Post Cardiac Arrest Flashcard
Rationale
C. Rationale: A cardiac arrest patient that has achieved a return of spontaneous circulation but is in a coma (Glasgow Coma Scale score of 3) should undergo targeted temperature management, which is known to improve survival to hospital discharge with good neurologic outcomes.
Question
A 54-year-old drowning patient has been revived in the ED and admitted to the ICU. Neurologic examination reveals a Glasgow coma scale score of 3. What important intervention must be performed immediately in this case?
a. Pharmacologic neuroprotective treatments
b. Increased oxygenation
c. Medical induced coma
d. Targeted temperature management
Answer
c. Medical induced coma
Rationale
A. Rationale: Esophageal thermometer, bladder catheter, and pulmonary catheter temperature measurements best approximate core body temperatures.
Question
A 65-year-old man with cardiac arrest has recently achieved return of spontaneous circulation after 26 minutes of cardiopulmonary resuscitation in the emergency department. He remains unresponsive to verbal commands and has a Glasgow Coma Scale score of 8. The team schedules him for targeted temperature management. Which one of the following thermometers best measures core temperature for targeted temperature management?
a. esophageal thermometer
b. axillary thermometer
c. oral thermometer
d. rectal thermometer
Answer
a. esophageal thermometer
Rationale
A. Rationale: If a patient has below normal core temperatures, end-tidal CO2 might be higher than the actual value.
Question
A post-cardiac arrest patient is intubated and undergoing targeted temperature management. If a patient has below-normal core temperatures, what is the likely reading of the patient’s end-tidal CO2 on waveform capnogram?
a. Higher than the actual value
b. Lower than the actual value
c. Unaffected
d. Variable
Answer
a. Higher than the actual value
Rationale
C. Rationale: Cooling down the core temperature protects the brain and other organs. It is recommended that the temperature must be maintained between 32°C and 36°C during targeted temperature management.
Question
For targeted temperature management when treating post-cardiac arrest patients with a suspected neurological insult, what is the optimum temperature that the patient must achieve?
a. Below 28°C
b. 28–32°C
c. 32–36°C
d. Above 36°C
Answer
c. 32–36°C
Rationale
D. Rationale: The recommended goal for targeted temperature management is to attain and maintain a constant core temperature between 32°C and 36°C for at least 24 hours after ROSC. (ACLS Case: Cardiac Arrest: Targeted Temperature Management)
Question
Targeted temperature management involves attaining and maintaining a constant core temperature between 32°C and 36°C for a minimum of how many hours after the return of spontaneous circulation?
a. 6 hours
b. 12 hours
c. 18 hours
d. 24 hours
Answer
d. 24 hours
Rationale
A. Rationale: TTM is the induction of hypothermia with active control and maintenance of the patient’s temperature. A target temperature range of 32–36°C is maintained for at least 24 hours. This method is used to improve neurologic function in comatose patients with ROSC after cardiac arrest.
Question
The attending neurologist recommends targeted temperature management (TTM) for a post-cardiac arrest patient. To achieve TTM, the patient’s temperature should be maintained at a range of:
a. 32–36°C
b. 20–25°C
c. 35–37°C
d. 30–32°C
Answer
a. 32–36°C
Rationale
C. Rationale: TTM is the induction of hypothermia with active control and maintenance of temperature used with a goal of improving neurologic function in comatose patients who have achieved ROSC. A target temperature between 32°C and 36°C is selected and maintained for at least 24 hours. (Post-Cardiac Arrest Care: Highlights of the Post-Cardiac Arrest Algorithm)
Question
The attending neurologist recommends that the recently post-cardiac arrest patient undergo targeted temperature management (TTM). At what range should the patient’s temperature be maintained to achieve TTM?
a. 22°C to 26°C
b. 20°C to 25°C
c. 32°C to 36°C
d. 35°C to 40°C
Answer
c. 32°C to 36°C
Rationale
A. Rationale: Targeted temperature management preserves brain function as well as the function of other vital organs.
Question
Which one of the following clinical findings necessitates targeted temperature management in immediate post-cardiac arrest patients?
a. Comatose patients
b. ST elevation myocardial infarction
c. Febrile patients
d. Cardiac arrest secondary to accidental hypothermia
Answer
a. Comatose patients
Rationale
D. Rationale: Targeted temperature management is the only intervention demonstrated to improve neurologic recovery after cardiac arrest.
Question
Which one of the following treatments in the immediate post-cardiac arrest period improves neurologic recovery after cardiac arrest?
a. Immediate reperfusion therapy
b. Improve hypotension
c. Supplemental oxygen and ventilation support
d. Targeted temperature management
Answer
d. Targeted temperature management