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MK SR INDEX CASES ACUTE CARE > ALS + ETLS > Flashcards

ALS + ETLS Flashcards

1
Q

Define Traumatic Brain Injury

A

Traumatic brain injury is an insult to brain tissue from an external force, leading to temporary or permanent impairment of cognitive, physical and psychosocial functions, with an associated diminished or altered state of consciousness

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2
Q

Pathophysiology of Brain Injury

A 
Primary brain injury – skull #,IC hematoma, contusions,lacerations, DAI etc
Acceleration and deceleration forces
Secondary brain injury
Prevent – Hypoxia
- Hypovolemia
- Hypo/hyperglycemia
? Prevent hyperthermia
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3
Q

Classification of shock

Stage 1 Shock - symptoms /signs

A 
15:LOVE
15% Blood Loss    	  
Slight increase in respiratory rate
Pulse up to 100 bpm
Feeling nervous
Capillary refill under 2 seconds  
Slightly pale
Feeling thirsty
BP normal
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4
Q

Classification of shock

Stage 2 Shock - symptoms /signs

A 
30:LOVE
15%-30% Blood loss		
Raised respiratory rate
Pulse over 100 bpm 
Starting to feel anxious  
Capillary refill at or over 2 seconds
Pale/Cool
Clammy
Dry mouth
Narrowing pulse pressure
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5
Q

Classification of shock

Stage 3 Shock - symptoms /signs

A

40:LOVE

30%-40% Blood Loss
Increased Respiratory rate
Pulse over 120 bpm
Anxiety/agitation
Pale/Cold
Peripheral cyanosis
Diaphoretic (profuse sweating)
BP falling
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6
Q

Classification of shock

Stage 4 Shock - symptoms /signs

A

GAME OVER

>40% Blood Loss
Respiratory distress
Pulse over 140 bpm 
Confused/loss of consciousness  
Moribund appearance
Central cyanosis
Diaphoretic (profuse sweating)
BP less than 70 mmHg systolic
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7
Q

45 yr old man burning rubbish in his back garden sustained burns to arms and chest. Bought in by ambulance (paramedic crew) 1 litre of 0.9% saline running i.v.

A: Clear, O2 mask in situ, screaming in pain
B: RR 28, chest clear, sats 99%. Obvious erythema and blistering/charring to anterior chest
C: HR 128, BP 136/85,
D: AVPU
E: Burns to both arms to elbows, anterior chest wall, under chin with singed hair on fringe/ eyebrows. Burns dressings in situ.

A 
ABCDE
History
BSA
Rule of 9’s
Serial Halving
Depth

Management
Fluids – 24 hours requirements
4ml x %BSA x kg

4 x 20 x 80 = 6,400mls

50% in first 8 hrs (3,200 ml)
Remainder over next 16 hrs
Does not include normal maintenance fluids

Urinary catheter is placed.
What is the aim for urine output?

Urine output - 0.5 – 1ml/kg/hr

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8
Q

Management of Burns

A

Management
Fluids – 24 hours requirements
4ml x %BSA x kg

4 x 20 x 80 = 6,400mls

50% in first 8 hrs (3,200 ml)
Remainder over next 16 hrs
Does not include normal maintenance fluids

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9
Q

Fluid regime in burns - what urine output should be aimed for?

A 
Classification of shock
Immediate management of burns
Fluid regime 
4mls x BSA x weight (kg)
 Urine output - 0.5 – 1ml/kg/hr
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10
Q

What is the Trimodal Death Distribution ?

A

1st peak: seconds to minutes

2nd peak: minutes to several hours

3rd peak: several days to weeks

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11
Q

True or False: ST-segment-elevation myocardial infarction (STEMI): Rarely causes VF.

A

False - During the acute phase, there is a substantial risk of VF.

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12
Q

True or False: ST-segment-elevation myocardial infarction (STEMI): A posterior STEMI will show ST depression in leads V1‒3.

A

True

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13
Q

True or False:ST-segment-elevation myocardial infarction (STEMI): May present with new left bundle branch block (LBBB) on the ECG.

A

True. New LBBB is diagnostic of STEMI.

