Cardiac Arrest and Post-Resuscitation Care - NREMT Paramedic Level

1. What is the amiodarone dose for refractory VF/pVT after defibrillation attempts?

   300 mg IV/IO bolus, then 150 mg IV/IO once. Amiodarone stabilizes cardiac membranes and prolongs refractory periods to terminate refractory ventricular arrhythmias.

2. What ventilation rate is recommended after an advanced airway is placed during CPR?

   1 breath every 6 seconds (10/min) with continuous compressions. Asynchronous ventilation prevents hyperventilation and allows uninterrupted chest compressions for better hemodynamics.

3. Which energy dose is recommended for the first biphasic defibrillation attempt in VF/pVT?

   120–200 J (use manufacturer recommendation). Biphasic waveforms require lower energy for effective defibrillation compared to monophasic, with doses tailored to device specifics.

4. What compression depth is recommended for adult CPR during cardiac arrest?

   At least 2 in (5 cm), not more than 2.4 in (6 cm). This depth balances effective cardiac compression with minimizing risks like rib fractures or internal injuries.

5. Which rhythms are nonshockable in the adult cardiac arrest algorithm?

   Asystole and pulseless electrical activity (PEA). These rhythms lack organized ventricular activity amenable to defibrillation, requiring focus on reversible causes and medications.

6. What ETCO2 value during CPR suggests poor chest compression quality and need for improvement?

   Persistently < 10 mmHg. Low ETCO2 reflects inadequate pulmonary perfusion, signaling the need to optimize compression technique and depth.

7. Which rhythms are shockable in the adult cardiac arrest algorithm?

   Ventricular fibrillation and pulseless ventricular tachycardia. These disorganized rhythms respond to electrical cardioversion to restore coordinated cardiac activity.

8. What is the lidocaine dose for refractory VF/pVT when used as an alternative to amiodarone?

   1–1.5 mg/kg IV/IO, then 0.5–0.75 mg/kg (max 3 mg/kg). Lidocaine suppresses ventricular ectopy by blocking sodium channels, serving as an alternative antiarrhythmic in persistent cases.

9. What oxygenation target is recommended after ROSC to avoid hyperoxia?

   Titrate oxygen to SpO2 92%–98%. Avoiding hyperoxia reduces oxidative stress and reperfusion injury in post-arrest tissues.

10. What is the recommended timing interval for repeat epinephrine dosing during adult cardiac arrest?

    Every 3–5 minutes. Repeated dosing maintains vasopressor effects without accumulation, aligning with pharmacokinetics in arrest scenarios.

11. Which drug is recommended for torsades de pointes (polymorphic VT) during cardiac arrest?

    Magnesium sulfate 1–2 g IV/IO. Magnesium corrects electrolyte imbalances that prolong QT interval, stabilizing polymorphic ventricular tachycardia.

12. What is the preferred method to confirm and continuously monitor endotracheal tube placement during arrest?

    Continuous waveform capnography. Waveform capnography provides real-time, quantitative confirmation of tube position and ventilation efficacy over other methods.

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

    1 mg IV/IO. Epinephrine acts as a vasopressor to enhance coronary and cerebral perfusion during low-flow states in arrest.

14. Which compression rate is recommended for adult CPR during cardiac arrest?

    100–120 compressions/min. AHA guidelines specify this rate to ensure adequate cardiac output and perfusion during resuscitation efforts.

15. What is the minimum waveform capnography value that suggests ROSC during CPR?

    Abrupt sustained increase in ETCO2 (often to ≥ 40 mmHg). Sudden ETCO2 rise indicates restored pulmonary blood flow from effective cardiac output post-resuscitation.

16. What systolic blood pressure target is recommended after ROSC in adult post–cardiac arrest care?

    SBP ≥ 90 mmHg (or MAP ≥ 65 mmHg). This target ensures adequate organ perfusion while avoiding excessive vasopressor use in hypotensive states.

17. What is the recommended adult ventilation rate after ROSC when an advanced airway is in place?

    10 breaths/min; titrate to normal PaCO2/ETCO2. This rate maintains normocapnia, preventing hypocapnia-induced vasoconstriction or hypercapnia-related acidosis.

18. Which post-ROSC ECG finding requires immediate consideration of emergent coronary reperfusion?

    ST-segment elevation myocardial infarction (STEMI). STEMI indicates acute coronary occlusion, where timely reperfusion can salvage myocardium and improve outcomes.

19. Which energy dose is recommended for defibrillation using a monophasic defibrillator in VF/pVT?

    360 J. Monophasic defibrillators deliver a single-direction current, necessitating higher energy to terminate ventricular arrhythmias effectively.

20. Identify the correct action immediately after delivering a defibrillation shock in VF/pVT.

    Resume CPR immediately for 2 minutes. Immediate CPR resumption maintains circulation while allowing rhythm analysis and drug effects to manifest.

21. What is the maximum recommended pause in chest compressions for rhythm checks or shocks?

    No more than 10 seconds. Minimizing interruptions maintains coronary perfusion pressure and improves survival outcomes in cardiac arrest.

22. What is the correct adult compression-to-ventilation ratio when no advanced airway is in place?

    30:2. This ratio optimizes circulation while providing sufficient oxygenation without excessive ventilation pauses.

23. Which temperature range is recommended for post–cardiac arrest temperature control in comatose adults?

    Maintain 32–37.5 °C and prevent fever. Targeted temperature management reduces metabolic demand and neuroinflammation, improving neurologic recovery.

24. Identify the correct immediate action when a post-ROSC patient becomes pulseless again.

    Restart CPR and follow the cardiac arrest algorithm. Prompt algorithm adherence ensures structured resuscitation, addressing recurrent arrest causes efficiently.

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