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ALS MCQ – Carbon Monoxide Suicide Attempt

A 20 year – old man is brought to hospital having been found in a running car in shut garage.  On arrival he is ataxic and listless with a GCS of 11.  Haemodynamically stable with a RR of 30 bpm and SaO2 99%.  Arterial blood gas showed: PaO2 40 kPa (300 mmHg), PaCO2 3.6 kPa (27 mmHg), carboxyhaemoglobin 22%, lactate 11 (99 mg/dl).  Which of the following statements is/are correct?:
a) The patient has moderate carbon monoxide poisoning.
b) Treatment with hydroxocobalamin can interfere with the measurement of carboxyhemoglobin.
c) Raised lactate in this context is non – specific  of inhalational injury.
d) Carboxyhaemoglobin levels in this patient are an indication for hyperbaric therapy.

Pretest ALS type MCQ

Regarding pulseless electrical activity (PEA):

a) Is an infrequent rhythm first monitored in a cardiac arrest.
b) Is defined by evidence of ventricular activity on the ECG that would normally be associated with a pulse.
c) Can be treated by administration of 300 mg amiodarone IV.
d) Is a common cardiac arrest rhythm in patients with severe haemorrhage.

Resuscitation

During resuscitation in a cardiac arrest?
a) Ventricular fibrillation is the most common initial rhythm identified.
b) Ventricular fibrillation is a positive predictor of survival.
c) To restore myocardial perfusion is the primary goal in cardiopulmonar resuscitation.
d) The initiation of thrombolytic therapy in the prehospital setting improves patient outcome.

Defibrillation

Defibrillation during cardiopulmonar resuscitation should be performed:

a) It should be delayed until the patient´s core temperature is over 30ºC:

b) After each shock a 10 – seconds pulse check should be done:

c) Adrenaline must be given after the third shock for refractory VT or VF:

d) It should be done after 2 minutes of good – quality CPR:

Tricyclic Antidepressant Intoxication.

A 48 year – old woman is brought by ambulance to the Emergency Department after 45 minutes of ingestion 58 tablets of Amitryptiline.  Her GCS is 14; BP 100/48 mmHg, HR 54, RR 22.  There are not arrhythmias but in the ECG can be observed a prolonged QT interval (460 ms). Her blood gas reveals the following results:

pH: 7.36
PaO2 12.5 kPa (93.7 mmHg)
PaCO2 3.5 kPa (26.2 mmHg)
CO3H 18 mmol/l
Lactate 4.9 mmol/l (88.2 mg/dl).
Na 142 mmol/l
K 4.4 mmol/l
Cl 102 mmol/l
Glucose: 5.4 mmol/l (97 mg/dl)
Salicylates and Paracetamol: Undetectable.
Which of the following statements are correct regarding this intoxication?: