Red Cross Pre-assessment Cardiac Arrest and Post-Cardiac Arrest Care

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

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

Mechanical circulatory support Correct 1- to 2-L intravenous (IV) isotonic crystalloid fluid bolus Correct Vasopressor infusion with epinephrine (2-10 mcg/min)

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 post-cardiac arrest patient who experienced in-hospital cardiac arrest is unable to follow verbal commands. Which interventions would be appropriate for this patient? Select all correct options that apply.

Obtain brain imaging Correct Initiate targeted temperature management (TTM) Correct Establish EEG monitoring

Which of the following rhythms are shockable?

Ventricular fibrillation Pulseless ventricular tachycardia

Which of the following rhythm strips is showing pulseless electrical activity (PEA)?

Looks like NSR but it's lying.

A patient in cardiac arrest has received one dose of lidocaine. What dosage should the patient receive the next time lidocaine is administered?

0.5 to 0.75 mg/kg Lidocaine: Alternatively, lidocaine may be used. The initial dose is 1 to 1.5 mg/kg IV/IO, followed by 0.5 to 0.75 mg/kg IV/IO every 5 to 10 minutes, up to a maximum dose of 3 mg/kg

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

150 mg

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

300 mg

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?

5 minutes

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:

65mmHg

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) A multimodal approach to predicting neurologic outcome is recommended and includes clinical examination, imaging, biomarkers and electrophysiology (see the Adult Post-Cardiac Arrest Care Code Card). Clinical examination findings that may be used to predict outcome include pupillary light reflex, quantitative pupillometry and corneal reflex (at 72 hours or later after ROSC) and myoclonus or status myoclonus (within 96 hours of ROSC). Imaging studies used for neuroprognostication in the post-cardiac arrest patient include brain computed tomography (CT) and magnetic resonance imaging (MRI). The biomarker neuron-specific endolase (NSE) may be evaluated within 72 hours of ROSC but should be considered in conjunction with other tests as part of a multimodal approach to neuroprognostication. Electroencephalography (EEG) and somatosensory evoked potential (SSEP) may also be considered as part of a multimodal approach to predicting neurological outcome. Neither background reactivity alone nor seizures on EEG or status epilepticus should be used to predict poor outcome.

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

Ensure adequate perfusion Support ventilations to keep carbon dioxide levels in physiologic range Place an endotracheal tube; if endotracheal tube already in place, confirm proper position and patency

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

Ensure that high-quality CPR is in progress. Correct Identify arrest rhythm on monitor.

A patient in cardiac arrest with a nonshockable 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 Causes of Cardiac Arrest in Pregnancy (BAACC TO LIFE™) B: bleeding A: anesthesia A: amniotic fluid embolism C: cardiovascular/cardiomyopathy C: clot/cerebrovascular T: trauma O: overdose (opioids, magnesium sulfate, other) L: lung injury/acute respiratory distress syndrome I: ions (glucose, potassium) F: fever (sepsis) E: eclampsia/emergency hypertension

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

However, in some situations it may be appropriate to consider prolonging the resuscitation effort, using specialized interventions or both. For example, it may be appropriate to prolong the resuscitation effort when more time is needed to address the underlying cause of the cardiac arrest (for example, drug overdose, hypothermia, pulmonary embolism).

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 12-lead ECG: flat T waves, prominent U waves and possibly prolonged QT intervals Hypokalemia: Renal disease, diuretics, eating disorder, diarrhea/ vomiting Peri-arrest signs and symptoms: m

Which of the following are reversible causes of cardiac arrest?

Hypokalemia Acidosis Hyperkalemia Hypoxia ------------------ Hypovolemia • Hypoxemia • Hydrogen ion excess (acidosis) • Hyperkalemia/hypokalemia • Hypothermia • Hyperglycemia/hypoglycemia • Tamponade (cardiac) • Tension pneumothorax • Thrombosis (pulmonary embolism) • Thrombosis (myocardial infarction) • Toxins

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

Your patient is in cardiac arrest and the monitor is showing the following rhythm. Identify the rhythm.

Pulseless ventricular tachycardia M line

The pathophysiologic consequences of cardiac arrest comprise what key areas?

Systemic dysfunction Brain injury Myocardial dysfunction Sometimes referred to as post-cardiac arrest syndrome, the pathophysiologic consequences of cardiac arrest comprise four key areas: ■ Brain injury. Brain injury, caused by ischemia and cerebral edema, is a significant cause of morbidity and mortality in patients who achieve ROSC. ■ Myocardial dysfunction. Myocardial stunning secondary to the ischemia/reperfusion response causes systolic and diastolic dysfunction, leading to hemodynamic instability in the immediate post-arrest period. ■ Systemic dysfunction. The ischemia/reperfusion response can trigger a systemic inflammatory response, which can lead to multiple organ dysfunction. In addition, organs that are sensitive to changes in perfusion pressure, such as the kidneys, are at increased risk for reperfusion injury. ■ Persistent precipitating conditions. The underlying cause of the cardiac arrest may continue to have pathophysiologic

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

TRUE PEA may be seen immediately after successful defibrillation of a patient with ventricular fibrillation or pulseless ventricular tachycardia. But when PEA is the presenting rhythm ("primary PEA"), the underlying cause is usually a condition that either affects contractility or ejection (e.g., hypoxia, acidosis, anterior wall myocardial infarction) or leads to inadequate preload (e.g., severe hypovolemia, pulmonary embolism, tension pneumothorax, cardiac tamponade, right ventricular infarction).

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

The duration of the resuscitation effort Correct The underlying cause of the arrest Correct Physiologic data Correct The initial cardiac arrest rhythm Correct The patient's health status prior to cardiac arrest