Critical Care: Cardiac Arrest

Question 1

ACLS stands for

Answer 1

Advanced Cardiac Life Support

Question 2

CAB stands for

Answer 2

Compressions, airway, breathing

Question 3

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.

Answer 3

1. Cycle of 30 chest compressions

2. Followed immediately by 2 rescue breaths.

Question 4

CPR stands for

Answer 4

Cardiopulmonary Resuscitation

Question 5

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

Answer 5

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

Question 6

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

Answer 6

As soon as it is available

Question 7

Interruptions in chest compressions should be _____ and ____ as possible

Answer 7

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

Question 8

These three common procedures should not interrupt chest compressions and defibrillation

Answer 8

1. Vascular access
2. Medication administration
3. Airway placement

Question 9

What is the best route of medication administration in ACLS?

Answer 9

Central venous administration

Question 10

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

Answer 10

Intraosseus

Question 11

Why is intraosseus preferred over endotracheal?

Answer 11

1. More predictable drug delivery

2. More predictable pharmacologic effect

Question 12

How to perform endotracheal drug administration?

Answer 12

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

Question 13

List five drugs which can be administered through an endotracheal tube

Answer 13

1. Naloxone
2. Atropine
3. vasopressin
4. Epinephrine
5. Lidocaine

Question 14

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

Answer 14

20 mL of IV fluid

Question 15

What is ROSC?

Answer 15

Return of spontaneous circulation

Question 16

After ROSC, _______ can improve survival and quality of life

Answer 16

Systematic post-cardiac arrest care

Question 17

Initial therapy following ROSC should optimize what three things?

Answer 17

1. ventilation
2. Oxygenation
3. Blood pressure

Question 18

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

Answer 18

94% or higher

Question 19

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

Answer 19

Insertion of an advanced airway may be necessary

Question 20

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

Answer 20

1. Hyperventilation

2. Excess oxygen delivery

Question 21

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

Answer 21

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

Question 22

What does TTM stand for?

Answer 22

Target temperature management (therapeutic hypothermia)

Question 23

For whom should TTM be considered?

Answer 23

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

Question 24

Cooling should be continued for at least ________ hours

Answer 24

24 hours

Question 25

Describe benefit of TTM

Answer 25

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.

Question 26

What temperature should be used for TTM?

Answer 26

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.

Question 27

List five methods of inducing hypothermia

Answer 27

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

Question 28

How should temperature be monitored in TTM?

Answer 28

Continuously

Question 29

Many patients will need what two adjunctive therapies for TTM?

Answer 29

1. Sedation | 2. Analgesia

Question 30

Rewarming should be done at what rate?

Answer 30

0.3 C to 0.5 C every hour

Question 31

List 8 complications of TTM

Answer 31

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)

Question 32

Why should shivering be treated and prevented?

Answer 32

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

Question 33

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

Answer 33

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

Question 34

List three sedatives for treating/preventing shivering

Answer 34

1. Dexmedetomidine 2. Clonidine 3. Ketamine

Question 35

List three analgesics used for shivering

Answer 35

1. Meperidine 2. Fentanyl 3. tramadol

Question 36

What steroid is used for preventing and treating shivering?

Answer 36

Dexamethasone

Question 37

What serotonin drugs are used for shivering?

Answer 37

1. Ondansetron | 2. Buspirone

Question 38

When is risk of shivering the greatest?

Answer 38

1. Induction of hypothermia | 2. During rewarming

Question 39

Describe use of paralytics in preventing shivering

Answer 39

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.

Question 40

List two broad effects of altered drug metabolism in TTM

Answer 40

1. Decreased clearance | 2. Altered distribution

Question 41

Decreased clearance of drugs can occur due to ______ in TTM

Answer 41

Depressed activity of CYP 3A4 and CYP 3A5

Question 42

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

Answer 42

Propofol

Question 43

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

Answer 43

Cooler temperatures

Question 44

Use ____ dosing during the induction of hypothermia

Answer 44

Bolus dosing

Question 45

Reduce maintenance doses ______ in TTM

Answer 45

As needed

Question 46

What is the most common arrhythmia in TTM?

Answer 46

Bradycardia

Question 47

How to treat arrhythmia and hypotension in TTM?

Answer 47

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

Question 48

____glycemia occurs during hypothermia, _____ocurs during rewarming.

Answer 48

1. Hyperglycemia during hypothermia | 2. Hypoglycemia during rewarming

Question 49

How to treat hyperglycemia, hypoglycemia in TTM?

Answer 49

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

Question 50

What electrolyte disturbances happen during TTM cooling?

Answer 50

Reductions in K+, Mg2+ and phosphate during cooling

Question 51

What electrolyte disturbances happen during rewarming?

Answer 51

Hyperkalemia during rewarming

Question 52

Why should special electrolyte protocols be used in TTM?

Answer 52

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.