Cardiovascular Critical Care II

Learning Objectives

Manage cardiac arrest from the initiation of basic

life support to the use of post–cardiac arrest care.

medication administration during cardiac arrest.

Categorize the patient groups that should receive

temperature control after cardiac arrest.

Develop treatment plans for common complications

of temperature control after cardiac arrest.

Analyze the therapeutic goals and clinical indi-

cations for the medications used in hypertensive

emergency.

Advanced cardiac life support

AED

Automated external defibrillator

BLS

Basic life support

BPV

Blood pressure variability

CPR

Cardiopulmonary resuscitation

DBP

Diastolic blood pressure

ED

Emergency department

ICP

Intracranial pressure

ICU

Intensive care unit

IO

Intraosseous

MAP

Mean arterial pressure

PEA

Pulseless electrical activity

pVT

Pulseless ventricular tachycardia

SCA

Sudden cardiac arrest

SBP

Systolic blood pressure

VF

Ventricular fibrillation

VT

Ventricular tachycardia

Self-Assessment Questions

Answers and explanations to these questions may be

found at the end of this chapter.

Questions 1–5 pertain to the following case.

T.B. is a 72-year-old man with a history of atrial fibril-

lation, coronary artery disease with drug-eluting stent

placement in 2009, heart failure with reduced ejec-

tion fraction (most recent ejection fraction was 45% on

echocardiogram in 2018), and gastroesophageal reflux

disease. T.B. is sent to the catheterization laboratory for

suspected acute myocardial infarction. Laboratory val-

ues for T.B. are as follows: international normalized ratio

(INR) 1, platelet count 200,000/mm3, hemoglobin 12 g/

dL, serum creatinine (SCr) 1.7 mg/dL (baseline 1.5 mg/

dL), white blood cell count (WBC) 17 x 103 cells/mm3,

and aspartate aminotransferase (AST) 100 IU/L. He is

admitted to the coronary care unit for observation after

catheterization when he suddenly loses consciousness

and becomes pulseless. The coronary care unit team of

which you are part is called to the bedside. Of note, T.B.

has peripheral intravenous access, and before this event,

was on room air without any oxygen support.

Which is the most appropriate first step in T.B.’s

resuscitation?

hypoxic pulmonary arrest.

lation (VF), and he remains pulseless. Which is the

most appropriate management of T.B.’s VF arrest?

at 120 J from a biphasic defibrillator.

mg.

T.B.’s rhythm changes from VF to pulseless electri-

cal activity (PEA) on the monitor. Which is the most

appropriate management of T.B.’s PEA arrest?

at 120 J from a biphasic defibrillator.

causes of cardiac arrest.

lowed by an infusion at 1 mg/minute.