Cardiac Arrest

Chapter 154 Cardiac Arrest




Clinical Case Problem 1: A 55-Year-Old Man Found Collapsed in the Street


A 55-year-old man is found collapsed in the street by a passerby. The passerby begins cardiopulmonary resuscitation (CPR) and is soon joined by another citizen. Someone calls 911, and CPR is continued until the paramedics arrive and initiate advanced cardiac life support (ACLS). Despite complete ACLS maneuvers, the patient remains pulseless and breathless as the paramedics hand over care to the emergency department physician on duty at the nearest hospital.



Select the best answer to the following questions




1. Which of the following rhythms is not one of the most commonly associated with pulseless cardiac arrest?


a. ventricular fibrillation (VF)

b. asystole

c. rapid ventricular tachycardia (VT)

d. pulseless electrical activity (PEA)

e. Mobitz II second-degree heart block

2. Components of good basic life support (BLS) care include all except which of the following?


a. high-quality bystander CPR

b. early defibrillation within minutes of collapse if there is pulseless VT or VF

c. await ACLS trained personnel to begin CPR

d. focus on CPR rather than getting medications and intravenous (IV) access in the field

e. early contact of the emergency medical services (EMS) system

3. Which of the following statements about delivery of medications during cardiac arrest is true?


a. the only drugs that can be given through the endotracheal tube are epinephrine and lidocaine

b. epinephrine is preferred to atropine in treatment of bradycardic PEA

c. central lines are critical in the success of ACLS

d. if a drug is given through a peripheral IV line, follow it with a 500-mL bolus of IV fluid

e. intraosseous (IO) access is useful for fluid resuscitation but not drug delivery or blood sampling

4. Which of the following is incorrect with regard to the management of witnessed arrest with a defibrillator on-site?


a. CPR should be performed while the defibrillator is being readied

b. after the delivery of two rescue breaths, the pulse should be checked

c. if no pulse is felt within 10 seconds, the defibrillator should be turned on and then adhesive pads or paddles should be placed and the rhythm checked

d. the automatic defibrillator will analyze the rhythm and provide instructions about whether and how to administer shocks

5. A “quick look” with biphasic paddles is performed on the patient in Clinical Case Problem 1. You diagnose VF. What should be your first step?


a. defibrillate with 120 to 200   J

b. defibrillate with 360   J

c. administer epinephrine 1   mg IV push

d. administer vasopressin 40 units IV bolus

e. intubate the trachea

6. What is the antiarrhythmic of choice in the management of VF?


a. bretylium

b. lidocaine

c. procainamide

d. magnesium

e. amiodarone

7. The patient is successfully converted to sinus rhythm. Unfortunately, on the way to the coronary care unit, he arrests again. The rhythm strip reveals asystole. CPR is restarted. Which of the following is the next logical step in treatment?


a. administer epinephrine 1 mg IV push

b. administer calcium chloride 10   mL of a 10% solution IV push

c. administer sodium bicarbonate 1   mEq/kg IV push

d. administer isoproterenol 2 to 20   mcg

e. administer lidocaine 75   mg IV push

8. With appropriate treatment, the patient again converts to sinus rhythm. He is stabilized in the coronary care unit. Unfortunately, 2 hours later, he develops VT. His blood pressure is 100/60   mm Hg, and he has a palpable pulse. Your next step should be to administer which of the following?


a. lidocaine 1 to 1.5   mg/kg IV

b. procainamide 20 to 30   mg/minute up to a maximum of 50   mg/minute

c. bretylium 5   mg IV bolus

d. verapamil 5   mg IV bolus

e. none of the above

9. Sinus rhythm is restored again, and his condition returns to satisfactory. Unfortunately, he develops a second-degree atrioventricular (AV) block (Mobitz type II). His pulse is 40 beats/minute, and his blood pressure drops to 70/40   mm Hg. Given this change, what would you do now?


a. observe the patient only

b. administer isoproterenol 2 to 10   mg/minute

c. administer atropine 0.5 to 1   mg

d. administer epinephrine 0.5 to 1   mg

e. none of the above

10. What is the definitive therapy for the dysrhythmia described in question 9?


a. a constant infusion of isoproterenol 2 to 20   mg/ minute

b. a constant infusion of lidocaine 2 to 4   mg/minute

c. a constant infusion of procainamide 2 to 4   mg/minute

d. a transvenous pacemaker

e. none of the above


Clinical Case Problem 2: A Witnessed Cardiac Arrest


CPR is in progress on a 70-kg man who collapsed in the street (witnessed arrest). BLS was begun, as was ACLS when the paramedics arrived. He was brought immediately to the emergency department, and a blood gas sample was drawn. The results were as follows: pH, 7.1; PCO2, 60   mm Hg; PO2, 75   mm Hg; and image, 15   mEq/L.



11. These results represent which of the following?


a. metabolic acidosis with respiratory alkalosis

b. respiratory acidosis with metabolic alkalosis

c. pure metabolic acidosis

d. pure respiratory acidosis

e. mixed respiratory and metabolic acidosis

12. What is the most appropriate treatment of this patient?


a. sodium bicarbonate 1   mEq/kg

b. sodium bicarbonate 0.5   mEq/kg

c. increased ventilation

d. a and c

e. b and c

13. Which of the following should be treated first in this patient?


a. respiratory acidosis

b. metabolic acidosis

c. respiratory alkalosis

d. metabolic alkalosis

e. all of the above

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Cardiac Arrest

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