Chapter 41 Cardiopulmonary Resuscitation
1. What is cardiopulmonary resuscitation (CPR)? What is basic life support (BLS)? What is advanced cardiac life support (ACLS)?
2. Who developed the Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care?
Basic life support (BLS)
3. What are the four major components of BLS? What major change was recommended in 2010 regarding the sequence of attention to airway, breathing, and circulation during BLS?
Closed-Chest (External) Cardiac Compressions
4. Where should the rescuer’s hands be placed on the adult patient to maximize blood flow when performing closed-chest cardiac compressions? What are some risks to the patient when the rescuer’s hands are placed incorrectly?
5. How should the rescuer be positioned relative to the patient when performing closed-chest cardiac compressions? By how much is the sternum of an adult patient depressed during each compression?
6. What is the minimum rate (number of compressions per minute) for adult BLS? What is the ratio of cardiac compressions to ventilation during one-rescuer CPR? What is the ratio of cardiac compressions to ventilation during two-rescuer CPR?
7. What are the two proposed mechanisms for blood flow during closed-chest cardiac compressions? Which of these is thought to be the most important?
8. How can the effectiveness of closed-chest cardiac compressions be verified? What should the goal be for end-tidal CO2 if an end-tidal CO2 monitor is available?
External Defibrillation
11. What is the definitive treatment for pulseless ventricular tachycardia (VT) and ventricular fibrillation (VF)? What is the most important determinant of return of spontaneous circulation in a patient with VT/VF when performing external defibrillation?
12. How many joules of electricity should be delivered during an initial attempt at external defibrillation? How many joules should be delivered in subsequent defibrillation attempts, provided they are necessary?
13. Where on the chest is the appropriate placement of paddles/pads for external defibrillation?
14. What is the risk of external defibrillation in the patient with a cardiac pacemaker?
Advanced cardiac life support
15. What are the three advanced cardiac life support (ACLS) algorithms most likely to be used in the operating room?
Drug therapy
32. What is the goal of initial drug therapy during CPR? What are the mainstays of treatment for the patient in cardiac arrest?
33. What actions of epinephrine are thought to be responsible for its beneficial effects during cardiac arrest?
34. What actions of vasopressin are thought to be responsible for its beneficial effects during cardiac arrest?
35. When is amiodarone administered during cardiac arrest?
36. What is the advantage of the delivery of drugs by a centrally placed intravenous catheter during CPR? How long should the rescuers wait for drug administered via a peripheral vein to reach the central circulation?
37. What are two alternatives for drug delivery when vascular access is not available?
Resuscitation of infants and children
38. Where should the pulse be palpated in infants up to 1 year of age? Where should it be palpated in children?
39. How should closed-chest cardiac compressions be performed in infants?
40. How should closed-chest cardiac compressions be performed in children?
41. What energy setting, in joules, should be applied for optimal success for a return of spontaneous circulation when using an external defibrillator? If the initial attempt at defibrillation is unsuccessful, what energy setting should be used for the subsequent attempts?
Special perioperative considerations
44. What are some of the more common drugs used in the operating room that can precipitate an anaphylactic reaction? In addition to removing or stopping the inciting agent, what is the primary treatment for anaphylaxis?
45. What is the treatment for an intraoperative venous gas embolism?
46. What is the primary treatment for local anesthetic toxicity? How long should the resuscitation continue in the event of complete cardiovascular collapse?
47. How should one manage cardiovascular collapse in a patient who has received neuraxial anesthesia?
Answers*
1. CPR is the institution of artificial circulation and ventilation until spontaneous cardiopulmonary function returns, extracorporeal life support is initiated, or resuscitation efforts are discontinued. It consists of BLS and ACLS. BLS is the rapid evaluation of an unresponsive individual with the activation of the emergency medical system and the acquisition of an automated external defibrillator (AED) or a regular defibrillator. Artificial circulation is achieved through closed-chest cardiac compressions and ventilation is performed via mouth-to-mouth, mask-to-mouth, or bag-valve mask. Any individual (including nonhealth care personnel) who has had the appropriate training and certification can perform BLS. ACLS, based on BLS, can only be performed by health care workers and adds advanced airway management, cardiovascular drugs, cardiac rhythm analysis, and postresuscitation management. ACLS also includes recognition, diagnosis, and initial treatment of acute myocardial infarction and acute stroke. (715)
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