Post Cardiac Arrest Flashcard 1
Rationale
A. Rationale: This patient meets criteria for being comatose and thus should receive temperature management with a goal of 32–36°C. In patients post cardiac arrest, hypothermia is associated with improved long-term brain functioning and should be maintained for at least 24 hours. This patient has no signs of ACS, significant PE, or stroke that would indicate the need for fibrinolysis or percutaneous coronary intervention. While blood pressure support is indicated as needed in all patients with ROSC, comatose patients should also receive hypothermia management.
Question
A 34-year-old woman is in the ICU following a VF-associated cardiac arrest. Currently, her perfusion is adequate, and ECG and chest X-ray are normal. She is unresponsive to verbal commands. What therapy should be started for this patient?
a. Temperature management with a goal of 32–36°C
b. Fibrinolytic therapy
c. Percutaneous coronary intervention
d. Blood pressure support only
Answer
a. Temperature management with a goal of 32–36°C
Rationale
C. Rationale: The patient has achieved ROSC. Consequently, he needs monitoring of cardiovascular, metabolic, and respiratory parameters to improve both short- and long-term outcomes. If he is being managed with an advanced airway, an ETCO2 of 35–40 mm Hg indicates adequate ventilation. In the ROSC period, systolic BP should be > 90 mm Hg, and SpO2 should be maintained at 94%, rather than 100%, to minimize toxicities associated with hyperoxygenation free radicals. Glucose should be monitored, and while there is no specific optimal glucose level, 40 mg/dL is too low and requires immediate treatment.
Question
A 65-year-old man with a cardiac arrest has palpable pulses and an organized rhythm noted on the defibrillator monitor following CPR. Which of the following is a reasonable goal at this time?
a. Systolic BP > 65 mm Hg
b. SpO2 of 100%
c. ETCO2 of 40 mm Hg
d. Blood glucose of 40 mg/dL
Answer
c. ETCO2 of 40 mm Hg
Rationale
A. Rationale: Following TTM, prognostication should start 72 hours after the patient has returned to normothermia.
Question
Following targeted temperature management in a post-cardiac arrest patient, prognostication should start how many hours after a return to normothermia?
a. 72 hours
b. 48 hours
c. 24 hours
d. 12 hours
Answer
a. 72 hours
Rationale
C. Rationale: Hypotension must be avoided immediately during the post-cardiac arrest care. A systolic blood pressure < 90 mm Hg or a diastolic blood pressure < 65 mm Hg warrants interventions to correct hypotension. These blood pressure levels were linked to higher mortality rates and diminished functional recovery.
Question
In post-cardiac arrest care, a blood pressure reading of 110/70 mm Hg:
a. warrants pharmacologic intervention
b. is linked to higher mortality rates
c. does not warrant intervention
d. is linked to diminished functional recovery
Answer
c. does not warrant intervention
Rationale
C. Rationale: Post-cardiac arrest care commences immediately after resuscitation when the patient achieves a return of spontaneous circulation (ROSC).
Question
Post-cardiac arrest care commences:
a. When the patient is discharged from the critical care unit to the general ward
b. When the patient is discharged from the hospital
c. When the patient achieves a return of spontaneous circulation
d. After a myocardial infarction has been diagnosed via 12-lead ECG
Answer
c. When the patient achieves a return of spontaneous circulation
Rationale
D. Rationale: Target temperature management (TTM) involves attaining and maintaining a constant core temperature between 32°C and 36°C for at least 24 hours.
Question
Target temperature management involves attaining and maintaining a constant core temperature between 32°C and 36°C for at least how many hours after 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 referred to as the induction of hypothermia with active control and maintenance of body temperature used for improving neurologic function in comatose patients after ROSC. A target temperature of 32°C to 36°C is selected and maintained for at least 24 hours.
Question
The attending neurologist recommends that the recently post-cardiac arrest patient undergo targeted temperature management (TTM). At what temperature should you maintain the patient’s temperature to achieve TTM?
a. 32 to 36°C
b. 20 to 25°C
c. 22 to 26°C
d. 35 to 40°C
Answer
a. 32 to 36°C
Rationale
C. Rationale: During post-cardiac care, oxygenation must be optimized by maintaining a minimum SpO2 of 94%.
Question
What is the minimum acceptable oxygen saturation during post-cardiac arrest care?
a. 89%
b. 92%
c. 94%
d. 95%
Answer
c. 94%
Rationale
C. Rationale: Targeted temperature management (TTM) is a recommended intervention for cardiac arrest patients that have achieved ROSC but remain in a coma because it has been shown to improve neurologic recovery. Also, efforts must be made to control hyperthermia in these patients after 24 hours, once TTM has been discontinued.
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
d. intracranial angiogram
Answer
c. targeted temperature management
Rationale
D. Rationale: Absent pupillary light reflex is an indication of a neurologic defect. Also, the absence of the N20 somatosensory cortical wave in evoked potential responses and a decrease in gray-white matter ratio of < 1.3 are all indications of poor neurologic outcomes.
Question
Which one of the following is a representation of poor neurologic outcome in a patient that has achieved ROSC but remains in a coma?
a. absence of the N20 somatosensory cortical wave
b. marked gray-white matter ratio reduction
c. absent pupillary light reflex
d. all of the above measurements are a representation of poor neurologic outcome
Answer
d. all of the above measurements are a representation of poor neurologic outcome