Cardiac Emergencies (ACLS) Flashcards

Termination of resuscitation (TOR) criteria in out-of-hospital cardiac arrest for paramedics typically include:

Answer: Arrest not witnessed, no bystander CPR, no ROSC after 3 analyses, and no shockable rhythm ever

Basic life support TOR rules consider multiple factors: unwitnessed arrest, absence of bystander CPR, failure to achieve ROSC after adequate ALS, and no shockable rhythm — each reducing survival probability to near zero.

Which finding after 20 minutes of ALS indicates futility in adult cardiac arrest?

Answer: ETCO2 persistently below 10 mmHg throughout CPR despite appropriate management

Persistently low ETCO2 (<10 mmHg) after 20 minutes of CPR indicates inadequate cardiac output despite resuscitation attempts and is associated with near-zero survival, supporting consideration of termination of efforts.

In ACLS, which is the preferred vascular access route if IV access cannot be established?

Answer: Intraosseous (IO) access

IO access provides rapid, reliable vascular access for medications and fluids in cardiac arrest when IV attempts fail; it delivers drugs to central circulation via the bone marrow venous sinuses.

During ACLS, the rhythm check should occur every:

Answer: 2 minutes (after each CPR cycle)

2-minute CPR cycles with rhythm checks at the end of each cycle maintain the recommended compression fraction (>80%) while allowing systematic assessment of rhythm and response to interventions.

The ACLS algorithm for stable monomorphic ventricular tachycardia with a pulse includes:

Answer: Amiodarone 150mg IV infusion over 10 minutes, or synchronised cardioversion

Stable monomorphic VT with a pulse can be treated pharmacologically with amiodarone (or procainamide/lidocaine), or electively cardioverted if pharmacological therapy fails or is not preferred.

Post-ROSC, the target systolic blood pressure in ACLS post-cardiac arrest care is:

Answer: At least 90 mmHg systolic (or MAP ≥65 mmHg)

Post-ROSC haemodynamic goals include SBP ≥90 mmHg or MAP ≥65 mmHg to ensure adequate organ perfusion; vasopressors (norepinephrine) and IV fluids are used to achieve and maintain these targets.