ACLS Post-Cardiac Arrest Care 2 — Questions and Answers
Question 1: What is the recommended mean arterial pressure (MAP) target during post-cardiac arrest care to ensure adequate organ perfusion?
- Greater than 65 mmHg (Correct answer)
- Greater than 50 mmHg
- Greater than 80 mmHg
- Greater than 90 mmHg
Correct answer: Greater than 65 mmHg
A MAP greater than 65 mmHg is the minimum recommended to ensure adequate perfusion of vital organs after ROSC.
Question 2: A post-cardiac arrest patient's arterial blood gas shows PaO2 of 200 mmHg on 100% FiO2. What is the most appropriate next action?
- Wean FiO2 to achieve SpO2 94–98% (Correct answer)
- Maintain 100% FiO2 to prevent re-arrest
- Increase PEEP to reduce FiO2 requirement
- Switch to non-invasive ventilation
Correct answer: Wean FiO2 to achieve SpO2 94–98%
Hyperoxia is harmful post-arrest; FiO2 should be titrated to maintain SpO2 94–98% and PaO2 within normal range.
Question 3: Which electrolyte abnormality is most commonly associated with recurrent ventricular fibrillation after ROSC?
- Hypomagnesemia (Correct answer)
- Hypernatremia
- Hypercalcemia
- Hyperphosphatemia
Correct answer: Hypomagnesemia
Hypomagnesemia lowers the threshold for ventricular fibrillation and should be corrected in post-arrest patients.
Question 4: Targeted temperature management (TTM) at 36°C versus 33°C has been shown to result in:
- Similar neurological outcomes between the two targets (Correct answer)
- Significantly better outcomes at 33°C
- Significantly better outcomes at 36°C
- Worse outcomes at both targets compared to no cooling
Correct answer: Similar neurological outcomes between the two targets
The TTM trial demonstrated no significant difference in outcomes between 33°C and 36°C, supporting either target as acceptable.
Question 5: Which finding on a 12-lead ECG post-ROSC is the strongest indication for emergent coronary angiography?
- ST-segment elevation in two or more contiguous leads (Correct answer)
- Right bundle branch block
- Sinus tachycardia with nonspecific T-wave changes
- QTc prolongation greater than 500 ms
Correct answer: ST-segment elevation in two or more contiguous leads
ST-elevation post-ROSC indicates acute coronary occlusion and warrants immediate catheterization lab activation regardless of patient responsiveness.
Question 6: When should neurological prognostication be performed after targeted temperature management in a post-cardiac arrest patient?
- At least 72 hours after return to normothermia (Correct answer)
- Immediately after ROSC
- Within 24 hours of ROSC
- After 48 hours of normothermia if sedation is minimal
Correct answer: At least 72 hours after return to normothermia
Prognostication should be deferred until at least 72 hours after normothermia to allow sedation and TTM effects to clear.
Question 7: A post-arrest patient is mechanically ventilated with PaCO2 of 30 mmHg. Why is this problematic?
- Hypocapnia causes cerebral vasoconstriction and reduces cerebral blood flow (Correct answer)
- Hypocapnia increases intracranial pressure significantly
- Low CO2 directly worsens myocardial contractility
- Hypocapnia triggers catecholamine surge causing re-arrest
Correct answer: Hypocapnia causes cerebral vasoconstriction and reduces cerebral blood flow
Hypocapnia causes cerebral vasoconstriction, reducing perfusion to an already-vulnerable post-ischemic brain.
ACLS Post-Cardiac Arrest Care 2
What is the recommended mean arterial pressure (MAP) target during post-cardiac arrest care to ensure adequate organ perfusion?