Grile Medicina de Urgenta An IV

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<ul><li><p>CARDIOPULMONARY AND CEREBRAL RESUSCITATION (1) </p><p>1. Clinical death defines: </p><p>a. cessation of blood circulation and breathing </p><p>b. heart starts beating in a regular rhythm </p><p>c. might develop in cardiac arrest </p><p>d. absence of pulse at a large artery in a non-monitored patient, with altered state of conscious </p><p>e. all of the above. </p><p>2. CPR: </p><p>a. stands for cardiopulmonary resuscitation </p><p>b. is formed of maneuvers and techniques to reanimate the sick in clinical death </p><p>c. it can be commenced at any give time after heart and breathing stopped. </p><p>d. irreversible injuries at cell level appear immediately </p><p>e. "mouth to mouth" breath combined with chest compressions is a technique rediscovered in 1960 by P. Safar &amp; Kouwenhoven. </p><p>3. Resuscitation time: </p><p>a. is a term with of no clinical importance </p><p>b. it contains 4 main components: a-lesion time, lesion time, phase of paralysis, time to die </p><p>c. is the time passed from cardiac arrest till the induction of irreversible injuries </p><p>d. RT is 20 to 30 minutes for the liver cell, retinal cell 120 minutes, 180 minutes for renal cell </p><p>e. phase of paralysis from the first signs of functional deficit till the disappearance of organ function </p></li><li><p>4. The optimal time for reversible resuscitation: </p><p>a. 4-8 minutes </p><p>b. 5-10 minutes </p><p>c. under 4 minutes for subjects in a state of hypothermia </p><p>d. 4 minutes </p><p>e. in case of opiate poisoning, the RT is shortened to 5-7 minutes </p><p>5. Causes of cardiac arrest: </p><p>a. secondary cardiac arrest due to arrhythmia, atrioventricular block, IMA, electrocution, drug overdose </p><p>b. secondary cardiac arrest due to depression of the respiratory centers, airway obstruction, massive pulmonary embolism, anaphylactic shock, electrolyte disturbances </p><p>c. causes of cardiorespiratory arrest are: airway obstruction, breathing problems (acute or chronic), circulatory problems </p><p>d. laryngospasm, bronchospasm is considered to be a cause of cardiac arrest </p><p>e. pneumothorax, haemothorax, infection, exacerbation of COPD, asthma, pulmonary embolus is considered to be a cause of cardiac arrest </p><p>6. Recognition of cardiac arrest: </p><p>a. patient is unconscious without a pulse in large vessels </p><p>b. skin is pink, warm, patient is breathing </p><p>c. pupils are miotic, small </p><p>d. absence of carotid pulse and lack of consciousness present in the first 15 seconds of the heart stopping </p><p>e. apnea is an early sign </p></li><li><p>7. Measures in case of a cardiac arrest: </p><p>a. listening to the heart or BP measurement are necessary gestures </p><p>b. start resuscitation after having an ECG monitor </p><p>c. chain of survival means early recognition of cardiac arrest, early CPR, post resuscitation care </p><p>d. chain of survival means early recognition of cardiac arrest, early CPR, early defibrillation, post resuscitation care </p><p>e. initiate the chain of survival </p><p>8. Objectives of cardio-pulmonary resuscitation: </p><p>a. first, initiate advanced life support </p><p>b. first, initiate basic life support </p><p>c. second advanced life support, resumption of spontaneous cardiac circulation and ventilation </p><p>d. in third stage, initiate prolonged life support with cerebral resuscitation &amp; maintenance of vital functions (intensive therapy) </p><p>e. BLS includes artificial ventilation, external cardiac massage, defibrillation, recognition of MI and stroke, removal of foreign bodies in case of obstructive airways </p><p>9. BLS: </p><p>a. cardiac arrest must be suspected in any person found unconscious without any reasons </p><p>b. if the person doesnt respond to any stimuli, you must follow the ABCDE of CPR </p><p>c. dont call for help before starting ABCDE assessing </p><p>d. the general population learns the phone fast/phone first algorithm </p><p>e. all of the above </p></li><li><p>10. ABCDE approach: </p><p>a. stands for