Post-ACLS Principles Care Flashcard 4
Rationale
C. Rationale: In immediate post-cardiac arrest patients, maintaining good circulation is very important. A systolic blood pressure ≥ 90 mm Hg should be maintained. Atropine is not recommended when treating hypotension, but it is an essential treatment for bradycardia.
Question
Which one of the following is NOT indicated for treating hypotension in immediate post-cardiac arrest patients?
a. Normal saline solution
b. Dopamine
c. Atropine
d. Epinephrine
Answer
c. Atropine
Rationale
D. Rationale: Excessive ventilation increases in-hospital mortality and must be avoided because it can increase intrathoracic pressure and reduce cerebral blood flow.
Question
You are part of an emergency response team that has successfully resuscitated a 60-year-old patient in cardiac arrest secondary to unknown causes. He has the following vital signs: HR = 88 bpm, BP = 100/60 mm Hg, ETCO2 = 40 mm Hg, oxygen saturation = 100%, T = 36.8°C. You are in charge of providing ventilatory support to the patient, giving 16 breaths per minute via bag-mask attached to an endotracheal tube. The team leader asks you to slow down your ventilations to 10 per minute. What would be the physiologic effect if you continued with 16 ventilations per minute?
a. Decreased intrathoracic pressure
b. Improved lung perfusion
c. Increased oxygen saturation
d. Decreased cerebral blood flow
Answer
d. Decreased cerebral blood flow
Rationale
C. Rationale: Normal saline and lactated Ringer solution are viable nonpharmacologic options to increase blood pressure in post-cardiac arrest patients.
Question
You are part of an EMS team that has resuscitated a 54-year-old woman in cardiac arrest with the following vital signs: HR = 58 bpm, BP = 70 mm Hg systolic, oxygen saturation = 97%, T = 36.0°C. You have not been authorized to give any medications at the moment. Until you reach the nearest emergency department, which one of the following interventions is a nonpharmacological treatment for hypotension in this patient?
a. Vagal maneuver
b. Valsalva maneuver
c. IV bolus of lactated Ringer solution
d. Trendelenberg position
Answer
c. IV bolus of lactated Ringer solution
Rationale
C. Rationale: Following the return of spontaneous circulation, oxygen saturation should be maintained between 92% and 98%. (Post-Cardiac Arrest Care: Box 2: Maintaining a Patent Airway)
Question
You are preparing a post-cardiac arrest patient for continued monitoring and care in the ICU. Following the return of spontaneous circulation, oxygen saturations should be maintained at:
a. Higher than 90%
b. Higher than 92%
c. Between 92% and 98%
d. Higher than 98%
Answer
c. Between 92% and 98%
Rationale
C. Rationale: Following the return of spontaneous circulation, oxygen saturation should be maintained at > 94%
Question
You are preparing a post-cardiac arrest patient for continued monitoring and care in the intensive care unit. Following the return of spontaneous circulation, in what range should this patient’s oxygen saturation be maintained?
a. > 90%
b. > 92%
c. > 94%
d. > 98%
Answer
c. > 94%
Rationale
C. Rationale: Oxygen toxicity increases in-hospital morbidity and mortality due to the formation of reactive oxygen species and toxic pulmonary effects. Once arterial oxygen saturation reaches 100%, it is necessary to adjust the inspired oxygen to the lowest concentration that maintains arterial oxyhemoglobin saturation between 94% and 100%.
Question
You are the nurse responsible for the care of a patient with recent cardiac arrest. He has the following vital signs: HR = 78 bpm, BP = 120/60 mm Hg, ETCO2 = 35 mm Hg, oxygen saturation = 100%, T = 36.8°C. The attending physician asks you to decrease the supplemental oxygen from 3 L/min to 1 L/min. Why have you been advised to decrease the fraction of inspired oxygen once oxyhemoglobin levels reach 100%?
a. The attending physician has made a mistake
b. To optimize end-tidal carbon dioxide pressure
c. To avoid oxygen toxicity
d. To improve cerebral blood flow
Answer
c. To avoid oxygen toxicity