ACLS EP Special Considerations Flashcard 2

C. Rationale: Upon bringing a person who was drowning out of the water to a safe environment, rescuers should provide 5 rescue breaths immediately (A-B-C instead of C-A-B).

C. Rationale: This should be rated as severe. You are also likely to hear wheezing on inhalation and exhalation. As the patient nears respiratory arrest, his respiratory rate will slow, he will become bradycardic, and the oxygen saturation will plummet. He is also likely to become much more confused or somnolent.

D. Rationale: Warm blankets is an external warming technique and not internal.

C. Rationale: Decisions to terminate resuscitation are very nuanced and require evaluation of prognosis, patient and family wishes, as well as ethical considerations. However, if there is clear evidence that a patient does not want resuscitation, this should be respected. A “do not resuscitate” bracelet effectively demonstrates this wish. Hypothermic patients should have resuscitation efforts that are prolonged as futility cannot be determined until normothermia is achieved. In a pregnant woman with a viable fetus and fatal injury, rapid caesarean section is the goal, which may require continued resuscitation efforts to ensure adequate perfusion to the fetus. Terminal illness does not indicated that patients should not be treated for other conditions. If there is an acute and reversible condition leading to arrest, a terminally ill individual can still benefit from resuscitative efforts.

A. Rationale: There is a 20% chance of recurrence of symptoms following treatment for anaphylaxis. The clinician must ensure that close monitoring is in place for at least 4 hours after treatment.

C. Rationale: Ground current is the type of lightning strike in which the patient absorbs current extending radially from an object on the ground that is directly hit. In this type of strike, the patient is NOT in direct contact with the object. This type of strike occurs in 30–60% of cases.

A. Rationale: The initial reaction to significant cold temperature is shivering to generate heat. As cold progresses, patients will have mental status changes, beginning with confusion and progressing to lethargy and finally coma. As mental status changes progress in severity, oxygen consumption will decrease. Pupillary dilation occurs when cardiac output is over 50% of oxygen consumption while tendon reflexes are lost when it is under 50% of oxygen consumption. Asystole occurs when cardiac output is lower than 25% of oxygen consumption.

D. Rationale: DKA is the classic anion gap metabolic acidosis. Due to the elevated ketones that are not measured, patients will have an increase in the anion gap. Nonanion gap metabolic acidosis will not have any ion outside of chloride and bicarbonate causing the disorder, e.g., diarrhea-based illnesses. Measuring the anion gap is typically used to evaluate metabolic disorders; there are no anion gap changes in respiratory acidosis.

B. Rationale: When an electric shock causes direct injury to cardiac tissue, the damage usually occurs in the inferior portion of the heart and can be identified in the ECG inferior leads.

D. Rationale: Factors associated with 100% mortality after drowning include all of the above EXCEPT for submersion between 5 and 10 minutes. Between 5 and 10 minutes, there is a 56% risk for long-term brain damage or death. Submersion over 25 minutes is associated with 100% mortality.