 2 minutes of CPR. Your partner attached the AED and delivered a shock as prompted by the AED.

What is the next step in the BLS algorithm?

A. Try 5 abdominal thrusts

B. Check a pulse and give 2 rescue breaths

C. Resume high quality compressions

D. Find a 3rd person to do chest compressions

Answer 40

C

Question 41

Choose:

When should a pulseless and apneic patient be ventilated during high-quality CPR with an advanced airway in place?

A. During the rescuer switch cycle

B. Continuously between every third compression

C. During compressions at a rate of 10 breaths per minute or one breath every 6 seconds

D. There is no need because the patient is getting passive oxygenation from the CPR motion

Answer 41

C

If the patient has an advanced airway in place, such as a King airway or endotracheal tube as provided by a paramedic, the new AHA guidelines state that ventilations can be performed during compressions. This optimizes oxygenation during resuscitative efforts in the field. However, this should be balanced with the need for effective chest compressions, and providers should ensure that ventilation does not interfere with the quality and rate of chest compressions. Therefore, the exact timing and frequency of ventilations may need to be adjusted based on the patient’s response and the provider’s assessment of the patient’s condition.

Question 42

Choose:

You have been called for a 3 kg baby who was delivered just before your arrival. After his airway has been suctioned and tactile stimulation has been provided, he still isn’t breathing on his own.

At what rate would you ventilate this neonate?

Answer 42

40-60 breaths per minute

Question 43

Choose:

You are called to the scene of a drowning. The patient is 1-year-old. The average weight of a 1-year-old is 10 kg.

If positive pressure ventilation is required, what tidal volume should be used?

A. 25ml

B. 125ml

C. 70ml

D. 175ml

Answer 43

C

A 1-year-old normally has a tidal volume capacity of 6-10 ml/kg, meaning that a 10 kg 1-year-old will require 60ml to 100ml of tidal volume.

This is in comparison to the 400ml-500ml for an adult. These volumes are to prevent overinflation of the lungs which will damage them, otherwise known as barotrauma.

Always confirm that your delivered tidal volume is appropriate by evaluating the patient’s heart rate. In practice, a pediatric AMBU bag and valve mask will be used, so ensure you check the volume of the bag.

Question 44

Choose:

During CPR, what is the BEST way to improve the amount of negative pressure within the chest cavity and increase the preload within the patient’s heart?

A. Adequate ventilations with a bag valve mask

B. Fast and hard chest compressions (100 to 120 bpm)

C. Allow the chest to completely recoil between compressions

D. By delivering chest compressions in the proper location on the sternum

Answer 44

C

Allowing chest recoil improves the negative pressure inside the chest, which is essential for the circulatory system to have good preload (the pressure that helps the heart fill with blood).

Negative pressure occurs normally when we breathe (chest expansion) and during a cardiac arrest, when the chest returns to its normal shape following compressions. This negative pressure not only causes air to be drawn into the chest, it also pulls blood through the inferior and superior venae cavae toward the heart.

Question 45

Choose:

AED kits normally contain both adult and child AED pads/cables.

At what age does it become appropriate to use an adult AED pad/cable set on a child?

A. 5 years old

B. 8 years old

C. 11 years old

D. 16 years old

Answer 45

B

When you have a choice between pediatric or adult AED pads, it is appropriate to use the adult-sized cables on a patient at least 8 years old and 55 pounds. But if pediatric pads are unavailable, you can use the adult pads at any age as well, you just change the placement.

Question 46

Choose:

You respond to the scene of a 4-year-old male who is choking. After abdominal thrusts, you are re-assessing the airway, but your patient loses consciousness.

Your next step, according to the AHA’s basic life support (BLS) algorithm is to:

A. Attempt ventilations via BVM

B. Perform abdominal thrusts

C. Use a finger to check the airway

D. Begin CPR

Answer 46

D

For pediatric patients who are choking, perform an initial round of abdominal thrusts. It may help dislodge the obstruction and you want to maintain perfusion while you determine the cause of the obstruction. Should a patient become unresponsive, re-evaluating the back of the throat for the foreign body and initiating CPR based on the BLS algorithm are vital to optimizing patient viability.