Category: Cardiac Arrest in Special Circumstances

ALS COVID-19

Posted by on in ALSMCQ PILLS, Cardiac Arrest in Special Circumstances

A 64-year-old woman is admitted to Intensive Care with acute respiratory failure due to coronavirus disease 2019 (COVID-19). She is severely hypoxaemic (O2 Saturation 67%) and requires intubation and mechanical ventilation. She is not considered for ECMO (extracorporeal membrane oxygenation) and two hours after proning the patient suffers a cardiac arrest. Which of the following statements are CORRECT regarding cardiopulmonar resuscitation in prone position?:

a) Chest compressions can be started by compressing the spine in between the scapulae aiming for a diastolic pressure of 35 mmHg on the arterial line: TRUE/FALSE.

b) If the cardiac arrest rhythm is shockable, attempt defibrillation by placing the defibrillator pads in a bi-axillary position: TRUE/FALSE.

c) If initial attempts at resuscitation are unsuccessful turn the patient supine to facilitate resuscitation: TRUE/FALSE.

d) Disconect the ventilator and start bag ventilation at 10 breaths per minute: TRUE/FALSE.

ALS COVID-19

Posted by on in 6. ALS Algorithms, Cardiac Arrest in Special Circumstances, Content

A 46 year old man presents to the Emergency Department with fever and shortness of breath. He is immediately isolated suspecting coronavirus disease 2019 (COVID-19) infection due to a contact with his wife who was tested positive for COVID-19 in the previous week. On examination he is is tachypnoeic (46 bpm), tachycardic (130 bpm), hypotensive (84/32 mmHg), hypoxaemic (O2 Saturation 77%) temperature of 39ºC and bilateral infiltrates in the chest XR. During the assessment the patient deteriorates and a cardiac arrest call is placed in absence of pulse. Which of the following statements are CORRECT regarding cardiopulmonar resuscitation?:

a) Chest compressions should be started immediately only if full advanced personal protective equipment is worn: TRUE/FALSE.

b) Avoid mouth-to-mouth ventilation but you can use until the resuscitation team arrives a pocket mask if available: TRUE/FALSE.

c) Bag - mask ventilation should be performed immediately once the hypoxic cardiac arrest can be reversed: TRUE/FALSE.

d) When patient returns to spontaneous circulation keep the Yankauer suction tube placed under the patient’s pillow for further assistance: TRUE/FALSE.

Local anaesthetic toxicity in ALS

Posted by on in Cardiac Arrest in Special Circumstances, Content

Regarding the management of severe local anaesthetic toxicity for a 70 Kg patient, which of the following are correct?.

a) Immediately give an initial intravenous bolus injection of 20% lipid emulsion 100 ml over 1 min.

b) Immediately start and intravenous infusion of 20% lipid emulsion at 1000 ml/h.

c) After 5 min, give a maximum of two repeat boluses of 200 ml.

d) Afer 5 min, continue infusion at 500 ml/h but double rate to 1000 ml/h if toxicity persists.

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