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14
Q

True or False: When using transcutaneous pacing: Electrical capture typically occurs with a current of 5‒10 amps.

A

False Capture typically occurs with a current of 50‒100 mA (i.e. 100 times less).

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15
Q

True or False: When using transcutaneous pacing: May be unsuccessful in a patient with hyperkalaemia.

A

True. Hyperkalaemia may prevent successful pacing.

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16
Q

True or False: When using transcutaneous pacing: Movement artefact may inhibit the pacemaker.

A

True. If there is lot of movement artefact on the ECG this may be misinterpreted by the pacemaker and inhibit it.

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17
Q

True or False: When using transcutaneous pacing: Electrical capture and generation of a QRS complex ensures return of a pulse.

A

False. A QRS complex does not guarantee myocardial contractility. Absence of a pulse in the presence of good electrical capture constitutes PEA.

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18
Q

True or False: With regard to the ECG: Continuous monitoring via self-adhesive pads is preferable to using ECG electrodes.

A

False. Adhesive defibrillator pads should only be used in an emergency to assess the cardiac rhythm.

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19
Q

True or False: With regard to the ECG: If adhesive electrodes are used for 3-lead monitoring, they should be applied over bone rather than muscle.

A

True. Electrodes should be placed over bone rather than muscle to minimise interference from muscle artefact.

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20
Q

True or False: With regard to the ECG: The normal QRS complex has a duration < 0.12 s.

A

True. The normal QRS complex interval is < 0.12 s (< 3 small squares).

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21
Q

True or False: In drowning: There is immediate entry of water into the victim’s lungs.

A

False. There is initially laryngospasm and breath holding preventing entry of water into the victim’s lungs

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22
Q

True or False: In drowning: Resuscitation should be considered even if the patient has been submersed in water for 5 min.

A

True. Submersion durations of less than 10 min are associated with a very high chance of a good outcome and submersion durations of more than 25 min are associated with a low chance of good outcome.

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23
Q

True or False: In drowning: Q4c: Following submersion, respiratory arrest usually precedes cardiac arrest.

A

True. Cardiac arrest is usually a secondary event following a period of hypoxia.

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24
Q

True or False: In drowning: Prophylactic antibiotic therapy should be given routinely.

A

False. Prophylactic antibiotics have not been shown to be of benefit in preventing chest infection.

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25
Q

True or False: You arrive at the bedside 4 min after the cardiac arrest of a 70 kg woman. An IV line is in place, there is no pulse. The ECG confirms asystole. Two nurses are performing CPR competently. You would recommend: Delivery of a 150 J shock.

A

False. The treatment of asystole does not include defibrillation.

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26
Q

True or False: You arrive at the bedside 4 min after the cardiac arrest of a 70 kg woman. An IV line is in place, there is no pulse. The ECG confirms asystole. Two nurses are performing CPR competently. You would recommend: Sodium bicarbonate 500 mmol IV.

A

False. Routine use not recommended and is associated with a number of significant side-effects.

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27
Q

True or False: You arrive at the bedside 4 min after the cardiac arrest of a 70 kg woman. An IV line is in place, there is no pulse. The ECG confirms asystole. Two nurses are performing CPR competently. You would recommend: Calcium chloride 5 mL 10% solution IV.

A

False. Indicated only for PEA caused by hyperkalaemia, hypocalcaemia and overdose of calcium channel blocking drugs.

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28
Q

True or False: You arrive at the bedside 4 min after the cardiac arrest of a 70 kg woman. An IV line is in place, there is no pulse. The ECG confirms asystole. Two nurses are performing CPR competently. You would recommend: Adrenaline 1 mg IV.

A

True. Adrenaline 1 mg IV should be given as soon as intravascular access is achieved in patients in asystole.

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29
Q

True or False: A 55-year-old man on CCU has a witnessed, monitored VF cardiac arrest. After the 3rd shock he develops sinus rhythm with a pulse and starts to breathe spontaneously. He is given oxygen via a reservoir mask with a flow of 15 L-1. Analysis of blood gas shows: PaO2 22.6 kPa (FiO2 85%). These suggest that oxygenation is appropriate for the inspired concentration.

