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ALSMCQ ECG

A 64-year-old man presented to the Emergency Department with epigastric pain and vomiting. He does not have fever, and he is haemodynamically stable with good saturation on room air. The CT abdomen evidences gallstone pancreatitis. However, on arrival to the ward, the nurse finds an ECG that the surgical team has not looked at (image below), with a Troponin result of 18. Which of the following options is/are CORRECT in the management of this patient?:

a) Call "Cardiac Arrest" for help: TRUE/FALSE.

b) Repeat ECG: TRUE/FALSE.

c) Start ACS (Acute Coronary Syndrome) treatment with aspirin, clopidogrel and atorvastatin: TRUE/FALSE.

d) T wave inversion can be seen in Pancreatitis and a negative troponin rules out ACS: TRUE/FALSE.

ALS COVID-19

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

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.

ALS CPR

ALSMCQ CPR

A 62 year - old man is receiving CPR due to an in - hospital cardiac arrest. You attend the cardiac arrest call and observe that the initial rhythm is pulseless electrical activity (PEA). According to ALS guidelines, which is the single most appropriate step in the management?:

a) Give amiodarone 300 mg, IV after the third shock if still in cardiac arrest: TRUE/FALSE

b) Give adrenaline 1 mg, IV, every 3 to 5 minutes: TRUE/FALSE

c) Chest compressions should be performed at 80 - 100 per minute: TRUE/FALSE

d) Atropine 600 mg, IV should be given: TRUE/FALSE

Advanced CPR

Regarding the European guidelines of advanced cardiopulmonar resuscitation. Which of the following statements is/are CORRECT?:

a) Adrenaline should be given immedately when the rhythm is non shockable: TRUE/FALSE.
b) Endotracheal intubation must be performed as soon as possible during the first minute: TRUE/FALSE.
c) Administer adrenaline after the third shock: TRUE/FALSE.
d) Atropine is indicated if there is no response after the third shock: TRUE/FALSE.