airway, breathing, circulation, defibrillation, environment </p><p>b. treat life-threatening problems before moving to the next part of assessment </p><p>c. call for appropriate help early </p><p>d. the aim of the initial treatment is to keep the patient alive </p><p>e. ABCDE can be skipped when talking about an in-hospital resuscitation </p><p>11. First steps in ABCDE: </p><p>a. ensure personal safety </p><p>b. if patient is awake, shake well and shout How are you? </p><p>c. if he responds normally he has a patent airway, is breathing and has brain perfusion </p><p>d. Look, Listen and Feel for no more than 1 minute </p><p>e. insert an IV cannula as soon as possible </p><p>12. ABCDE approach airway: </p><p>a. signs of airway obstruction - paradoxical chest and abdominal movements, use of the accessory muscles of respiration </p><p>b. central cyanosis is a late sign of airway obstruction </p><p>c. airway obstruction causes hypothermia </p><p>d. simple methods of airway clearance are required (head tilt, chin lift, jaw thrust, guedel canulla) </p><p>e. provide high-concentration oxygen using a mask with an oxygen reservoir (15 l/min) </p></li><li><p>13. ABCDE approach breathing </p><p>a. look, listen and feel for the general signs of respiratory distress </p><p>b. assess the depth of each breath, the pattern, chest expansion </p><p>c. count the respiratory rate (normal respiratory rate is 20-25 breaths/min) </p><p>d. percuss the chest, look for any deformity, auscultate the chest </p><p>e. use a pocket mask or a bag-mask ventilator to improve oxygenation and ventilation </p><p>14. ABCDE approach circulation: </p><p>a. consider hypovolaemia to be the primary cause of shock, until proven otherwise </p><p>b. color of the skin, limb temperature, capillary refill time </p><p>c. count the pulse rate </p><p>d. dont measure patients BP, unnecessary measure </p><p>e. insert one or more large IV cannulae and give a rapid fluid challenge if the patient is hypertensive </p><p>15. Immediate treatment for acute coronary syndromes include: </p><p>a. aspirin 75 mg orally </p><p>b. nitroglycerine as sublingual glyceryl trinitrate </p><p>c. oxygen to aim a SpO2 of 100% </p><p>d. Morphine or fentanyl to avoid sedation </p><p>e. aspirin 300 mg orally, nitroglycerine, oxygen to obtain an SpO2 of 94-98%, titrated morphine to avoid respiratory depression </p></li><li><p>16. ABCDE approach disability: </p><p>a. exclude or treat hypoxia and hypertension </p><p>b. check the drug cart for reversible drug-induced causes of depressed consciousness </p><p>c. examine the pupils </p><p>d. assess using AVPU score or Glasgow Coma Scale </p><p>e. measure blood glucose to exclude hyperglycaemia </p><p>17. BLS: </p><p>a. the presence of pulse and normal breathing continues to be the main sign of cardiac arrest in a non-responsive victim </p><p>b. maintaining airway patency and supporting breathing and the circulation </p><p>c. the rescuer should only stop CPR if the victim shows signs of regaining consciousness </p><p>d. dont ask for an automated external defibrillator </p><p>e. compress the chest to a depth of 5-6 cm and at a rate of 100-120 min </p><p>18. BLS: </p><p>a. keeping the airway open, look, listen, and feel for normal breathing </p><p>b. shout for help </p><p>c. open the airway using head tilt and chin lift </p><p>d. start chest compression before assessing breathing and circulation </p><p>e. all of the above </p></li><li><p>19. BLS: </p><p>a. after 30 compressions open the airway again using head tilt and chin lift </p><p>b. seal the airway and give a rescue breath </p><p>c. give five breaths and 30 compressions </p><p>d. check the victim's mouth and remove any visible obstruction </p><p>e. continue with chest compressions and rescue breaths in a ratio of 30:2 </p><p>20. In-hospital resuscitation select the incorrect answers: </p><p>a. personal safety is not something important, you are in a hospital, nothing dangerous </p><p>b. give oxygen, attach monitoring, record vital signs, obtain IV access </p><p>c. if the doesnt respond, turn the patient on to his belly, open airway </p><p>d. in case of cervical spine injury, perform head