Cardiac Arrest and Resuscitation - NREMT AEMT Level

1. What is the recommended interval for switching compressors to reduce fatigue during CPR?

   About every $2$ minutes (every $5$ cycles of $30:2$). Regular switching prevents rescuer fatigue, ensuring consistent compression quality throughout resuscitation.

2. What is the recommended adult defibrillation energy for a biphasic defibrillator if the manufacturer dose is unknown?

   $200$ J (then equal or higher for subsequent shocks). This energy level optimizes first-shock success for biphasic waveforms, with escalation for refractoriness.

3. What antiarrhythmic medication and dose may be given for refractory VF/pVT after defibrillation attempts?

   Amiodarone $300$ mg IV/IO bolus. Amiodarone stabilizes membranes and prolongs action potential to terminate refractory ventricular arrhythmias.

4. What is the recommended adult defibrillation energy for a monophasic defibrillator?

   $360$ J. Monophasic defibrillators require higher energy to achieve equivalent efficacy to biphasic devices.

5. What is the correct adult epinephrine dose and route for cardiac arrest?

   $1$ mg IV/IO. Epinephrine acts as a vasopressor to increase coronary and cerebral perfusion pressures during low-flow states.

6. Which two cardiac arrest rhythms are classified as shockable rhythms?

   Ventricular fibrillation and pulseless ventricular tachycardia. These rhythms respond to defibrillation as they involve chaotic or rapid ventricular activity that can be terminated by electrical shock.

7. What rhythm check interval is recommended during cardiac arrest management with ongoing CPR?

   Every $2$ minutes. This interval allows assessment without prolonged CPR interruption, balancing rhythm identification with perfusion.

8. Which two cardiac arrest rhythms are classified as nonshockable rhythms?

   Asystole and pulseless electrical activity. These rhythms lack ventricular electrical activity suitable for defibrillation, requiring focus on identifying and treating underlying causes.

9. What is the correct adult chest compression rate during high-quality CPR?

   $100$ to $120$ compressions per minute. This rate ensures adequate cardiac output during CPR by mimicking normal heart rate while allowing full chest recoil.

10. Which cardiac rhythm is most commonly associated with sudden adult cardiac arrest and is shockable?

    Ventricular fibrillation (VF). VF is the most frequent initial rhythm in out-of-hospital cardiac arrests in adults, amenable to defibrillation to restore organized rhythm.

11. How often should epinephrine be repeated during adult cardiac arrest?

    Every $3$ to $5$ minutes. This interval aligns with epinephrine's pharmacokinetics to maintain therapeutic levels without toxicity.

12. What does the term PEA (pulseless electrical activity) mean in cardiac arrest management?

    Organized ECG rhythm without a palpable pulse. PEA indicates electrical activity on ECG that should produce a pulse but does not due to underlying mechanical or metabolic issues.

13. Which assessment finding is required to declare ROSC during resuscitation?

    Return of a palpable pulse with signs of perfusion. ROSC confirms restoration of effective cardiac output, distinguishing from transient or artifactual findings.

14. What alternative antiarrhythmic and dose may be used instead of amiodarone for VF/pVT?

    Lidocaine $1$ to $1.5$ mg/kg IV/IO. Lidocaine suppresses ventricular ectopy as an alternative when amiodarone is unavailable or contraindicated.

15. What is the correct adult chest compression depth during high-quality CPR?

    $2$ to $2.4$ inches ($5$ to $6$ cm). Adequate depth compresses the heart sufficiently against the spine to generate blood flow without causing injury.

16. What is the maximum recommended pause duration in compressions for rhythm check or shock delivery?

    Less than $10$ seconds. Minimizing pauses maintains coronary perfusion pressure, which is critical for successful resuscitation.

17. Identify the correct immediate action when the AED advises no shock for an unresponsive, pulseless adult.

    Resume CPR immediately and reassess rhythm in about $2$ minutes. Continuing CPR maintains circulation in nonshockable rhythms while preparing for next rhythm assessment.

18. What is the correct adult naloxone role in a patient with suspected opioid overdose who is pulseless and apneic?

    Prioritize CPR and ventilation; naloxone is not the initial priority. In cardiac arrest from opioids, restoring circulation and oxygenation takes precedence over reversal agents.

19. In a shockable rhythm, when should epinephrine be given relative to shocks and CPR cycles?

    After the second shock (during the next CPR cycle). Timing allows initial defibrillation attempts before adding vasopressor support in the shockable algorithm.

20. What is the second dose of amiodarone for refractory VF/pVT if needed?

    Amiodarone $150$ mg IV/IO bolus. The reduced second dose maintains efficacy while minimizing cumulative toxicity risks.

21. What is the correct adult compression-to-ventilation ratio for $1$ rescuer CPR with no advanced airway?

    $30:2$. This ratio balances circulation from compressions with oxygenation from ventilations in basic life support scenarios.

22. In a nonshockable rhythm, when should epinephrine be administered during the arrest algorithm?

    As soon as possible after IV/IO access is obtained. Early administration in nonshockable rhythms supports perfusion while addressing reversible causes.

23. What ventilation rate is recommended for an adult with an advanced airway during CPR?

    $1$ breath every $6$ seconds ($10$ per minute). This rate provides sufficient oxygenation without causing hyperventilation or gastric distension in intubated patients.

24. Identify the correct immediate action when the AED advises a shock for an unresponsive, pulseless adult.

    Clear the patient and deliver the shock, then resume CPR immediately. Immediate shock delivery terminates shockable rhythms, followed by CPR to support circulation post-defibrillation.

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