ACLS Post-Cardiac Arrest Care 3 — Questions and Answers
Question 1: A comatose post-arrest patient has bilaterally absent N20 somatosensory evoked potentials at 72 hours. What does this indicate?
- Poor neurological prognosis with high specificity for poor outcome (Correct answer)
- Normal finding that requires repeat testing at 96 hours
- Possible good recovery if other signs are favorable
- Artifact from hypothermia requiring repeat testing after warming
Correct answer: Poor neurological prognosis with high specificity for poor outcome
Bilaterally absent N20 cortical responses on SSEP at 72+ hours post-arrest is one of the most specific predictors of poor neurological outcome.
Question 2: Which vasopressor is considered first-line for refractory hypotension (MAP <65 mmHg) in post-cardiac arrest syndrome?
- Norepinephrine (Correct answer)
- Epinephrine alone
- Dopamine
- Vasopressin alone
Correct answer: Norepinephrine
Norepinephrine is the preferred vasopressor for post-arrest hemodynamic support due to its alpha-adrenergic potency with less tachycardia than dopamine.
Question 3: Post-cardiac arrest syndrome includes all of the following EXCEPT:
- Hyperglycemia exclusively from pre-existing diabetes (Correct answer)
- Post-arrest brain injury
- Myocardial dysfunction
- Systemic ischemia/reperfusion response
Correct answer: Hyperglycemia exclusively from pre-existing diabetes
Post-cardiac arrest syndrome causes stress hyperglycemia in all patients regardless of diabetes history, so attributing it exclusively to pre-existing diabetes is incorrect.
Question 4: What is the significance of status epilepticus (SE) developing in a post-cardiac arrest patient?
- It is associated with poor neurological outcome and requires aggressive treatment (Correct answer)
- It is a good prognostic sign indicating cortical activity
- It should be observed for 24 hours before treating
- It reliably indicates the patient will regain consciousness
Correct answer: It is associated with poor neurological outcome and requires aggressive treatment
Post-anoxic status epilepticus, particularly myoclonic SE, is strongly associated with poor neurological prognosis and requires prompt treatment.
Question 5: Targeted temperature management is currently recommended for which post-cardiac arrest population?
- Comatose survivors of cardiac arrest regardless of initial rhythm (Correct answer)
- Only patients with shockable initial rhythms (VF/pVT)
- All patients including those who are alert after ROSC
- Only in-hospital cardiac arrest patients
Correct answer: Comatose survivors of cardiac arrest regardless of initial rhythm
Current ACLS guidelines recommend TTM for all comatose adult survivors of cardiac arrest, regardless of presenting rhythm.
Question 6: What is the primary goal of blood glucose management during post-cardiac arrest care?
- Avoid both hypoglycemia and severe hyperglycemia, targeting 140–180 mg/dL (Correct answer)
- Aggressive normalization to 80–110 mg/dL with intensive insulin
- Allow permissive hyperglycemia up to 250 mg/dL to fuel brain recovery
- Maintain glucose above 200 mg/dL to prevent hypoglycemic injury
Correct answer: Avoid both hypoglycemia and severe hyperglycemia, targeting 140–180 mg/dL
Moderate glucose control targeting 140–180 mg/dL balances the risks of hypoglycemia (worse outcomes) and severe hyperglycemia (osmotic and cellular injury).
Question 7: A post-arrest patient undergoes CT brain showing diffuse cerebral edema with loss of gray-white differentiation. This finding suggests:
- Severe anoxic brain injury with poor prognosis (Correct answer)
- Reversible cerebral vasospasm
- Hypertensive encephalopathy responding to treatment
- Normal appearance in the setting of hypothermia
Correct answer: Severe anoxic brain injury with poor prognosis
Diffuse cerebral edema with gray-white matter blurring on CT indicates severe anoxic injury and portends a poor neurological outcome.
ACLS Post-Cardiac Arrest Care 3
A comatose post-arrest patient has bilaterally absent N20 somatosensory evoked potentials at 72 hours.
What does this indicate?