Cardiac Arrest and Post-Cardiac Arrest Care - Pre-Assessment

What medication should be considered for torsades de pointes?

Magnesium sulfate

When should decision-making related to continuation or withdrawal of life-sustaining treatments for a patient who remains comatose after cardiac arrest take place?

No earlier than 72 hours after the patient achieves return of spontaneous circulation (ROSC) and normothermia

A patient is in cardiac arrest. Metabolic acidosis is determined to be the underlying cause. What initial dose of sodium bicarbonate should be considered?

1 mEq/kg

After delivering three shocks, the team leader orders the administration of lidocaine to a patient in cardiac arrest. What is the dose?

1 to 1.5 mg/kg IV/IO, followed by 0.5 to 0.75 mg/kg IV/IO every 5 to 10 minutes, maximum dose of 3 mg/kg

A post-cardiac arrest patient has a systolic blood pressure of less than 90 mmHg. What interventions should be considered next?

1-2L IV isotonic crystalloid fluid bolus Vasopressor infusion w/epinephrine (0.1-0.5mcg/kg/min) Mechanical circulatory support

What diagnostic study should be delayed until return of spontaneous circulation (ROSC)?

12-lead EKG

What is the initial dose of amiodarone for a patient in cardiac arrest?

300 mg; 150mg for subsequent doses

The risk for torsades de pointes is increased when the corrected QT interval (QTc) is greater than ________ milliseconds.

500

Current recommendations suggest that hypotension should be treated in a post-cardiac arrest patient when the systolic blood pressure is less than 90 mmHg or the mean arterial pressure (MAP) is less than:

65 mmHg

The pathophysiologic consequences of cardiac arrest comprise what key areas?

Brain Injury Myocardial dysfunction Systemic dysfunction

What assessments may be included as part of a multimodal approach to neuroprognostication in a comatose post-cardiac arrest patient?

Certain biomarkers Brain computed tomography (CT) Quantitative pupillometry Somatosensory evoked potentials (SSEP)

Which of the following would be important to note when reviewing the history of a patient in cardiac arrest?

Changes in clinical condition prior to arrest Risk factors for cardiac/pulmonary conditions Medication use Disorders/situations that could predispose patient to Hs or Ts

Which diagnostic studies are useful for identifying causes of the patient's cardiac arrest?

Chest X-ray Bedside U/S Serum electrolytes

What initial interventions are appropriate for the primary assessment of a patient who has achieved return of spontaneous circulation (ROSC)?

Consider placement of an ET tube to support mechanical ventilation; if endotracheal tube already in place, confirm proper position and patency Ensure adequate perfusion Support ventilations to keep carbon dioxide levels in physiologic range

Which of the following are key questions to answer in the assessment and management of a post-cardiac arrest patient?

Does patient require reperfusion therapy? Is patient a candidate for TTM? Is there a potentially reversible underlying cause for the cardiac arrest?

A patient in cardiac arrest with a non-shockable rhythm is receiving high-quality CPR. When should compressions be paused to conduct a rhythm check?

Every 2 minutes

What are causes of cardiac arrest in a pregnant patient?

Fever Eclampsia Anesthesia

A patient has gone into cardiac arrest. Prior to the arrest, a 12-lead ECG showed flat T waves, prominent U waves and prolonged QT intervals. What underlying cause should you suspect?

Hypokalemia

Which of the following are reversible causes of cardiac arrest?

Hypokalemia Hyperkalemia Acidosis Hypoxia

The resuscitation team responds to an in-hospital cardiac arrest. What actions would they perform immediately?

ID arrest rhythm on the monitor Ensure high-quality CPR is in progress

The rhythm check reveals a shockable rhythm. When should chest compressions resume?

Immediately after rhythm check

A post cardiac arrest patient who experienced in-hospital cardiac arrest is unable to follow verbal commands. Which interventions would be appropriate for this patient?

Implement Targeted Temperature Management (TTM) Obtain brain imaging Establish EEG monitoring

A 32-year-old patient (30 weeks gestation) goes into cardiac arrest. The fundus is above the umbilicus. How can team members maximize the effectiveness of chest compressions for this patient?

Position the patient in the supine position and provide manual left uterine displacement

A 78-year-old patient who had knee replacement surgery 2 days ago goes into cardiac arrest. Which underlying cause should be given priority consideration?

Pulmonary embolism

In what instances might extracorporeal cardiopulmonary resuscitation (ECPR) be an appropriate intervention for a patient in cardiac arrest?

Pulmonary embolism Hypothermia Drug overdose

Your patient is in cardiac arrest and the monitor is showing the following rhythm. Identify the rhythm. (Rhythm strip shows tombstoning)

Pulseless ventricular tachycardia

Torsades de pointes may revert to which of the following rhythms?

Pulseless ventricular tachycardia Ventricular fibrillation Sinus rhythm

Which of the following would be done as part of the secondary assessment of a patient in cardiac arrest?

Reviewing medical history

Which of the following diagnostic tests is used for monitoring perfusion status in a post-cardiac arrest patient?

Serum lactate

Which of the following rhythm strips is showing pulseless electrical activity (PEA)? (One strip shows what looks like normal sinus rhythm at about 90 bpm, other strip is a flatline)

The one that actually has electrical activity

The underlying cause of primary pulseless electrical activity (PEA) can be related to inadequate volume, impaired myocardial contractility or both.

True

Which of the following factors should be taken into consideration when determining whether to continue the resuscitation effort?

Underlying cause of arrest Initial cardiac arrest rhythm Physiologic data Duration of resuscitation effort Patient's health status prior to cardiac arrest

Which of the following rhythms are shockable?

Ventricular fibrillation Pulseless ventricular tachycardia

A 28 year old patient (27 weeks gestation) was admitted to the intensive care unit for treatment of pneumonia-related sepsis. The patient goes into cardiac arrest. When should resuscitative cesarean delivery (RCD) be performed?

Within 5 minutes from the time of the arrest