tilt, chin lift to open the airway without manual in-line stabilization of head &amp; neck </p><p>e. if no pulse or breathing, start CPR and call for help </p><p>21. In-hospital resuscitation: </p><p>a. ensure low quality chest compressions of 5-6 cm depth, rate 100-120 compressions/min </p><p>b. change about every 2 min or earlier the person that is doing the chest compressions </p><p>c. tracheal intubation should be attempted immediately as you discover the patient is not breathing </p><p>d. once the patients trachea has been intubated, continue chest compressions uninterrupted </p><p>e. wait until you have an ECG monitor to for a defibrillator </p></li><li><p>22. In-hospital resuscitation: </p><p>a. when the defibrillator arrives, apply self-adhesive defibrillation electrodes and analyse the rhythm </p><p>b. pause for 30 seconds briefly to assess the heart rhythm </p><p>c. if rhythm is VF or pulseless VT, charge the defibrillator, restart chest compressions, deliver shock </p><p>d. wait for 3-5 minutes between shocks to deliver the next one </p><p>e. all of the above </p><p>CARDIOPULMONARY AND CEREBRAL RESUSCITATION (2) </p><p>23. Advanced life support: </p><p>a. heart rhythms associated with cardiac arrest shockable &amp; non-shockable rhythms </p><p>b. shockable rhythms: VT &amp; PEA </p><p>c. non-shockable rhythms: PEA &amp; asystole </p><p>d. chest compressions, airway management, ventilation, IV access, adrenaline and identification and correction of reversible factors are common in both groups </p><p>e. non-shockable rhythms: VF &amp; asystole </p><p>24. Shockable rhythms choose the incorrect answers: </p><p>a. first monitored rhythm is VF/VT in 25% of cardiac arrest </p><p>b. uninterrupted chest compressions, apply self-adhesive defibrillation/monitoring pads </p><p>c. confirm VF/VT from ECG (after 3-5 min of CPR) </p><p>d. once the defibrillator is charged, give the shock without any warning </p><p>e. restart CPR using a ratio of 30:2, starting with rescue breaths </p></li><li><p>25. Shockable rhythms: </p><p>a. if VF/VT is seen on ECG, charge the defibrillator </p><p>b. tell everyone to stand clear, then deliver the shock </p><p>c. deliver the next shock within 2 minutes </p><p>d. if no signs of life, stop CPR within 5 minutes </p><p>e. If VF/VT persists, deliver up to third shocks and give 1 mg adrenaline iv and amiodarone 300 mg iv while performing a further 2 min CPR </p><p>26. Adrenaline in shockable rhythms: </p><p>a. the first dose of adrenaline is given immediately after delivery of the first shock </p><p>b. amiodarone 300 mg may be given after the third shock </p><p>c. subsequent doses of adrenaline are given after alternate 2 minute loops of CPR (every 3-5 min ~ 4 min) for as long as cardiac arrest persists </p><p>d. lidocaine 1 mg/kg may be used after amiodarone </p><p>e. non of the above </p><p>27. Precordial thump: </p><p>a. has a high success rate for cardioversion of a shockable rhythm </p><p>b. there is more success with pulseless VT than with VF </p><p>c. use the ulnar edge of a clenched fist, deliver a sharp impact to the lower half of the sternum </p><p>d. it can be given in the first 5 minutes after the onset of a shockable rhythm </p><p>e. can be used more than 10 times if unsuccessful </p></li><li><p>28. Non-shockable rhythms: </p><p>a. they are PEA and asystole </p><p>b. PEA is non-organized cardiac electrical activity in the absence of any palpable pulse </p><p>c. asystole is absence of electrical activity on the ECG trace </p><p>d. attempts to pace true asystole are successful </p><p>e. PEA = pulseless electrical anormality </p><p>29. Treatment of PEA/Asystole: </p><p>a. start CPR and wait for 2 minutes until delivering first shock </p><p>b. give amiodarone 300 mg immediately </p><p>c. give adrenaline 1 mg iv as soon as IV acces is achieved, continue CPR 30:2 ratio </p><p>d. recheck the rhythm after 2 minutes, organized electrical activity is seen, check for a pulse, if not, continue CPR </p><p>e. if VF/VT at rhythm check, administer adrenaline 1 mg IV </p><p>30. During CPR: </p><p>a. good quality chest compressions between defibrillation