Category: ALSMCQ PILLS

In acute severe asthma as a cause of cardiac arrest:
a) The risk of cardiac arrest is minimised if hypercarbia is avoided.
b) Bronchospasm responds better when oxygen titrated to 88 – 92%.
c) A PaCO2 of 3.4 kPa should alert us that the patient is becoming exhausted.
d) Treatment with magnesium sulfate 2 g (8 mmol) is indicated in life threatening asthma.

You are called urgently by the nurses from the respiratory ward.  A patient with a previous stroke who has a tracheostomy has suddenly desaturated.  As you attend, you notice the tracheostomy appears to be several centimetres out from where it should sit.  The nurses are administering oxygen both via the face and via the tracheostomy.  You try to pass a suction catheter but does not progress.  The patient is continuing to desaturate, so you remove the tracheostomy.  The patient is not breathing.  You call the cardiac arrest team and meanwhile, which is the most appropriate step?:
a) Ventilate via an LMA applied to the tracheostomy stoma.
b) Reinsert the tracheostomy tube an ventilate through it.
c) Pass an introducer (bougie) through the tracheostomy stoma and insert a 6.0 cuffed endotracheal tube over the bougie.
d) Sedate and proceed with standard endotracheal intubation.

With reference to the rhythm strip:

a) Ventricular rate is between 60 – 80 bpm.
b) The rhythm is compatible with complete heart block.
c) External pacing may be indicated.
d) Amiodarone 300 mg IV should be administered.