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.

Airway Management

You are called to assist with the emergency care of a 45 year-old gentleman who underwent an urgent surgical tracheostomy two days previously for airway obstruction due to laryngeal cancer. The tracheostomy was performed because of a failed intubation performed by an experienced anaesthetist. On your arrival, the patient had a respiratory rate of 35 breaths per minute, a see-saw respiratory pattern and SaO2 of 86% on FiO2 0.5. Which is/are the best management option/s?:
a) Deflate the cuff of the tracheostomy and reposition the tracheostomy tube: TRUE/FALSE.
b) Provide oxygen via facemask and via tracheostomy tube: TRUE/FALSE.
c) Assess tracheostomy patency removing the inner tube: TRUE/FALSE.
d) Remove the tracheostomy tube and re – intubate in a standard fashion: TRUE/FALSE.

ALS new myocardial infarction definition

The term acute myocardial infarction should be used when there is acute myocardial injury with clinical evidence of acute myocardial ischaemia and with detection of a rise and/or fall of cTn (Troponin) values with at least one value above the 99th percentile URL and any of the following:

    a)  New ischaemic ECG changes: TRUE / FALSE.
    b) Development of pathological Q waves: TRUE / FALSE.
    c) Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality: TRUE / FALSE.
    d) Identification of a coronary thrombus: TRUE / FALSE.

European Heart Journal, ehy462,

ALS death

In the diagnosis of death:

A) After a cardiorespiratory arrest, death can be diagnosed without attempting to auscultate heart sounds: TRUE / FALSE.

B) Irreversible cardiorespiratory arrest can be concluded after a minimum of 5 minutes of observation: TRUE / FALSE.

C) CPR should never be started in recognition of life extinct (ROLE) situations: TRUE / FALSE.

D) Brainstem death testing should be performed with core temperature greater than 34ºC and potassium > 3 mmol/l: TRUE / FALSE.

ALS Capacity

A North East Ambulance Service attends an emergency call of a 95 year – old lady complaining of chest pain. On arrival to the house the patient is in bed, awake, pale with HR 30 bpm, RR 15 bpm and BP 67/46 mmHg. She says that she was a nurse, knows about DNACPR (do not attempt cardiopulmonary resuscitation) and would like not to be taken to hospital or being resuscitated. You wonder if she has capacity. To have capacity to take a healthcare decision, a patient must be able to:

A. Understand information relevant to the decision being made: TRUE / FALSE.

B. Score 12 or above on the Glasgow Coma Scale or 25 or above on the mini mental state exam: TRUE / FALSE.

C. Communicate their decisions either verbally or non – verbally: TRUE / FALSE.

D. Depend on family for Next of Kin to make the decision on their behalf: TRUE / FALSE.