Assessment Flashcard 11
Rationale
D. Rationale: Clinicians must wait until the patient has achieved normothermia before prognosticating after targeted temperature management. This is usually achieved after 72 hours.
Question
You are taking care of a post-cardiac arrest patient during targeted temperature management. When is the best time to start assessing and prognosticating the patient’s neurologic outcome to guide further management?
a. Immediately after post-cardiac arrest care
b. After 24 hours
c. After 48 hours
d. After 72 hours
Answer
d. After 72 hours
Rationale
A. Rationale: If you are unsure whether the patient has a pulse, you should proceed as if the patient is pulseless. Begin CPR, starting with compressions. Don’t worry that performing compressions on a patient with a pulse would cause harm; failing to provide necessary compressions is far more harmful and will decrease the patient’s chances of survival.
Question
You check an adult patient for the presence of a carotid pulse. After 10 seconds, you are unsure whether a pulse is present. You should:
A. Begin CPR, starting with compressions
B. Begin CPR, starting with ventilations
C. Provide ventilations only
D. Place the patient in the recovery position
Answer
A. Begin CPR, starting with compressions
Rationale
D. Rationale: Assessing circulation is the third step in the BLS survey. Once unresponsiveness has been determined, EMS has been activated, and an AED has been requested; if the patient is found to be pulseless, the rescuer should begin CPR at a ratio of 30 compressions to 2 ventilations.
Question
You encounter an adult patient lying on the ground and not moving. You assess for responsiveness by tapping his shoulder and shouting, “Are you okay?” You watch the patient’s chest and find that he is not breathing after 5 to 10 seconds of observation. You ask a passerby to call 9-1-1 and bring a defibrillator if one is available. You check the carotid pulse on the side closest to you and determine that the patient’s heart is not beating. What should you do next?
A. Start CPR, beginning with ventilations
B. Begin compressions when the passerby returns from dialing 9-1-1, with the passerby providing ventilations
C. Start CPR, beginning with chest compressions at a ratio of 15 compressions to 2 ventilations.
D. Start CPR, beginning with chest compressions at a ratio of 30 compressions to 2 ventilations
Answer
D. Start CPR, beginning with chest compressions at a ratio of 30 compressions to 2 ventilations
Rationale
B. Rationale: Teams giving immediate post-cardiac arrest care must pay attention to adequate ventilation and oxygen saturation. They should provide assisted ventilation of 10 breaths per minute and titrate as necessary to achieve an end-tidal CO2 pressure of 35–40 mm Hg. They should avoid overventilating the patient as this leads to increased mortality.
Question
Your emergency response team has successfully resuscitated a 45-year-old man who arrested secondary to an acute myocardial infarction. What is the target end-tidal carbon dioxide pressure to maintain good ventilation?
a. 15–20 mm Hg
b. 30–35 mm Hg
c. 35–40 mm Hg
d. 45–50 mm Hg
Answer
b. 30–35 mm Hg
Rationale
D. Rationale: Immediately after the shock is delivered, resume compressions and ventilations at a 30:2 ratio. After 2 minutes, the AED will prompt analysis of the rhythm again to determine whether another shock is needed. Each shock is followed by 2 minutes of high-quality CPR. Continue this pattern until the patient begins to move or help arrives.
Question
Your patient, who is unresponsive, apneic, and pulseless, has just received a shock from the AED that arrived moments ago. After the shock is delivered, you should:
A. Push Analyze to determine whether the patient’s rhythm has changed
B. Push Shock to deliver a second shock
C. Do nothing – wait 2 minutes for the AED to analyze the patient’s rhythm again
D. Immediately resume CPR, beginning with chest compressions at a ratio of 30 compressions to 2 ventilations
Answer
D. Immediately resume CPR, beginning with chest compressions at a ratio of 30 compressions to 2 ventilations
Rationale
C. Rationale: Quantitative waveform capnography in intubated patients monitors CPR quality, optimizes chest compressions, and detects ROSC during CPR. End-tidal carbon dioxide determines the perfusion of blood to the lungs. After 20 minutes of resuscitation, a value < 20 mm Hg suggests that return of spontaneous circulation is unlikely.
Question
Your team has been trying to resuscitate an intubated patient. After 20 minutes, waveform capnography measures an ETCO2 level of 8 mm Hg. What are your considerations?
a. The patient should be placed on the ventilator.
b. Ventilation is not sufficient.
c. Resuscitative efforts are futile.
d. Return of spontaneous circulation is imminent.
Answer
c. Resuscitative efforts are futile.
Rationale
C. Rationale: Resuscitative efforts are unlikely to result in ROSC. Quantitative waveform capnography in intubated patients monitors CPR quality, allowing responders to optimize chest compressions and detect ROSC. End-tidal carbon dioxide is an indicator of blood perfusion to the lungs. After 20 minutes of resuscitation, a value < 10 mm Hg suggests that return of spontaneous circulation is unlikely. (Prognostication During CPR)
Question
Your team has been trying to revive an intubated patient after 20 minutes of high-quality CPR and ACLS interventions. Waveform capnography measures an end-tidal carbon dioxide level of 8 mm Hg. What action is indicated at this point?
a. Hook the patient to a ventilation machine
b. Ventilation is no longer needed
c. Resuscitative efforts are unlikely to result in ROSC
d. Return of spontaneous circulation is imminent
Answer
c. Resuscitative efforts are unlikely to result in ROSC