A

False. The PaO2 should be numerically about 10 less than the inspired concentration. In this case this would be > 60 kPa.

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30
Q

True or False: Pulseless electrical activity (PEA):

Is rarely the first monitored rhythm in a cardiac arrest.

A

False. The first monitored rhythm is VF/pVT in only 20% of cardiac arrests. Therefore, PEA and asystole are relatively more common.

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31
Q

True or False: Pulseless electrical activity (PEA): Is characterised by evidence of ventricular activity on the ECG that would normally be associated with a pulse.

A

True. This is the definition of PEA.

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32
Q

True or False: Pulseless electrical activity (PEA): Should be treated by giving 300 mg amiodarone IV.

A

False. Amiodarone is only indicated in the treatment of cardiac arrest due to VF/pVT.

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33
Q

True or False: Pulseless electrical activity (PEA): Is usually the cardiac arrest rhythm in patients with severe hypovolaemia.

A

True. Hypovolaemia, usually caused by severe haemorrhage, will cause PEA.

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34
Q

True or False: If a DNACPR decision is made with a person who has an implanted cardioverter-defibrillator (ICD) the shock function of the ICD should then be deactivated.

A

False. Some people with ICDs may not want to receive CPR, but would choose to receive treatment from their ICD which would be likely to restore their current clinical situation.

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35
Q

True or False: Adrenaline:

Has purely alpha-adrenergic effects.

A

False. Adrenaline has both alpha and beta-adrenergic effects.

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36
Q

True or False: Adrenaline: Is not associated with any long-term benefit to patients when given during a cardiac arrest.

A

True. Although there is no evidence of long-term benefit from the use of adrenaline, the improved short-term survival documented in some studies warrants its continued use.

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37
Q

True or False: Adrenaline: Increases systemic vasoconstriction.

A

True. This is due to the alpha-adrenergic effect of adrenaline.

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38
Q

True or False: Adrenaline: Improves coronary and cerebral perfusion pressures during CPR.

A

True. These are some of the alpha-adrenergic effects.

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39
Q

True or False: When monitoring the cardiac rhythm: Asystole presents as a completely straight line.

A

False. A completely straight line indicates usually that a monitoring lead has become disconnected.

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40
Q

True or False: When monitoring the cardiac rhythm: At a standard paper speed of 25 mm s-1 the ventricular rate is calculated by dividing the number of large squares between consecutive R waves by 60.

A

False. The best way of estimating the heart rate is to count the number of cardiac cycles (R wave to R wave, including fractions) that occur in 6 s (30 large squares) and multiply by 10. This provides an estimate of heart rate, even when the rhythm is irregular.

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41
Q

True or False: When monitoring the cardiac rhythm: A ventricular tachycardia will always require immediate cardioversion.

A

False. Cardioversion is required only if adverse features (e.g. shock, syncope, heart failure).

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42
Q

True or False: When monitoring the cardiac rhythm: A 55-year-old woman presents with a 1 h history of crushing central chest pain, nausea and sweating. Her pulse rate is 38 min-1, BP 75/45 mmHg. The ECG monitor shows sinus bradycardia. You would recommend that:
Atropine 500 mcg IV should be given.

A

True. Atropine is the first line treatment in a bradycardia with adverse features in an attempt to increase heart rate and cardiac output.

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43
Q

True or False: When monitoring the cardiac rhythm: When monitoring the cardiac rhythm: A 55-year-old woman presents with a 1 h history of crushing central chest pain, nausea and sweating. Her pulse rate is 38 min-1, BP 75/45 mmHg. The ECG monitor shows sinus bradycardia. You would recommend that: An adrenaline infusion, 20‒100 mcg min-1, may be required.

A

False. An adrenaline infusion may be required, but the correct rate is 2‒10 mcg min-1 IV.

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44
Q

True or False: When monitoring the cardiac rhythm: When monitoring the cardiac rhythm: A 55-year-old woman presents with a 1 h history of crushing central chest pain, nausea and sweating. Her pulse rate is 38 min-1, BP 75/45 mmHg. The ECG monitor shows sinus bradycardia. You would recommend that: Opioid analgesia is contraindicated.

