Post-ACLS Principles Care Flashcard 2
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, lower mortality rate, and improve functional recovery. (Post-Cardiac Arrest Care: Box 3: Diagnosing and Treating Hypotension)
Question
In post-cardiac arrest care, a blood pressure reading of 110/70 mm Hg:
a. Requires 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
B. Rationale: In the post-cardiac arrest care algorithm, therapeutic hypothermia is recommended for patients who remain comatose (do not respond in a meaningful way to verbal commands) with ROSC.
Question
In the ACLS post-cardiac arrest care algorithm, the decision to consider induced hypothermia is based on:
A. The patient’s blood pressure
B. The patient’s ability to follow commands
C. The patient’s oxygen saturation
D. The presence of a perfusing rhythm
Answer
B. The patient’s ability to follow commands
Rationale
B. Rationale: Oxygen toxicity must be avoided, and thus the minimum oxygen supplementation must be administered to keep arterial oxygen saturation ≥ 94%.
Question
Oxygen toxicity is a cause of mortality in the hospital after a patient has been resuscitated. The lowest necessary inspired oxygen supplementation must be administered to the patient. What is the lowest feasible oxygen saturation level to maintain post-cardiac arrest?
a. 90%
b. 94%
c. 97%
d. 100%
Answer
b. 94%
Rationale
C. Rationale: Post-cardiac arrest care begins immediately after resuscitation when the patient achieves a return of spontaneous circulation (ROSC). (Systems of Care)
Question
Post-cardiac arrest care begins when:
a. The patient is transferred from the critical care unit to the general ward
b. The patient is discharged from the hospital
c. The patient achieves a return of spontaneous circulation
d. A myocardial infarction has been diagnosed via 12-lead ECG
Answer
c. The patient achieves a return of spontaneous circulation
Rationale
D. Rationale: Post-cardiac arrest care commences after resuscitation when the patient achieves a return of spontaneous circulation.
Question
Post-cardiac arrest care commences when:
a. The patient has been discharged from the critical care unit to the general ward
b. The patient has been discharged from the hospital
c. The patient achieves a return of spontaneous circulation
d. A myocardial infarction has been diagnosed thru 12-lead ECG
Answer
d. A myocardial infarction has been diagnosed thru 12-lead ECG
Rationale
D. Rationale: End-tidal CO2 pressure is an indicator of perfusion and ventilation at the level of the alveoli. A pressure of 30–45 mm Hg is recommended during post-cardiac arrest care.
Question
Post-cardiac arrest patients must maintain which end-tidal CO2 pressure to increase the chance of survival to hospital discharge?
a. < 10 mm Hg
b. 10–20 mm Hg
c. 20–30 mm Hg
d. 30–45 mm Hg
Answer
d. 30–45 mm Hg
Rationale
A. Rationale: Systolic blood pressure must be maintained ≥ 90 mm Hg.
Question
Post-cardiac arrest patients should be maintained with vasopressors to optimize circulation. What is the level at which the systolic blood pressure should be maintained?
a. At or above 90 mm Hg
b. Below 140 mm Hg
c. Above 80 mm Hg
d. As long as there is any measurable blood pressure
Answer
a. At or above 90 mm Hg
Rationale
A. Rationale: The treatment of choice for pulmonary thromboembolism is fibrinolysis, which can be performed on a cardiac arrest patient with diagnosed pulmonary embolism that has achieved a return of spontaneous circulation. It is recommended that an expert perform this intervention.
Question
Specific post-cardiac arrest management for pulmonary thromboembolism is which one of the following interventions?
a. Fibrinolysis
b. Mechanical ventilation
c. Extracorporeal CPR
d. Hemodialysis
Answer
a. Fibrinolysis
Rationale
D. Rationale: Hypothermia may be induced using endovascular catheters, surface cooling devices, and simple surface interventions such as ice bags or rapid infusion of cold fluids. Patients should be cooled to a temperature of 32–34 degrees Celsius for 12–24 hours.
Question
The only intervention that has been found to improve neurological recovery after cardiac arrest is:
A. Excessive ventilation
B. Optimization of blood pressure
C. Coronary reperfusion
D. Therapeutic hypothermia
Answer
D. Therapeutic hypothermia
Rationale
B. Rationale: Uneven pupils or anisocoria indicate increased intracerebral pressure. This pressure is significant enough to cause uncal herniation and compression of the brainstem and produces the anisocoria.
Question
Uneven pupil size is a sign of which one of the following medical conditions?
a. Concussion
b. Increased intracerebral pressure
c. Cerebellar ischemia
d. Return of spontaneous circulation
Answer
b. Increased intracerebral pressure