Post-Cardiac Arrest Flashcard 4
Rationale
B. Rationale: During post-cardiac care, oxygenation must be optimized by maintaining an oxygen saturation SpO2 between 92% and 98%. (Case: Post-Cardiac Arrest Care)
Question
What is the lowest acceptable oxygen saturation during post-cardiac arrest care?
a. 89%
b. 92%
c. 94%
d. 95%
Answer
b. 92%
Rationale
C. Rationale: It is recommended that post-cardiac arrest patients maintain a minimum systolic and diastolic blood pressure of 90/60 mm Hg.
Question
What is the recommended minimum systolic and diastolic pressure to be maintained in post-cardiac arrest care?
a. 120 mm Hg systolic and 80 mm Hg diastolic
b. 100 mm Hg systolic and 70 mm Hg diastolic
c. 90 mm Hg systolic and 60 mm Hg diastolic
d. 80 mm Hg systolic and 60 mm Hg diastolic
Answer
c. 90 mm Hg systolic and 60 mm Hg diastolic
Rationale
C. Rationale: Hemofiltration aims to improve humoral response to ischemic reperfusion injury after cardiac arrest. Hemofiltration removes medium molecular-weight molecules responsible for reperfusion injury and improves myocardial performance and hemodynamics.
Question
What is the role of hemofiltration in post-cardiac arrest care?
a. Increasing cardiac output to improve hypotension and reperfusion from shock
b. Reducing systemic vascular resistance and improving tissue reperfusion
c. Improving the humoral response to ischemic reperfusion injuries after cardiac arrest
d. Increasing myocardial contractility and heart rate to improve preload and afterload
Answer
c. Improving the humoral response to ischemic reperfusion injuries after cardiac arrest
Rationale
C. Rationale: Hyperventilating the patient will cause physiologic constriction of the intracerebral vasculature, thereby controlling the swelling in the brain. This is performed carefully to not elicit the adverse effects of overventilation.
Question
Which of the following interventions helps to reduce intracerebral pressure in traumatic brain injury patients with brain swelling?
a. Increase oxygen supplementation to 100%
b. Electroconvulsive therapy
c. Hyperventilation
d. Targeted temperature management
Answer
c. Hyperventilation
Rationale
C. Rationale: There is no evidence to support continued prophylactic administration of antiarrhythmic medications once the patient acheives ROSC.
Question
Which of the following interventions is NOT part of immediate post-cardiac arrest care?
a. Increasing or decreasing ventilations
b. Increasing or decreasing oxygen supplementation
c. Prophylactic administration of antiarrhythmics
d. Titrating vasopressor infusion
Answer
c. Prophylactic administration of antiarrhythmics
Rationale
C. Rationale: Targeted temperature management is a recommended intervention for cardiac arrest patients that have achieved ROSC but remain in a coma. After TTC discontinuation, all efforts should be toward controlling hyperthermia to promote better neurologic outcomes if the patient survives. (Case: Post-Cardiac Arrest Care)
Question
Which of the following interventions is recommended if a patient has achieved ROSC but has a Glasgow Coma Scale of 3?
a. Intensive antibiotic treatment
b. Induction of coma
c. Targeted temperature management (TTM)
d. Intracranial angiogram
Answer
c. Targeted temperature management (TTM)
Rationale
D. Rationale: The following are common neuroprotective agents that help to prevent further brain injury: thiopental, glucocorticoids, nimodipine, lidoflazine, diazepam, magnesium sulfate, and coenzyme-Q10.
Question
Which of the following is a neuroprotective agent to improve neurologic outcomes in patients with brain injury?
a. Fluoxetine
b. Amitriptyline
c. Clozapine
d. Diazepam
Answer
d. Diazepam
Rationale
C. Rationale: The treatment goals for post-cardiac arrest care include optimizing oxygenation, ventilation, and the treatment of hypotension. Other case-specific treatments include immediate reperfusion therapies for acute MI and targeted temperature management for comatose patients.
Question
Which of the following is a treatment goal for all patients in post-cardiac arrest care?
a. Electric therapies
b. Pharmacologic neuroprotective treatments
c. Address hypotension
d. Cardiac pacing
Answer
c. Address hypotension
Rationale
A. Rationale: Milrinone is a phosphodiesterase inhibitor that increases myocardial contractility while reducing pulmonary vascular resistance. It is used in post-cardiac arrest because its vasoactive effects can attenuate post-resuscitation myocardial dysfunction.
Question
Which of the following is a vasoactive drug that can be used to increase the blood pressure of a patient in post-cardiac arrest care?
a. Milrinone
b. Betamethasone
c. Lidocaine
d. Amiodarone
Answer
a. Milrinone
Rationale
C. Rationale: IV fibrinolytic therapy can be performed while CPR is being conducted. Common fibrinolytic agents include alteplase, streptokinase, and recombinant urokinase. Aspirin is not a treatment for pulmonary embolism.
Question
Which one of the following interventions can be initiated while performing CPR in a patient with cardiac arrest secondary to pulmonary embolism?
a. Surgical embolectomy
b. Aspirin therapy
c. IV fibrinolytic therapy
d. No other intervention is feasible while performing CPR
Answer
c. IV fibrinolytic therapy