Pharmacology
Cardiovascular
Question 52 of 180
You are reviewing a patient who presented with shortness of breath. The patient suddenly loses consciousness. You detect no breath sounds or pulse. You alert the resuscitation team and commence chest compressions. The monitoring is connected and the rhythm detected shown below. What is your teams next immediate action:
ECG. Image by Rodhullandemu / Public domain
Answer:
The ECG shows normal sinus rhythm and thus this is pulseless electrical activity (PEA), a non-shockable rhythm. For a non-shockable rhythm adrenaline 1 mg IV should be given as soon as intravenous access is achieved and then given every 3 - 5 minutes/after alternate shocks thereafter.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 |
