Post Cardiac Arrest Flashcard 1
Rationale
C. Rationale: Oxygen saturation < 90% will render the patient hypoxic.
Question
A 4-year-old post-cardiac arrest patient had been successfully resuscitated and intubated. To maintain adequate oxygenation, the goal for oxygen saturations must be at:
a. Less than 85%
b. Greater than 85% to less than 90%
c. Greater than 94% and less than 100%
d. Greater than 100%
Answer
c. Greater than 94% and less than 100%
Rationale
D. Rationale: When a child is receiving oxygen supplementation with 100% FiO2, and the SPO2 remains below 90%, the team should consider placement of an advanced airway with mechanical ventilatory support and positive end-expiratory pressure.
Question
A 6-year-old post-cardiac arrest patient is in the emergency department after a drowning episode. After ROSC and stabilization, he suddenly develops severe dyspnea. Oxygen supplementation at 100% FiO2 is given. However, his SPO2 is 80%. What is the best management?
a. Observe and monitor oxygen saturations closely
b. Continue giving oxygen supplementation at 100% FiO2
c. Sedate the patient and request an arterial blood gas analysis
d. Intubate the patient and mechanically ventilate with positive end-expiratory pressure
Answer
d. Intubate the patient and mechanically ventilate with positive end-expiratory pressure
Rationale
B. Rationale: Post-ROSC, ventilation strategies should be implemented to maintain a target PaCO2. Hypo- and hypercapnia are both associated with poor outcomes. Positive end-expiratory pressure and tidal volume are parameters of ventilation that can be adjusted to achieve the targeted PaCO2. Vital capacity is a measurement of the patient’s lung volume.
Question
A good indication of optimal ventilation strategies involves maintaining target physiologic measurements such as which one of the following?
a. Positive end-expiratory pressure
b. Partial pressure of carbon dioxide
c. Vital capacity
d. Tidal volume
Answer
b. Partial pressure of carbon dioxide
Rationale
B. Rationale: The maintenance infusion rate of a post-cardiac arrest infant with shock weighing 15 kg is calculated at 40 mL per hour plus 2 mL/kg for each kg between 10 and 20 kg.
Question
An infant weighing 15 kg with shock is receiving post-cardiac arrest care. What is the maintenance infusion rate for IV fluids in this case?
a. 40 mL per hour
b. 50 mL per hour
c. 60 mL per hour
d. 70 mL per hour
Answer
b. 50 mL per hour
Rationale
A. Rationale: A team leader must be prepared to immediately stop the inappropriate action of a team member at any time. The intervention must be timely to prevent any harm to the patient. The team leader must intervene constructively, without any hostility towards team members. For cardiac arrest patients < 1 year of age, the two-finger technique or the two-thumbs encircling hand technique is recommended.
Question
As the team leader of a PALS team, you notice in the middle of a code that the compressor is performing the one-handed technique on a 3-month-old female in cardiac arrest. What is your next course of action?
a. Immediately stop the actions of that team member
b. Allow the team member to finish the 5 cycles of CPR, then intervene
c. Do nothing at this time that would interrupt CPR
d. Acknowledge that this is the best way to perform chest compressions in pediatric patients < 1 year of age
Answer
a. Immediately stop the actions of that team member
Rationale
A. Rationale: Hypercarbia is an increase in serum carbon dioxide pressure. It is an indication that gas exchange is inadequate due to poor ventilation.
Question
Hypercarbia is an indication of:
a. Poor ventilation
b. Poor oxygenation
c. Poor blood volume
d. Poor metabolism
Answer
a. Poor ventilation
Rationale
A. Rationale: Inotropes affect cardiac muscle fibers by increasing the velocity of their shortening, thereby producing an overall effect of increased cardiac contractility. Inotropes should help to increase cardiac output in pediatric patients with cardiac arrest, but their impact is more significant in older patients because the underdeveloped heart in infants relies more on heart rate to improve cardiac output.
Question
Inotropes are necessary for post-cardiac arrest care in conjunction with the use of volume expanders such as crystalloid solution. What is the mechanism of action of inotropes?
a. Increases myocardial contractility
b. Increases cardiac rate
c. Increases systemic vascular resistance
d. Decreases blood pressure
Answer
a. Increases myocardial contractility
Rationale
A. Rationale: Post resuscitation hyperthermia is common and associated with poor neurological outcomes. Targeted temperature management offers neuroprotection in patients suffering from ischemic brain injury either from a primary neurologic disease or trauma or a secondary neurologic disease due to cardiopulmonary arrest. Targeted temperature management involves either targeting a period of induced hypothermia (32–34°C) or targeting normothermia (36–37.5°C).
Question
Post resuscitation care for the comatose pediatric patient after a cardiac arrest should include:
a. A plan for targeted temperature management
b. 7 days of hypothermia at 32–34°C
c. Maintaining hypothermia at 30–32°C until brain function resumes
d. 5 days of hypothermia at 30–32°C and then increasing by 1°C per day to reach normothermia
Answer
a. A plan for targeted temperature management
Rationale
B. Rationale: AHA PALS guidelines recommend the maintenance of systolic blood pressure in pediatric cardiac arrest patients with the use of volume expanders and vasoactive drug infusion. These interventions are adjusted so that the patient achieves a blood pressure reading that is above the 5th percentile for age.
Question
Systolic blood pressure in pediatric patients ages 1 to 10 that have achieved a return of spontaneous circulation after cardiac arrest must be maintained at which level?
a. At least 100 mmgHg
b. Above the 5th percentile for age
c. At least 120 mmHg
d. Above the 50th percentile for age
Answer
b. Above the 5th percentile for age
Rationale
B. Rationale: TTM is applicable to all patients who have achieved a return of spontaneous circulation. Studies have shown improved neurological outcomes when TTM is applied. Fever is associated with poor outcomes due to increased metabolic demand. Therapeutic hypothermia may be considered for comatose patients following cardiac arrest care.
Question
Targeted temperature management (TTM) is indicated in which of the following situations?
a. Comatose patient after ROSC
b. All patients after ROSC
c. Accidental hypothermia
d. Burn injuries
Answer
b. All patients after ROSC