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BCPS Exam > Critical Care: Cardiac Arrest > Flashcards

Critical Care: Cardiac Arrest Flashcards

1
Q

ACLS stands for

A

Advanced Cardiac Life Support

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2
Q

CAB stands for

A

Compressions, airway, breathing

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3
Q

In an unresponsive patient or a patient who is not breathing, one rescuer should initiate a cycle of _____ chest compressions as soon as possible, followed immediately by _ rescue breaths.

A
  1. Cycle of 30 chest compressions

2. Followed immediately by 2 rescue breaths.

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4
Q

CPR stands for

A

Cardiopulmonary Resuscitation

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5
Q

CPR should have a compression rate of ____ compressions/minute at a depth of at least __ inches and allow complete _____

A
  1. 100-120 compression/minute
  2. Depth of at least 2 inches
  3. Allow complete chest recoil
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6
Q

Electricaly therapy (by an automated external defibrillator or a defibrillator) should be initiated ______

A

As soon as it is available

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7
Q

Interruptions in chest compressions should be _____ and ____ as possible

A

Interruptions in chest compressions should be minimal and as short as possible.

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8
Q

These three common procedures should not interrupt chest compressions and defibrillation

A
  1. Vascular access
  2. Medication administration
  3. Airway placement
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9
Q

What is the best route of medication administration in ACLS?

A

Central venous administration

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10
Q

What is the second best route of medication administration in ACLS?

A

Intraosseus

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11
Q

Why is intraosseus preferred over endotracheal?

A
  1. More predictable drug delivery

2. More predictable pharmacologic effect

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12
Q

How to perform endotracheal drug administration?

A
  1. Administer 2-2.5 times the standard IV dose, and dilute in 5-10 mL of sterile water
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13
Q

List five drugs which can be administered through an endotracheal tube

A
  1. Naloxone
  2. Atropine
  3. vasopressin
  4. Epinephrine
  5. Lidocaine
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14
Q

If medications are administered through a peripheral vein, follow the medicationsn with _______ to faciliate drug flow from the extremity to central circulation.

A

20 mL of IV fluid

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15
Q

What is ROSC?

A

Return of spontaneous circulation

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16
Q

After ROSC, _______ can improve survival and quality of life

A

Systematic post-cardiac arrest care

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17
Q

Initial therapy following ROSC should optimize what three things?

A
  1. ventilation
  2. Oxygenation
  3. Blood pressure
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18
Q

SaO2 should be maintained at ___% of higher in systematic post-cardiac arrest care

A

94% or higher

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19
Q

In order to maintain an adequate SaO2, _____ may be required

A

Insertion of an advanced airway may be necessary

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20
Q

Regarding: oxygenation:_______ and _______ are harmful and should be avoided, especially afte ROSC

A
  1. Hyperventilation

2. Excess oxygen delivery

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21
Q

Hypotension (SBP of ___ or less) should be treated with what two treatments?

A
  1. 90 mm Hg or less
  2. Fluid boluses
  3. vasopressors
22
Q

What does TTM stand for?

A

Target temperature management (therapeutic hypothermia)

23
Q

For whom should TTM be considered?

A

Consider hypothermia in patients who have been successfully resuscitated after a cardiac arrest but who remain comatose (usually defined as a lack of meaningful response

24
Q

Cooling should be continued for at least ________ hours

A

24 hours

25
Q

Describe benefit of TTM

A

Inducation of hypothermia (32 C-36 C for at least 24 hours) beginning as soon as possible after ROSC can improve neurologic recovery and mortality.

26
Q

What temperature should be used for TTM?

A

One study has shown that a standard target temperature of 33 C does not confer benefit over a higher temperature of 36 C. AHA guidelines allow clinician to select the exact target temperature.

27
Q

List five methods of inducing hypothermia

A
  1. Surface cooling devices
  2. Endovascular catheters
  3. Cooling blankets
  4. Ice packs
  5. Cold IV fluids
28
Q

How should temperature be monitored in TTM?

A

Continuously

29
Q

Many patients will need what two adjunctive therapies for TTM?

A
  1. Sedation

2. Analgesia

30
Q

Rewarming should be done at what rate?

A

0.3 C to 0.5 C every hour

31
Q

List 8 complications of TTM

A
  1. Shivering
  2. Altered drug metabolism (hepatic)
  3. Coagulopathy (hepatic)
  4. Increased renal excretion of water and subsequent volume depletion (renal)
  5. Arrhythmia and hypotension (heart)
  6. Hyperglycemia and hypoglycemia (metabolic)
  7. Infection
  8. Electrolyte disturbances (renal, metabolic)
32
Q

Why should shivering be treated and prevented?

A
  1. Excess heat production
  2. Increased oxygen consumption
  3. General stress response
33
Q

List seven drug/drug classes used for treating and preventing shivering

A
  1. Sedatives
  2. Anesthetics
  3. Analgesics
  4. Steroid
  5. Serotonin drugs
  6. Magnesium
  7. Paralytics
34
Q

List three sedatives for treating/preventing shivering

A
  1. Dexmedetomidine
  2. Clonidine
  3. Ketamine
35
Q

List three analgesics used for shivering

A
  1. Meperidine
  2. Fentanyl
  3. tramadol
36
Q

What steroid is used for preventing and treating shivering?

A

Dexamethasone

37
Q

What serotonin drugs are used for shivering?

A
  1. Ondansetron

2. Buspirone

38
Q

When is risk of shivering the greatest?

A
  1. Induction of hypothermia

2. During rewarming

39
Q

Describe use of paralytics in preventing shivering

A
  1. Not mandatory and should be avoided if possible
  2. May be most beneficial during induction of hypothermia and during rewarming
  3. Should be continually reevaluated and discontinued if posisble once goal temperature is achieved.
40
Q

List two broad effects of altered drug metabolism in TTM

A
  1. Decreased clearance

2. Altered distribution

41
Q

Decreased clearance of drugs can occur due to ______ in TTM

A

Depressed activity of CYP 3A4 and CYP 3A5

42
Q

The altered distribution of _______ can have a clinically significant effect in TTM

A

Propofol

43
Q

The effects of altered drug metabolism in TTM are more pronounced at ______ temperatures

A

Cooler temperatures

44
Q

Use ____ dosing during the induction of hypothermia

A

Bolus dosing

45
Q

Reduce maintenance doses ______ in TTM

A

As needed

46
Q

What is the most common arrhythmia in TTM?

A

Bradycardia

47
Q

How to treat arrhythmia and hypotension in TTM?

A

Discontinue or slightly warm patient if life-threatening arrhythmias or persistent hemodynamic instability develops

48
Q

____glycemia occurs during hypothermia, _____ocurs during rewarming.

A
  1. Hyperglycemia during hypothermia

2. Hypoglycemia during rewarming

49
Q

How to treat hyperglycemia, hypoglycemia in TTM?

A

Monitor blood glucose often (i.e. every 1-2hours) and adjust insulin accordingly.

50
Q

What electrolyte disturbances happen during TTM cooling?

A

Reductions in K+, Mg2+ and phosphate during cooling

51
Q

What electrolyte disturbances happen during rewarming?

A

Hyperkalemia during rewarming

52
Q

Why should special electrolyte protocols be used in TTM?

A
  1. Electrolyte shifts occur during the induction and rewarming phases of TTM.
  2. Special protocols ensure patients do not receive too much potassium during cooling such that they are hyperkalemic during rewarming.
  3. Frequent monitoring and careful repletion is important to prevent complications.

BCPS Exam (34 decks)

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