Pharmacology
This was previously featured in an exam
This was previously featured in an exam
Cardiovascular
Question 122 of 134
A 65 year old patient who presented to ED with chest pain suddenly collapses in the waiting room. He is not breathing and has no pulse and you commence chest compressions after calling for the resuscitation team. Monitoring detects ventricular fibrillation. After three shocks, there is still no pulse. You ask a colleague to administer intravenous adrenaline. What dose of adrenaline should be given:
Answer:
For a shockable rhythm, IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be given after 3 shocks and every 3 - 5 minutes/after alternate shocks thereafter. For a non-shockable rhythm IV adrenaline 1 mg should be given as soon as IV access is achieved and then given every 3 - 5 minutes.Life Support Algorithms
Pharmacology / Cardiovascular
Last Updated: 30th April 2023
Basic Life Support
- For chest compressions in adult basic life support the heel of one hand should be placed over the middle of the lower half of the patient's sternum with the other hand on top.
- The sternum should be depressed to a depth of 5 - 6 cm.
- Chest compressions should be performed at a rate of 100 - 120 per minute.
- Thirty compressions should be given before two breaths and that ratio continued (30:2).
- The person giving CPR should be changed every 2 minutes if possible to avoid exhaustion and poor quality chest compressions.
- Interruptions should be minimised (pauses should be < 5 seconds).
Advanced Life Support
- In adult advanced life support, basic life support should continue whilst the defibrillator pads are attached and the airway managed.
- The pads should be positioned one to the right of the upper sternum below the clavicle and the other in the left midaxillary line in the 5th intercostal space.
- Chest compressions should be paused briefly (< 5 secs) to assess the rhythm and then continued as the defibrillator charges if a shockable rhythm is identified or continued for a further two whole minutes if a non-shockable rhythm is identified.
- When delivering a shock, everybody should be clear of the patient (and any GTN patches and oxygen sources removed).
- Once the shock has been delivered, compressions should resume immediately and continue for a further two minutes before checking the rhythm again or feeling for a pulse.
Shockable Rhythm (ventricular fibrillation or pulseless ventricular tachycardia)
- IV adrenaline 1 mg (10 mL of 1:10,000 solution) should be given after 3 shocks and every 3 - 5 minutes/after alternate shocks thereafter.
- IV amiodarone 300 mg should be given after 3 shocks. A further dose of IV amiodarone 150 mg may be considered after a total of five defibrillation attempts. Lidocaine (1 mg kg<sup>-1</sup>) may be used as an alternative if amiodarone is not available but may not be given if amiodarone has been given already.
Non-shockable Rhythm (asystole or pulseless electrical activity)
- IV adrenaline 1 mg should be given as soon as IV access is achieved and then given every 3 - 5 minutes thereafter.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
