BLS Post-Resuscitation Care 5 — Questions and Answers
Question 1: Which of the following BEST describes the multimodal approach to neuroprognostication?
- Relying solely on GCS score at 24 hours
- Combining clinical exam, EEG, SSEP, biomarkers, and neuroimaging (Correct answer)
- Using only CT scan findings
- Performing a single blood test for brain injury
Correct answer: Combining clinical exam, EEG, SSEP, biomarkers, and neuroimaging
No single test is sufficiently reliable; combining clinical findings, electrophysiology, biomarkers, and imaging improves prognostic accuracy.
Question 2: What is 'post-cardiac arrest shock' primarily characterized by?
- Hypertension and bradycardia
- Hypotension with low cardiac output due to myocardial dysfunction (Correct answer)
- Hypertension with tachycardia
- Normal hemodynamics with fever only
Correct answer: Hypotension with low cardiac output due to myocardial dysfunction
Post-arrest shock involves global myocardial stunning causing low cardiac output and hypotension requiring vasopressor or inotropic support.
Question 3: A post-arrest patient on mechanical ventilation has a PaO2 of 350 mmHg on 100% FiO2. What action should be taken?
- Maintain current settings — high PaO2 improves outcomes
- Wean FiO2 down to achieve SpO2 of 92–98% (Correct answer)
- Increase PEEP to raise PaO2 further
- Hyperventilate to reduce PaCO2
Correct answer: Wean FiO2 down to achieve SpO2 of 92–98%
Hyperoxia (PaO2 >300 mmHg) is harmful; FiO2 should be weaned to maintain SpO2 92–98%, avoiding excessive oxygen exposure.
Question 4: Which patient population is MOST likely to benefit from emergent PCI after resuscitation from out-of-hospital cardiac arrest?
- All cardiac arrest patients regardless of rhythm
- Patients with STEMI or high suspicion of acute coronary occlusion on ECG (Correct answer)
- Patients with asystole as the arrest rhythm
- Elderly patients over age 80 only
Correct answer: Patients with STEMI or high suspicion of acute coronary occlusion on ECG
Emergent PCI is most beneficial when STEMI or signs of acute coronary occlusion are present on post-ROSC ECG.
Question 5: What complication does aggressive hyperventilation cause in post-arrest patients?
- Cerebral hyperemia and brain swelling
- Cerebral vasoconstriction reducing cerebral blood flow (Correct answer)
- Metabolic alkalosis corrected by kidneys immediately
- Increased intracranial pressure
Correct answer: Cerebral vasoconstriction reducing cerebral blood flow
Hyperventilation lowers PaCO2, causing cerebral vasoconstriction and reduced cerebral blood flow, worsening ischemic brain injury.
Question 6: Which statement about pupillary reflexes in post-cardiac arrest prognostication is correct?
- Absent pupillary reflexes at 24 hours reliably predict poor outcome regardless of sedation
- Bilaterally absent pupillary light reflexes at ≥72 hours, confirmed with quantitative tools, predict poor outcome (Correct answer)
- Present pupils always guarantee good neurological recovery
- Pupillary reflexes are not useful in post-arrest assessment
Correct answer: Bilaterally absent pupillary light reflexes at ≥72 hours, confirmed with quantitative tools, predict poor outcome
Bilaterally absent pupillary light reflexes confirmed at ≥72 hours (ideally with quantitative pupillometry) are a reliable predictor of poor neurological outcome.
Question 7: Which of the following interventions is specifically recommended to reduce secondary brain injury in the post-resuscitation phase?
- Routine steroids for all patients
- Avoiding fever, hypoxia, hypotension, and hypoglycemia (Correct answer)
- Immediate therapeutic hypothermia to 28°C for all patients
- Prophylactic antiepileptic drugs in all patients
Correct answer: Avoiding fever, hypoxia, hypotension, and hypoglycemia
Preventing secondary insults — fever, hypoxia, hypotension, and glucose abnormalities — is the most evidence-based strategy for reducing secondary brain injury.
BLS Post-Resuscitation Care 5
Which of the following BEST describes the multimodal approach to neuroprognostication?