Questions and Answers
What is a common but sometimes fatal mistake in cardiac arrest management?
What assessment step is most important for a 58-year-old man with chest pain and a blood pressure of 92/50 mm Hg?
Obtaining a 12-lead ECG
What is the preferred method of access for epinephrine administration during cardiac arrest in most patients?
Peripheral intravenous
An activated AED does not promptly analyze the rhythm. What is your next action?
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You notice a PETCO2 level of 8 mm Hg after inserting an ET tube during cardiac arrest. What does this mean?
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What does quantitative capnography allow for in intubated patients?
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After 25 minutes of resuscitation in a patient who presented in V Fib, what should you consider?
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Which is a safe and effective practice within the defibrillation sequence?
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What is the primary purpose of a medical emergency team (MET) or rapid response team (RRT)?
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What is an appropriate indication to stop or withhold resuscitative efforts?
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What is the first treatment priority for a patient who achieves ROSC?
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What is the minimum systolic blood pressure one should attempt to achieve in a hypotensive post-cardiac arrest patient?
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What is the potential danger of using ties that pass circumferentially around the patient's neck when securing an advanced airway?
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What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube?
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What is the recommended IV fluid bolus dose for a patient who achieves ROSC but is hypotensive?
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Which condition is a contraindication to therapeutic hypothermia during the post-arrest cardiac period?
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What is the usual post-cardiac arrest target range for PETCO2 when ventilating a patient?
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What is the usual post-cardiac arrest target PETCO2 range when ventilating a patient who achieves return of spontaneous circulation?
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What is appropriate ventilation strategy for an adult in respiratory arrest with a pulse rate of 80 p/min?
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Match the following drugs with their correct dosages or usage:
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What action improves the quality of chest compressions during a resuscitation attempt?
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What is a common sign of effective CPR?
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What is the appropriate interval for an interruption in chest compressions?
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Study Notes
Cardiac Arrest Management
- Prolonged interruptions in chest compressions are a common error during cardiac arrest management and can be fatal.
- High-quality CPR involves allowing complete chest recoil and compressing immediately before defibrillation to increase chances of success.
Assessment Priorities
- For a patient with chest pain, obtaining a 12-lead ECG is critical after evaluating vital signs: BP 92/50 mm Hg, HR 92/min.
- In cases of no pulse and unresponsive patients, immediate chest compressions are essential.
Medication and Procedures
- Peripheral intravenous access is the preferred method for administering epinephrine during cardiac arrest.
- Administer 1 mg of epinephrine every 3-5 minutes during resuscitation efforts.
- For patients in V Fib or unresponsive after defibrillation and CPR, consider terminating resuscitation efforts after consulting medical control.
Monitoring and Interventions
- Continuous waveform capnography is the most reliable method to confirm endotracheal tube placement and track ventilation efficiency.
- A PETCO2 level of 8 mm Hg indicates ineffective chest compressions during CPR.
- The minimum systolic blood pressure to target in hypotensive patients post-ROSC is 90 mm Hg.
Conditions and Contraindications
- Evidence of rigor mortis or lividity are indications for halting resuscitation efforts.
- Therapeutic hypothermia is contraindicated in patients who respond to verbal commands after achieving ROSC.
Advanced Airway Management
- Using ties that go circumferentially around the neck can obstruct venous return from the brain.
- Ventilation rates for patients in cardiac arrest with an advanced airway should be 8-10 breaths/minute.
Emergency Responses
- Rapid response teams aim to identify and treat early signs of clinical deterioration.
- In case of possible acute stroke scenarios, diverting patients to facilities with CT scan capabilities might be necessary.
Pharmacology
- For managing bradycardia: Atropine 0.5 mg IV, repeat every 3-5 minutes (max 3 mg); Dopamine may be administered at 2-10 mcg/kg/min as needed.
- Adenosine can be used for tachycardia with a first dose of 6 mg IV, followed by a 12 mg second dose if necessary.
- Amiodarone is indicated for cardiac arrest with a dose of 300 mg IV bolus or a second dose of 150 mg if needed.
Additional Key Points
- The appropriate fluid bolus for hypotensive patients after ROSC is 1-2 liters.
- Regular assessment and switching providers every 2 minutes helps maintain optimal compression quality during CPR.
- Valsalva maneuvers can be employed for patients experiencing tachycardia.
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Description
Test your knowledge on the best practices for managing cardiac arrest. This quiz covers critical assessment priorities, medication protocols, and monitoring interventions essential for effective resuscitation. Enhance your skills in high-quality CPR and timely intervention during emergencies.