A

False. Relief of pain is important and IV morphine should be titrated to control symptoms.

45
Q

True or False: When monitoring the cardiac rhythm: When monitoring the cardiac rhythm: A 55-year-old woman presents with a 1 h history of crushing central chest pain, nausea and sweating. Her pulse rate is 38 min-1, BP 75/45 mmHg. The ECG monitor shows sinus bradycardia. You would recommend that: 24% oxygen via a mask should be given until the results of arterial blood gas analysis are known.

A

False. Oxygen by face mask should be given to achieve an oxygen saturation (SpO2) of 94‒98% (88‒92% in the presence of COPD). Initially, this may require more than 24%.

46
Q

True or False: During CPR: If ventilating with high-flow oxygen via an LMA, it must be disconnected and placed at least 1 m away.

A

False. The ventilation bag can be left connected to the tracheal tube or supraglottic airway device. No increase in oxygen concentration occurs in the zone of defibrillation, even with high-flow.

47
Q

True or False: Following successful resuscitation from VF cardiac arrest: All patients should be given as close to 100% oxygen as possible.

A

False. If ROSC is achieved, adjust the inspired oxygen to a target oxygen saturation (SpO2) at 94‒98%.

48
Q

True or False: Following successful resuscitation from VF cardiac arrest: Intubated patient’s lungs should be ventilated to achieve a PaCO2 < 4.5 kPa.

A

False. Ventilation should be adjusted to achieve normocarbia, PaCO2 4.7‒6.0 kPa.

49
Q

True or False: Following successful resuscitation from VF cardiac arrest: Targeted temperature management (TTM) is recommended for adults after in-hospital cardiac arrest who remain unresponsive after ROSC

A

True. The ALS Task Force of ILCOR have made several recommendations following the TTM trial, and 36ºC is becoming the preferred target temperature for post-cardiac arrest temperature control.

50
Q

True or False: Following successful resuscitation from VF cardiac arrest: Absence of both pupillary light and corneal reflexes at 72 h can be used to help predict outcome in comatose patients 72 h after cardiac arrest.

A

True. This is one of the multimodal categories of tests that can be used after 72 h.

51
Q

True or False: Giving 8.4% sodium bicarbonate: May exacerbate an intracellular acidosis.

A

True. It does this by generating CO2 which diffuses intracellular.

52
Q

True or False: Giving 8.4% sodium bicarbonate: Is recommended after 5 min of CPR if ROSC has not been achieved.

A

False. Routine use is not recommended.

53
Q

True or False: Giving 8.4% sodium bicarbonate: Should be considered as a treatment for arrhythmias due to tricyclic antidepressant overdose.

A

True. 50 mmol (50 mL of 8.4% solution) can be given with further doses guided by acid-base status.

54
Q

True or False: Giving 8.4% sodium bicarbonate: Facilitates release of oxygen to the tissues.

A

False. It shifts the oxygen dissociation curve to the left, inhibiting release of oxygen to the tissues.

55
Q

True or False: The correct management of an adult patient in ventricular fibrillation includes: Digoxin 500 mcg IV.

A

False. Digoxin is not indicated in the treatment of VF. It is used in the treatment of atrial fibrillation.

56
Q

True or False: The correct management of an adult patient in ventricular fibrillation includes: Adrenaline, 1 mg IV after every shock.

A

False. Adrenaline is given after the 3rd shock and subsequently after alternate shocks (every 3-5 min).

57
Q

True or False: The correct management of an adult patient in ventricular fibrillation includes: Atropine 3 mg after 2 loops.

A

False. Atropine is not indicated in the treatment of VF.

58
Q

True or False: The correct management of an adult patient in ventricular fibrillation includes: An initial shock energy of at least 150 J.

A

True. This is the correct energy for the first shock. Subsequent shocks can be the same or a higher energy.

59
Q

True or False: Adrenaline 1 mg IV should be given to all patients in cardiac arrest.

A

False. Adrenaline is only given after the 3rd shock in VF. If ROSC is achieved before this adrenaline will not be required.

60
Q

True or False: Lidocaine 100 mg is the treatment of choice for all patients in ventricular tachycardia (VT).

