Assessment Flashcard 10
Rationale
C. Rationale: All of the statements are true except the normal ETCO2 range should be 35–40 mm Hg. A sudden increase of the ETCO2 to normal is an indicator of ROSC.
Question
Which of the following statements is INCORRECT concerning end-tidal CO2?
A. ROSC is unlikely when ETCO2 values are persistently low.
B. Improving chest compressions may help to increase ETCO2.
C. Normal ETCO2 range is 25–30 mm Hg.
D. Delivery of blood to the lungs is the main determining factor influencing ETCO2 during CPR.
Answer
C. Normal ETCO2 range is 25–30 mm Hg.
Rationale
D. Rationale: Cardiac tamponade is a reversible cause of cardiac arrest. It is caused by fluid or blood accumulation within the pericardium secondary to infection, malignancy, trauma, or other underlying conditions. Significant pressure buildup in this area can restrict the heart’s movement and eventually lead to cardiac arrest. Urgent intervention is to perform a pericardiocentesis or an emergency thoracotomy in severe cases.
Question
Which one of the following conditions causes a restriction to the wall motion of the heart due to pressure buildup from extravasated fluid between the pericardial sac and the epicardium?
a. Myocarditis
b. Ebstein anomaly
c. Tetralogy of Fallot
d. Tamponade
Answer
d. Tamponade
Rationale
D. Rationale: Hypovolemia and hypoxia are common causes of pulseless electrical activity. Patients in PEA must be assessed initially for these two clinical conditions.
Question
Which one of the following is a common underlying and potentially reversible cause of pulseless electrical activity?
a. Hypothermia
b. Pulmonary embolism
c. Cardiac thromboembolism
d. Hypovolemia
Answer
d. Hypovolemia
Rationale
B. Rationale: An advanced airway with waveform capnography measures carbon dioxide through spectrometry. The exhaled carbon dioxide is an indirect measure of improved cardiac output as alveolar perfusion improves. A measured end-tidal CO2 < 10 mm Hg prompts the team to improve CPR quality.
Question
Which one of the following measures exhaled carbon dioxide and can be used to indicate CPR quality?
a. Pulse oximetry
b. Waveform capnography
c. Intraarterial pressure
d. Electrocardiogram
Answer
b. Waveform capnography
Rationale
A. Rationale: All ACLS providers must know the reversible causes of pulseless electrical activity. Review the Hs and Ts mnemonics. The American Heart Association has removed “Trauma” from the list.
Question
Which one of the following medical conditions is NOT a reversible cause of pulseless electrical activity?
a. Trauma
b. Hypoxia
c. Hypovolemia
d. Acidosis
Answer
a. Trauma
Rationale
C. Rationale: The Early Warning Score uses the following physiological parameters and assigns points for them: respiratory rate, oxygen saturation, supplementary oxygen, temperature, systolic BP, heart rate, and level of consciousness.
Question
Which one of the following physiologic parameters is used in the Early Warning Score?
a. Diastolic blood pressure
b. Urine output
c. Respiratory rate
d. Visual acuity
Answer
c. Respiratory rate
Rationale
D. Rationale: The normal gray-white matter ratio is 1:3. CT scans exhibiting a low gray-white matter ratio 2 hours after achieving ROSC predict a poor neurologic outcome.
Question
Which one of the following tests indicates the neurologic outcome of a comatose post-cardiac arrest patient?
a. Functional CT scan of the head
b. CT scan of the head with contrast
c. Triple-phase CT scan
d. Gray-white matter ratio
Answer
d. Gray-white matter ratio
Rationale
D. Rationale: Absent pupillary light reflex is an indication of a neurologic defect. The absence of the N20 somatosensory cortical wave in evoked potential responses and a decrease in the gray-white matter ratio to < 1.3 are also indications of a poor neurologic outcome. (Case: Post-Cardiac Arrest Care)
Question
Which represents a 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 a poor neurologic outcome.
Answer
d. All of the above measurements are a representation of a poor neurologic outcome.
Rationale
D. Rationale: Hyperglycemia is not one of the reversible causes for adults. The team must be adept at looking for and treating the reversible causes of cardiac arrest to give the patient every chance of achieving a return of spontaneous circulation.
Question
You and your team have been trying to resuscitate a patient on the wards for about 10 minutes. He is in cardiac arrest with asystole. Which of the following conditions is NOT a reversible cause of cardiac arrest?
a. Hypoxia
b. Acidosis
c. Cardiac tamponade
d. Hyperglycemia
Answer
d. Hyperglycemia
Rationale
A. Rationale: The jaw-thrust maneuver is a noninvasive technique to open the airway of unresponsive patients in need of resuscitation.
Question
You are performing noninvasive techniques to maximize oxygenation and ventilation in an unresponsive patient by performing the jaw-thrust maneuver. Which sequence of the primary assessment are you providing?
a. Airway
b. Breathing
c. Circulation
d. Disability
Answer
a. Airway