RECOVER

Question 1

What is the recommendation on compression only CPR?

Answer 1

Conflicting evidence - no recommendation can be made at this point
if cardiac arrest witnessed - reasonable to start compressions and intubate then as soon as possible, otherwise ABC is still recommended due to the relatively high causes of noncardiac arrest in SA

Question 2

What type of defibrillation is suspected to be more susceptible to lidocaine increasing the defibrillation threshold?

Answer 2

Monophasic

study on dogs just using monophasic defib showded increased threshold

pig study looking at monophasic versus biphasic showed lidocaine did not affect the biphasic defib threshold

Question 3

Which drug is most likely to be useful in patients with shock-resistant pulseless VT or Vfib?

Answer 3

amiodarone

Question 4

What are 2 beneficial effects of naloxolne during CPR besides opioid reversal?

Answer 4

• positive inotrope
• antiarrhythmic

currently only indicated if opioids administered before CPA

Question 5

What is the current recommendation on bicarbonate administration during CPR?

Answer 5

may be considered in prolonged arrest

Question 6

When is Ca-therapy indicated in CPR?

Answer 6

• severe ionized hypocalcemia
• Ca-channel blocker overdosage

routine use not warranted

Question 7

How does a impedance threshold device work?

Answer 7

applied to the ET tube - during compressions&raquo_space; lets air move out but no air back in
creates a more negative intrathoracic pressure and improves preload

Question 8

What are contraindication for impedance threshold devices?

Answer 8

severe lung disease or existing pulmonary edema

patients < 10 kg

Question 9

What is myocardial stunning?

Answer 9

phenomenom occuring after global myocardial ischemia&raquo_space; LV and RV ejection fraction decreases + end diastolic pressure increases

Question 10

What are the SAP and MAP targets during PCA care?

Answer 10

SAP 100-200
MAP 80-120

Question 11

By what mechanism does cyclosporin help in PCA care?

Answer 11

inhibits the mitochondrial permeability transition pore (mPTP)

Question 12

What are the recommended steps for patients during PCA care that are hypertensive?

Answer 12

1. decrease pressors
2. treat pain
3. anti-hypertensives

Question 13

What is the recommendation for mild therapeutic hypothermia for PCA care?

Answer 13

if patient remains comatose - initiate MTH as soon as possible and maintain for 24-48 hours
if mechanical ventilation and advanced critical care are available

Question 14

Does coarse or fine VF have a better prognosis for ROSC?

Answer 14

coarse

Question 15

What is the minimum required PCA monitoring and what monitoring may be considered?

Answer 15

minimum:
* ecg
* arterial BP
* assessment of oxygenation and ventilation

consider:
* glucose
* lactate
* body temp