A

False. If the patient has adverse features, then cardioversion will be required. If no adverse features, treatment will depend on the QRS morphology.

61
Q

True or False: Adenosine is effective in the treatment of paroxysmal supraventricular tachycardia.

A

True. This can be tried after vagal manoeuvres if the rhythm is not atrial flutter.

62
Q

True or False: The initial dose of amiodarone for shock refractory ventricular fibrillation is 300 mg IV.

A

True. This is given after the 3rd shock for patients in VF.

63
Q

True or False: In acute severe asthma: Cardiac arrest is secondary to hypercapnia.

A

False. Although the patient may be hypercapnic, cardiac arrest is secondary to hypoxia.

64
Q

True or False: In acute severe asthma: Oxygen should be titrated to achieve an SpO2 of 88-92%.

A

False. Oxygen should be given to achieve an SpO2 of 94-98%. This may need to be high-flow.

65
Q

True or False: In acute severe asthma: A PaCO2 of 5.3 kPa is normal.

A

False. Although this is normal for a non-asthmatic patient, it is one of the indicators that the patient has life-threatening asthma and becoming exhausted. PaCO2 is normally low in an asthma attack due to hyperventilation.

66
Q

True or False: In acute severe asthma: Magnesium sulfate 2 g (8 mmol) IV may produce bronchodilatation.

A

True. Magnesium is a bronchodilator and can be effective in these circumstances.

67
Q

True or False: In a patient with suspected anaphylaxis: Adrenaline 0.5 mg IM is the first line treatment of choice.

A

True. Adrenaline 0.5 mg IM is the first line treatment of choice.

68
Q

True or False: In a patient with suspected anaphylaxis: Steroids must be given early.

A

Steroids are a second line drug and may help prevent or shorten protracted reactions. They have no effect in the acute situation.

69
Q

True or False: In a patient with suspected anaphylaxis: Colloids are preferred to crystalloids for restoring the circulation.

A

False. Hartmann’s solution or 0.9% saline are suitable fluids for initial resuscitation. A large volume of fluid may be needed. Consider colloid infusion as a cause in a patient receiving a colloid at the time of onset of an anaphylactic reaction.

70
Q

True or False: A 65-year-old man with a 2 h history of central chest pain develops a tachyarrhythmia that appears regular with a rate of approximately 180 beats min-1. The following treatment should be given: If his systolic blood pressure is < 90 mmHg, immediate cardioversion should be attempted.

A

True. This patient has an adverse sign, hypotension, and therefore DC shock is indicated.

71
Q

True or False: A 65-year-old man with a 2 h history of central chest pain develops a tachyarrhythmia that appears regular with a rate of approximately 180 beats min-1. The following treatment should be given: If he has no adverse signs, the QRS complex is < 0.12 s and regular, amiodarone 300 mg IV should be given.

A

False. The patient is stable and has a narrow-complex tachycardia. The treatment is vagal manoeuvres and adenosine.

72
Q

True or False: A 65-year-old man with a 2 h history of central chest pain develops a tachyarrhythmia that appears regular with a rate of approximately 180 beats min-1. The following treatment should be given: If he has no adverse signs, the QRS complex is < 0.12 s and regular, adenosine 6 mg IV should be given.

A

True. The patient is stable and has a narrow-complex tachycardia. The treatment is vagal manoeuvres and adenosine.

73
Q

True or False: A 65-year-old man with a 2 h history of central chest pain develops a tachyarrhythmia that appears regular with a rate of approximately 180 beats min-1. The following treatment should be given: If he has no adverse signs, the QRS complex is > 0.12 s and regular, amiodarone 300 mg IV should be given.

A

True. This is a regular, broad-complex tachycardia and the initial treatment is amiodarone.

74
Q

True or False: Severe hyperkalaemia:

A

False. Hyperkalaemia is defined as a plasma potassium concentration > 5.5 mmol L-1 severe hyperkalaemia is > 6.5 mmol L-1.

75
Q

True or False: Severe hyperkalaemia: Causes tall, peaked T waves and ST depression on the ECG.

A

True. These are characteristic ECG changes.

