QBank Fortnightly Newsletter Vol: 1, Issue: 9

2. American Heart Association (AHA) guidelines for CPR and ECC 2020

MCQ ID- MD5884| MD5883| MD5881. Pearl ID- 188

Adult Basic and Advanced life support:

•  A sixth link, ‘recovery’ has been added to all 4 chains of survival

IHCA (In-hospital cardiac arrest) chain of survival includes:

1. Early recognition and prevention                    
2. Activation of emergency response
3. High-quality CPR
4. Defibrillator
5. Post cardiac arrest care
6. Recovery

• Double sequential defibrillation not supported

The usefulness of double sequential defibrillation for refractory shockable rhythm has not been established.

• Early administration of epinephrine

With respect to timing, for cardiac arrest with a non-shockable rhythm, it is reasonable to administer epinephrine as soon as feasible.

• Early Initiation of CPR by Lay Rescuers

 AHA recommends that laypersons initiate CPR for presumed cardiac arrest because the risk of harm to the patient is low even if the patient is not in cardiac arrest.

• Real-Time Audiovisual Feedback

It may be reasonable to use audiovisual feedback devices during CPR for real-time optimization of CPR performance.

• Cardiac Arrest in Pregnancy

1. As pregnant patients are more prone to hypoxia, oxygenation and airway management should be prioritized during resuscitation from cardiac arrest in pregnancy.
2. Because of potential interference with maternal resuscitation, fetal monitoring should not be undertaken during cardiac arrest in pregnancy.
3. The AHA recommends targeted temperature management for pregnant women who remain comatose after resuscitation from cardiac arrest.
4. During targeted temperature management of the pregnant patient, it is recommended that the fetus be continuously monitored for bradycardia as a potential complication, and obstetric and neonatal consultation should be sought.

•  IV Access Preferred Over IO

It is reasonable for providers first to attempt establishing IV access for drug administration in cardiac arrest. Intraosseous (IO)access may be considered if attempts at IV access are unsuccessful or not feasible.

• Post–Cardiac Arrest Care and Neuroprognostication

Neuroprognostication should be performed no sooner than 72 hours after return to normothermia, and prognostic decisions should be based on multiple modes of patient assessment. EEG, neurological imaging is introduced as part of post-resuscitation care.

Pediatric Basic and advanced life support

• Cuffed ETTs

It is reasonable to choose cuffed ETTs over uncuffed ETTs for intubating infants and children. When a cuffed ETT is used, attention should be paid to ETT size, position, and cuff inflation pressure (usually <20-25 cm H2O).

• Changes to the Assisted Ventilation Rate: Rescue Breathing

For infants and children with a pulse but an absent or inadequate respiratory effort, it is reasonable to give 1 breath every 2 to 3 seconds (20-30 breaths/min).

• Cricoid Pressure During Intubation

Routine use of cricoid pressure is not recommended during the endotracheal intubation of pediatric patients.

• Emphasis on Early Epinephrine Administration

For pediatric patients in any setting, it is reasonable to administer the initial dose of epinephrine within 5 minutes from the start of chest compressions.

• Corticosteroid Administration

For infants and children with septic shock unresponsive to fluids and requiring vasoactive support, it may be reasonable to consider stress-dose corticosteroids.

• A new algorithm for pediatric tachycardia with a pulse (QRS duration 0.09 sec)

A wide QRS duration of >0.09 second is suggestive of possible ventricular tachycardia.

4. Occluding junctions (tight junction)

MCQ ID- MB9305

According to Robbins and Cotran 10th edition, complexes that mediate the tight junctions are composed of transmembrane proteins including the claudin and tight junction-associated MARVEL protein (TAMP) families. These connect to a host of intracellular adaptor and scaffolding proteins, including the three members of the zonula occludens protein family (ZO-1, ZO-2, ZO-3) and cingulin.