CPR Special Resuscitation Circumstances 2 — Questions and Answers
Question 1: A pregnant patient at 28 weeks gestation is in cardiac arrest. What is the recommended uterine displacement technique during CPR?
- Place a wedge under the left hip to tilt 15-30 degrees left (Correct answer)
- Place a wedge under the right hip to tilt 15-30 degrees right
- Keep patient supine with no tilt to maximize compression effectiveness
- Tilt 45 degrees left to fully relieve aortocaval compression
Correct answer: Place a wedge under the left hip to tilt 15-30 degrees left
Left lateral uterine displacement of 15-30 degrees relieves aortocaval compression while maintaining effective CPR compressions.
Question 2: Which dysrhythmia is most commonly associated with hypothermic cardiac arrest at core temperatures below 30°C (86°F)?
- Ventricular fibrillation (Correct answer)
- Asystole
- Pulseless electrical activity
- Atrial fibrillation with complete heart block
Correct answer: Ventricular fibrillation
Ventricular fibrillation is the most common dysrhythmia in severe hypothermia and is the primary shockable rhythm encountered.
Question 3: A patient is rescued from a house fire and is in cardiac arrest with suspected cyanide toxicity. After standard ACLS, what antidote should be administered?
- Hydroxocobalamin 5g IV (Correct answer)
- Sodium thiosulfate 12.5g IV alone
- Atropine 1mg IV
- Flumazenil 0.2mg IV
Correct answer: Hydroxocobalamin 5g IV
Hydroxocobalamin (Cyanokit) 5g IV is the preferred cyanide antidote in smoke inhalation victims as it does not cause methemoglobinemia.
Question 4: During resuscitation of a patient with tension pneumothorax, which finding confirms successful needle decompression?
- Rush of air upon needle insertion and return of pulses (Correct answer)
- Decrease in end-tidal CO2 to below 10 mmHg
- Bilateral breath sounds without improvement in hemodynamics
- Immediate restoration of normal sinus rhythm on the monitor
Correct answer: Rush of air upon needle insertion and return of pulses
A rush of air confirming pressure release followed by return of spontaneous circulation indicates successful decompression of a tension pneumothorax.
Question 5: In pediatric drowning resuscitation, which modification to standard CPR protocol is recommended?
- Begin with 5 rescue breaths before starting chest compressions (Correct answer)
- Start with 30 compressions before any ventilations regardless of age
- Avoid ventilations entirely until advanced airway is placed
- Use only 1 breath per 10 compressions to limit gastric inflation
Correct answer: Begin with 5 rescue breaths before starting chest compressions
Drowning victims suffer hypoxic cardiac arrest, so the pediatric drowning protocol prioritizes 5 initial rescue breaths before compressions.
Question 6: A patient with known hyperkalemia is in cardiac arrest with a wide-complex rhythm. Which medication should be given first?
- Calcium chloride 1g IV (Correct answer)
- Sodium bicarbonate 50 mEq IV
- Regular insulin 10 units IV
- Albuterol nebulization
Correct answer: Calcium chloride 1g IV
Calcium chloride immediately stabilizes the cardiac membrane potential and is the fastest-acting treatment for hyperkalemic cardiac toxicity.
Question 7: What is the maximum recommended number of defibrillation attempts before initiating active rewarming in a hypothermic cardiac arrest patient with a core temperature below 30°C?
- 3 shocks (Correct answer)
- 1 shock
- 6 shocks
- No limit — continue shocking every 2 minutes as per standard ACLS
Correct answer: 3 shocks
Current guidelines recommend up to 3 defibrillation attempts in severe hypothermia, then withholding further shocks until core temperature rises above 30°C.
CPR Special Resuscitation Circumstances 2
A pregnant patient at 28 weeks gestation is in cardiac arrest.
What is the recommended uterine displacement technique during CPR?