76
Q

True or False: Severe hyperkalaemia: May be caused by renal failure.

A

True. Renal failure (i.e. acute kidney injury or chronic kidney disease) is a common cause of hyperkalaemia.

77
Q

True or False: Severe hyperkalaemia: Can be treated by giving 10 mL 1% calcium chloride IV.

A

False. The correct concentration of calcium chloride is 10%, not 1%.

78
Q

True or False: With regard to decisions about CPR: The only indication for not starting CPR in a patient is the presence of a recorded, valid DNACPR decision.

A

False. There are other reasons for not starting CPR. For example, if it would not restart the heart, CPR should not be attempted.

79
Q

True or False: If a patient lacks capacity to make a decision about CPR their family must be asked to decide whether or not CPR should be attempted.

A

False. If a patient lacks capacity to make decisions, their family should be involved in those decisions. This is to guide the healthcare team on what the patient would have chosen had they not lost capacity. It is important that they do not think that they are entitled to or expected to make decisions.

80
Q

True or False: In second-degree atrioventricular (AV) heart block: There are always more P waves than QRS complexes.

A

True. Second-degree block results in lack of QRS complexes after some P waves.

81
Q

True or False: In second-degree atrioventricular (AV) heart block: The PR interval is always regular.

A

False. There is progressive lengthening of the PR interval in Type I block.

82
Q

True or False: In second-degree atrioventricular (AV) heart block: Immediate treatment for a bradycardia will be required.

A

False. Immediate decisions about treatment of these rhythms will be determined by the effect of the resulting bradycardia on the patient.

83
Q

True or False: In second-degree atrioventricular (AV) heart block: When it is Mobitz type II there is a risk of asystole.

A

True. Mobitz type II is more likely to progress to complete block and asystole.

84
Q

True or False: Higher defibrillation energies may be required in patients whose cardiac arrest has been caused by asthma.

A

True. Hyperinflation increases thoracic impedance. Higher energies should be considered if the first shock fails.

85
Q

True or False: The amplitude of the VF waveform is irrelevant in determining the need for a shock.

A

False. If there is doubt whether the rhythm is asystole or extremely fine VF, do not attempt defibrillation; instead, continue chest compressions and ventilation as continuing high quality CPR may improve the amplitude and frequency of the VF and improve the chance of subsequent successful defibrillation to a perfusing rhythm.

86
Q

True or False: Self-adhesive pads must be placed in the antero-posterior position in a patient with an implantable cardioverter-defibrillator (ICD).

A

False. Pads should be placed at least 10-15 cm from the ICD or alternatively in the antero-posterior position.

87
Q

True or False: If the rhythm changes from asystole to VF, a shock should be given.

A

False. CPR should be continued until the end of the 2 min cycle and then a shock delivered.

88
Q

True or False: In a patient suspected of having an acute coronary syndrome (ACS): A single, normal 12-lead ECG excludes this as a possible diagnosis.

A

False. A single normal 12-lead ECG does not exclude ACS

89
Q

True or False: In a patient suspected of having an acute coronary syndrome (ACS): Troponin values above the normal range always indicate myocardial infarction.

A

False. he release of troponin does not in itself indicate a diagnosis of ACS. Troponin release aids diagnosis and is a marker of risk when the history indicates a high probability of AMI. Troponin may be released in other life-threatening conditions presenting with chest pain, such as pulmonary embolism.

90
Q

True or False: In a patient suspected of having an acute coronary syndrome (ACS): Thrombolysis is contraindicated if the patient has had a surgical procedure within the last month.

A

False. Major surgery within three weeks is an absolute contraindication.

91
Q

True or False: In a patient suspected of having an acute coronary syndrome (ACS): Fibrinolytic therapy is as effective as PPCI.

A

False. Fibrinolytic therapy substantially reduces mortality from AMI when given during the first few hours after the onset of chest pain, but is less effective than PPCI.

92
Q

True or False: A 28-year-old man, known to have asthma has been very wheezy for 6 h and has had no relief from his inhalers. On examination he is breathless at rest, unable to complete sentences and has a respiratory rate of 36 min-1, there is poor air entry and wheeze throughout both lung fields. While breathing oxygen from a reservoir mask (flow 15 L min-1), analysis of an arterial blood sample shows: PaO2 26.6 kPa (FiO2 85%). Oxygenation is lower than predicted from the inspired concentration.