attempts, recognizing and treating reversible causes (4 H and 4 T), obtaining a secure airway, a vascular access </p><p>b. a bag mask or a supraglottic airway device (LMA) should be used in the absence of personnel skilled in tracheal intubation </p><p>c. obtain IV access immediately, flush the drugs with 20-30 ml of glucose 10% </p><p>d. if iv access can not be established, consider gaining intraosseous (IO) access </p><p>e. maintain low quality, uninterrupted chest compressions </p></li><li><p>31. Reversible causes of cardiac arrest select the incorrect answers: </p><p>a. H stands for hypoxia, hypovolemia, hyperkalemia/hypokalemia, hyperthermia </p><p>b. T stands for tension pneumothorax, cardiac tamponade, toxins, thrombosis </p><p>c. toxins can be antagonized with appropriate antidotes (if they are available) </p><p>d. hypothermia can be suspected in any drowning incident, use a low reading thermometer </p><p>e. all of the above </p><p>32. Reversible causes of cardiac arrest: </p><p>a. hypoxia can be minimized by ventilating the patient lungs adequately </p><p>b. hypovolemia is the most common cause of cardiac arrest and appears due to severe haemorrhage (trauma, drains, occult) </p><p>c. hyperkalemia/hypokalemia can be seen by testing the arterial blood gases </p><p>d. tension pneumothoras primary cause of PEA </p><p>e. cardiac tamponade is easy to diagnose </p><p>33. Airway management &amp; ventilation: </p><p>a. airway obstruction is partial or complete </p><p>b. the commonest site of airway obstruction in a conscious patient is the pharynx </p><p>c. laryngeal obstruction may be caused by oedema from burns, inflammation or anaphylaxis </p><p>d. obstructions in the airway below the larynx are the most common </p><p>e. all of the above </p></li><li><p>34. Recognition of airway obstruction select the incorrect answers: </p><p>a. inspiratory stridor - presence of liquid or semisolid foreign material in the upper airways </p><p>b. use the Look, Listen and Feel approach </p><p>c. expiratory wheeze - laryngeal spasm or obstruction </p><p>d. in partial airway obstruction, air entry is diminished and usually noisy </p><p>e. complete airway obstruction will be noisy </p><p>35. Chocking: </p><p>a. severe airway obstruction: patient unable to speak, breathing sounds wheezy, attempts at coughing are silent, patient becomes unconscious </p><p>b. conscious patient shows signs of mild airway obstruction - 5 back blows followed by 5 abdominal thrusts </p><p>c. unconscious patient with signs of severe airway obstruction start CPR </p><p>d. severe airway obstruction and patient is conscious 5 sharp back blows followed by 5 abdominal thrusts </p><p>e. conscious patient with severe airway obstruction encourage to cough </p><p>36. Opening the airway: </p><p>a. head tilt, chin lift </p><p>b. jaw thrust </p><p>c. in case of cervical spine injury, undertake head tilt, chin lift with jaw thrust without any manual in-line stabilization of the head &amp; neck </p><p>d. guedel airway </p><p>e. all of the above </p></li><li><p>37. Artificial ventilation: </p><p>a. is started as soon as possible in any patient in whom spontaneous ventilation is inadequate or absent </p><p>b. tidal volumes in the region of 6-7 ml/kg will provide adequate oxygenation and ventilation </p><p>c. the pocket resuscitation mask or bag-mask ventilation. have a unidirectional valve, which directs the patients expired air away from the rescuer. </p><p>d. some masks have a port for additional oxygen </p><p>e. gastric inflation can be prevented by delivering up to 10 ml/kg of oxygen </p><p>38. Laryngeal Mask Airway (LMA): </p><p>a. can provide high inflations pressures, avoiding this way the gastric inflation </p><p>b. difficult cu use, requires the use of laryngoscope </p><p>c. limitations - may cause coughing, laryngospasm, risk of Mendelsohn syndrome </p><p>d. maintain chest compressions while inserting the LMA </p><p>e. appropriate sizes are 4 for women and 5 for male </p><p>39. Tracheal intubation: </p><p>a. advantages - maintenance of a patent airway, protected from aspiration of gastric contents or blood </p><p>b. di...</p></li></ul>