267.3 🩺 內科專科考前版

267.3.0.1 1⃣ TTM2 Trial Implications

  • 33°C vs 36°C — no mortality difference
  • Many institutions now use 36°C or fever avoidance only
  • Maintain normothermia (avoid > 37.5°C)
  • Practical implementation considerations (resource use)

267.3.0.2 2⃣ Epinephrine Timing in Cardiac Arrest

  • Earlier epinephrine (within 10 min of arrest) improves outcomes
  • IV/IO route preferred
  • Continue every 3-5 minutes during arrest

267.3.0.3 3⃣ ECPR Patient Selection

  • Initial shockable rhythm
  • Witnessed arrest
  • Bystander CPR
  • Age < 65-70 (variable institutional)
  • Limited comorbidities
  • Reversible cause likely

267.3.0.4 4⃣ Post-Arrest Coronary Angiography Decision

  • STEMI on post-arrest ECG: clear indication
  • Without ST elevation: case-by-case
  • High suspicion CAD: angiography reasonable
  • Comatose state + reversible cause possibility

267.3.0.5 5⃣ Neurologic Prognostication Pitfalls

  • Don’t withdraw care too early
  • TTM affects clinical exam (sedation, paralysis)
  • Wait ≥ 72 hours after rewarming
  • Multimodal assessment essential
  • Family discussion + shared decision-making

267.3.0.6 6⃣ Perimortem Cesarean

  • Within 4-5 minutes of arrest in pregnant patient with viable fetus
  • Benefits both mother + fetus (decompression of vena cava improves CPR)
  • Cardio + OB collaboration

267.3.0.7 7⃣ ROSC Definition

  • Return of spontaneous circulation
  • Palpable pulse + spontaneous rhythm
  • Distinguish from organized rhythm without pulse (PEA)

267.3.0.8 8⃣ End-Tidal CO2 During CPR

  • ETCO2 monitoring during cardiac arrest
  • < 10 mmHg = poor quality CPR or failure of ROSC

  • 35-45 mmHg = effective CPR + good prognosis

  • Important quality measure

267.3.0.9 9⃣ 健保 / Taiwan

  • 健保 ACLS + post-arrest care covered
  • ECPR available in specialized centers
  • AED widely deployed in public areas
  • Community CPR training programs (Taiwan Heart Foundation, others)

267.3.0.10 10. Future + Innovations

  • ECPR expansion to more centers + improving outcomes
  • AI for cardiac arrest prediction (in-hospital especially)
  • Targeted temperature management refinement
  • Brain MRI biomarkers for prognostication
  • Drone AED delivery in remote areas
  • Smartphone-based dispatcher-assisted CPR