A

True. High-flow oxygen would provide an FiO2 of around 80%. We would expect the PaO2 to be 60-70 kPa.

93
Q

True or False: A 35-year-old lady is on the ward following a cholecystectomy. She complains of abdominal pain and appears pale and sweaty: A normal systolic blood pressure rules out the possibility of shock.

A

False. In shock, the blood pressure may be normal, because compensatory mechanisms increase peripheral resistance in response to reduced cardiac output particularly in the younger patient.

94
Q

True or False: Following successful resuscitation from a cardiac arrest: The patient may be hyperkalaemic.

A

True. Immediately after a cardiac arrest there is typically a period of hyperkalaemia.

95
Q

True or False: Following successful resuscitation from a cardiac arrest: Maintain the patient’s blood glucose between 4.0-8.0 mmol L-1.

A

False. Based on the available data and expert consensus, following ROSC, maintain blood glucose at < 10 mmol L-1 and avoid hypoglycaemia (< 4.0 mmol L-1).

96
Q

True or False: Following successful resuscitation from a cardiac arrest: Cerebral perfusion returns to normal immediately with ROSC.

A

False. Immediately after ROSC, there is a period of cerebral hyperaemia due to impaired autoregulation.

97
Q

True or False: Following successful resuscitation from a cardiac arrest: Seizures occur in > 50% of patients who remain comatose.

A

Seizures occur in about one-third of patients who remain comatose after ROSC.

98
Q

True or False: Immediate general treatment for ACS includes aspirin 300 mg crushed or chewed as soon as possible.

A

True.

99
Q

True or False: VF cab be associated with a spontaneous circulation.

A

False. The rhythm is ventricular fibrillation and not associated with a detectable cardiac output.

100
Q

True or False: In VF a precordial thump may be indicated.

A

A precordial thump has a very low success rate for cardioversion of a shockable rhythm. Its routine use is not recommended. Consider a precordial thump only when it can be used without delay whilst awaiting the arrival of a defibrillator in a monitored VF/pVT arrest.

101
Q

True or False: Defibrillation is the treatment of choice in the pulseless patient with VF.

A

True. Early defibrillation is one of the few interventions that contribute to improved survival from VF.

102
Q

True or False: The QRS complex is < 0.12 s so the rhythm is supraventricular in origin.

A

True. The QRS complex is < 0.12 s (3 small squares) and therefore originates above the ventricles.

103
Q

True or false: The patient has complete heart block with broad complexes which puts them at risk of asystole.

A

True

104
Q

True or False. In complete heart block If the patient is dyspnoeic and hypotensive, systolic blood pressure 80 mmHg, transvenous pacing may be appropriate.

A

True These are adverse signs and if there is no response to drugs, transvenous pacing is appropriate.

105
Q

True or false: In first-degree heart block. Atropine 0.5 mg IV is the initial treatment of this rhythm in a patient with adverse signs.

A

True. Atropine 0.5 mg IV up to a maximum of 3 mg is the initial treatment of a bradycardia in a patient with adverse features.

106
Q

True or false: In first-degree heart block. Adrenaline is contraindicated in the presence of this rhythm.

A

False. Adrenaline may be used if pacing cannot be achieved promptly.

107
Q

True or false: in the presence of a regular broad-complex tachycardia. If the patient is conscious, this rhythm does not require any treatment.

A

False. This is a regular, broad-complex tachycardia, and may progress to VF. Treatment with amiodarone IV will be required.

108
Q

True or false: in the presence of a regular broad-complex tachycardia. In the presence of a systolic blood pressure of 70 mmHg, a synchronised cardioversion is the treatment of choice.

A

True.

109
Q

True or false: in the presence of a regular broad-complex tachycardia. Amiodarone may be indicated.

A

True.

In the absence of adverse features, it may be treated with amiodarone, 300 mg IV over 20-60 min.

MK SR INDEX CASES ACUTE CARE (42 decks)

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