Assessment Flashcard 4
Rationale
D. Rationale: The normal end-tidal CO2 is 35–40 mmHg. This indicates normal gas exchange occurring at the level of the alveoli, where oxygen is absorbed while carbon dioxide is expelled.
Question
A waveform capnogram measuring 35 mm Hg indicates which of the following physiologic events?
a. Poor ventilation and perfusion in the alveoli
b. Adequate ventilation but poor perfusion in the alveoli
c. Poor ventilation but adequate perfusion in the alveoli
d. Adequate ventilation and perfusion in the alveoli
Answer
d. Adequate ventilation and perfusion in the alveoli
Rationale
D. Rationale: An end-tidal CO2 reading of 35 mm Hg is normal. Thus, there is a chance that the patient has a return of spontaneous circulation. To confirm, check the patient’s pulse and check for spontaneous breathing. Once confirmed, CPR is halted, and post-cardiac arrest care of the patient commences.
Question
After 5 cycles of high-quality CPR and providing one dose of epinephrine, the patient with cardiac arrest exhibits an end-tidal CO2 of 35 mm Hg. What is your next course of action?
a. Continue CPR.
b. Defibrillate.
c. Check for pulse and breathing.
d. Discontinue CPR and transfer the patient for post-cardiac arrest care.
Answer
d. Discontinue CPR and transfer the patient for post-cardiac arrest care.
Rationale
C. Rationale: Absence of brain activity 72 hours after a return of spontaneous circulation or 72 hours after the patient has been normothermic indicates a poor outcome. This data can be used as one of the indications of brain death.
Question
After 72 hours from the return of spontaneous circulation, electroencephalogram studies reveal no activity. What can you conclude at this point?
a. There is no indication of seizures.
b. There is no sign of irreversible brain function.
c. The patient will have a poor outcome.
d. The patient is in status epilepticus.
Answer
c. The patient will have a poor outcome.
Rationale
C. Rationale: In a conscious patient, the next step is to directly initiate the primary assessment.
Question
After ensuring scene safety, you come to the aid of a patient who was electrocuted in a wall socket. You ask if he is okay, and he tells you that his left arm is numb. Following the systematic approach, what is the next step?
a. Secondary assessment
b. BLS assessment
c. Primary assessment
d. Tertiary assessment
Answer
c. Primary assessment
Rationale
B. Rationale: Healthcare providers start by making sure that the scene where a suspected cardiac arrest has taken place is safe for the people involved. The rescuer then assesses the patient’s consciousness. If a patient is unconscious, the provider initiates the BLS assessment. This is followed by the primary assessment and then the secondary assessment. (The Systematic Approach in ACLS: BLS Assessment)
Question
After ensuring scene safety, you come to the aid of an adult male pedestrian who was in a vehicular crash. You try to wake him up by tapping on his shoulder and shouting, “Hey, are you okay?” There is no response. According to the systematic approach, what is the next step initiated?
a. Primary assessment
b. BLS assessment
c. Secondary assessment
d. Tertiary assessment
Answer
b. BLS assessment
Rationale
B. Rationale: Responders start by making sure that the scene is safe for the people involved. Next, the responder assesses the patient’s level of consciousness. If a patient is unconscious, the provider initiates the BLS assessment. Afterward, they follow the primary and then the secondary assessments.
Question
After ensuring scene safety, you come to the aid of an adult pedestrian who was just involved in a vehicular crash. You try to wake him by tapping on his shoulders and shouting, “Hey, are you okay?” There is no response. According to the systematic approach, what is the next step?
a. Primary assessment
b. BLS assessment
c. Secondary assessment
d. Tertiary assessment
Answer
b. BLS assessment
Rationale
D. Rationale: Some clinical findings associated with a poor neurologic outcome are absent pupillary reflex to light, the presence of status myoclonus, marked reduction of the gray-white matter ratio on CT scan taken 2 hours from arrest, and absence of electroencephalogram reactivity to external stimuli at 72 hours after cardiac arrest.
Question
After gathering all the data from neurological exams and imaging modalities, a post-cardiac arrest patient’s neurologist is optimistic that the patient will survive. Which one of the following is associated with a good neurologic outcome?
a. Lack of EEG reactivity to external stimuli at 72 hours post-arrest
b. Brain CT scan GWR of 0.8 taken within 2 hours of arrest
c. Status myoclonus
d. Positive pupillary reflex
Answer
d. Positive pupillary reflex
Rationale
A. Rationale: The patient is in cardiac arrest secondary to pulseless electrical activity. Blunt force trauma can rupture the spleen. The net effect is severe hypovolemia as the cause of the patient’s cardiac arrest. To achieve return of spontaneous circulation, it is important to immediately replace the volume of blood lost from the injury with a rapid infusion of normal saline solution.
Question
An 18-year-old football player was tackled pretty badly during a game. He experienced abdominal pain overnight and came into your clinic the next day. But while waiting to be seen, he suddenly lost consciousness. He has no pulse and is not breathing. Your emergency response team immediately initiates high-quality CPR. An ECG records the following rhythm:
Which of the following treatments is an integral component of his care?
a. Rapid infusion of normal saline solution
b. Epinephrine 1 mg IV bolus
c. Fibrinolytic therapy
d. Percutaneous coronary intervention
Answer
a. Rapid infusion of normal saline solution
Rationale
B. Rationale: After noting that a patient is unresponsive, EMS should be called immediately.
Question
An older man is seen lying on the ground. After verifying that the scene is safe, the responder checks the patient for a response. He is unresponsive to verbal commands and shaking. What is the next step for a layperson trained in Basic Life Support?
a. Check for pulse
b. Call for help/activate EMS
c. Check for spontaneous breathing
d. Begin CPR
Answer
b. Call for help/activate EMS
Rationale
D. Rationale: Checking for responsiveness in the adult patient includes tapping the patient on the shoulder or arm while shouting “Are you all right?” (or words to that effect) and checking the chest for movement indicating breathing, absence of breathing, or ineffective breathing (gasping or irregular, shallow breaths) by observing for 5 to 10 seconds. This is the first step in the BLS survey.
Question
Assessing for responsiveness in the adult patient involves:
A. Shaking the patient and shouting, “Are you all right?”
B. Looking at the patient’s chest to detect movement while simultaneously feeling the chest for rise and fall
C. Scanning the chest for the absence of breathing while listening for breaths with your ear to the patient’s mouth
D. Tapping the patient and shouting, “Are you all right?” and scanning the chest for movement
Answer
D. Tapping the patient and shouting, “Are you all right?” and scanning the chest for movement