Updated New 2023! Advanced Cardiac Life Support
HESI Case Study Latest Version Updated 2023-2024
questions and accurate answers
What are the predictors of outcome (determine if a patient will make it out of hospital)? -
--------- Answer -------- > 3-6 minutes until initiation of CPR
Cardiac vs. pulmonary cause
Mult. preexisting comorbid illnesses
Non-witnessed arrest
Non-telemetry ward
"Third shift" arrest
Total duration of arrest
Asystolic or PEA arrest
-i.e. non-defibrillating rhythm
Malignancy
What is sig. about the NAVEL drugs? ---------- Answer -------- Can be admin. by the
endotracheal route during cardiac arrest
What is the typical endotracheal dose compared to the IV dose? ---------- Answer --------
2-2.5 times
How is the endotracheal drugs admin.? ---------- Answer -------- Dilute recommended
dose in 5-10 mL of sterile water or NS and inject directly into endotracheal
What do we do after we get a pulse? ---------- Answer -------- Check vitals!
Vasopressor or inotrope
Lab assessment
Targeted temp. management (TTM)
What is TTM? ---------- Answer -------- Maintaining body temp. b/t 32-36 degrees C for 24
hours after ROSC
What does TTM improve? ---------- Answer -------- Mortality
How does TTM work? ---------- Answer -------- inhibits release of glutamate and
dopamine
inhibits apoptosis (reduction in calcium overload and glutamate release)
suppresses the inflammation that occurs after global cerebral ischemia
reduces reperfusion injury
What we do to cool the patient? ---------- Answer -------- surface cooling
-ice packs around the head, neck, torso, and limbs
cold-air mattress covering the entire body
, -spray patient with water and use fans
core cooling
-IV cooling catheters
combo of both
How do we monitor temperature? ---------- Answer -------- core/central temperatures are
monitored by esophageal, bladder, or pulmonary monitoring
What are the phases of TTM? ---------- Answer -------- phase 1-cooling
phase 2-maintenance
phase 3-rewarming
What is the most common complication f hypothermia? ---------- Answer -------- shivering
What medications are used to decrease shivering threshold? ---------- Answer --------
acetaminophen
buspirone
Mg
propofol-bradycardia
meperidine-no longer recommended
dexmedetotomidine/clonidine-hypotension
How do we prevent/treat shivering? ---------- Answer -------- paralytic
-avoid if patient is seizing
What does hypothermia do to paralytics? ---------- Answer -------- decreases clearance
and prolongs duration
What are TTM complications? ---------- Answer -------- seizures
hyperglycemia
renal
coag
How do we treat seizures? ---------- Answer -------- benzos
How do we treat hyperglycemia? ---------- Answer -------- continous insulin infusion
How do we treat renal complications? ---------- Answer -------- electrolyte replacement
but be very cautious when replacing especially during rewarming
Should we cool actively bleeding patients? ---------- Answer -------- no
What is unstable bradycardia? ---------- Answer -------- condition in which vital organ
function is acutely impaired or cardiac arrest is ongoing
HESI Case Study Latest Version Updated 2023-2024
questions and accurate answers
What are the predictors of outcome (determine if a patient will make it out of hospital)? -
--------- Answer -------- > 3-6 minutes until initiation of CPR
Cardiac vs. pulmonary cause
Mult. preexisting comorbid illnesses
Non-witnessed arrest
Non-telemetry ward
"Third shift" arrest
Total duration of arrest
Asystolic or PEA arrest
-i.e. non-defibrillating rhythm
Malignancy
What is sig. about the NAVEL drugs? ---------- Answer -------- Can be admin. by the
endotracheal route during cardiac arrest
What is the typical endotracheal dose compared to the IV dose? ---------- Answer --------
2-2.5 times
How is the endotracheal drugs admin.? ---------- Answer -------- Dilute recommended
dose in 5-10 mL of sterile water or NS and inject directly into endotracheal
What do we do after we get a pulse? ---------- Answer -------- Check vitals!
Vasopressor or inotrope
Lab assessment
Targeted temp. management (TTM)
What is TTM? ---------- Answer -------- Maintaining body temp. b/t 32-36 degrees C for 24
hours after ROSC
What does TTM improve? ---------- Answer -------- Mortality
How does TTM work? ---------- Answer -------- inhibits release of glutamate and
dopamine
inhibits apoptosis (reduction in calcium overload and glutamate release)
suppresses the inflammation that occurs after global cerebral ischemia
reduces reperfusion injury
What we do to cool the patient? ---------- Answer -------- surface cooling
-ice packs around the head, neck, torso, and limbs
cold-air mattress covering the entire body
, -spray patient with water and use fans
core cooling
-IV cooling catheters
combo of both
How do we monitor temperature? ---------- Answer -------- core/central temperatures are
monitored by esophageal, bladder, or pulmonary monitoring
What are the phases of TTM? ---------- Answer -------- phase 1-cooling
phase 2-maintenance
phase 3-rewarming
What is the most common complication f hypothermia? ---------- Answer -------- shivering
What medications are used to decrease shivering threshold? ---------- Answer --------
acetaminophen
buspirone
Mg
propofol-bradycardia
meperidine-no longer recommended
dexmedetotomidine/clonidine-hypotension
How do we prevent/treat shivering? ---------- Answer -------- paralytic
-avoid if patient is seizing
What does hypothermia do to paralytics? ---------- Answer -------- decreases clearance
and prolongs duration
What are TTM complications? ---------- Answer -------- seizures
hyperglycemia
renal
coag
How do we treat seizures? ---------- Answer -------- benzos
How do we treat hyperglycemia? ---------- Answer -------- continous insulin infusion
How do we treat renal complications? ---------- Answer -------- electrolyte replacement
but be very cautious when replacing especially during rewarming
Should we cool actively bleeding patients? ---------- Answer -------- no
What is unstable bradycardia? ---------- Answer -------- condition in which vital organ
function is acutely impaired or cardiac arrest is ongoing
