ACLS Post-Cardiac Arrest Care 5

Question 1

A post-cardiac arrest patient maintained at 33°C develops QTc prolongation to 520 ms. What is the priority action?

Accepted Answer

Review and discontinue QT-prolonging medications while continuing TTM

Answer

Hypothermia itself prolongs QTc; review for concurrent QT-prolonging drugs (antiarrhythmics, antibiotics) that compound the risk, and discontinue them while maintaining TTM.

Question 2

What does the concept of 'self-fulfilling prophecy' refer to in post-cardiac arrest prognostication?

Accepted Answer

Withdrawal of care based on premature poor prognosis leading to the predicted death

Answer

Self-fulfilling prophecy occurs when early withdrawal of life-sustaining therapy, based on inaccurate or premature prognostication, causes the predicted death rather than the underlying injury.

Question 3

Which of the following is the most appropriate initial tidal volume setting for mechanical ventilation in a post-cardiac arrest patient?

Accepted Answer

6–8 mL/kg of predicted body weight

Answer

Lung-protective ventilation using 6–8 mL/kg of predicted body weight reduces ventilator-induced lung injury in post-arrest patients.

Question 4

A post-arrest patient has return of spontaneous circulation but remains hypotensive despite adequate volume resuscitation. Bedside echocardiography shows severely reduced left ventricular ejection fraction. The MOST appropriate next step is:

Accepted Answer

Add dobutamine to norepinephrine for inotropic support

Answer

Post-arrest myocardial stunning with severely reduced EF requires inotropic support; dobutamine added to a vasopressor addresses both cardiac output and vascular tone.

Question 5

According to ACLS guidelines, at what point should fever (>37.7°C) be actively treated following the TTM maintenance phase?

Accepted Answer

Immediately and for at least 72 hours post-arrest

Answer

Active fever prevention is recommended for at least 72 hours post-ROSC because fever worsens neurological outcomes from increased cerebral metabolic demand.

ACLS Practice Test

ACLS Practice Test

ACLS Post-Cardiac Arrest Care 5