Sun31October0735PM 17

A 60-year-old female patient was brought to the emergency department by paramedics following a witnessed collapse at home.

When the paramedics arrived there was no response from the patient, no pulse and no recordable blood pressure. On arrival at the Emergency department her GCS was 3/15. She had been intubated by the paramedics. She had IV access.

A defibrillator was attached and she was having chest compressions. She was in VF and had had two DC shocks by the crew, at appropriate energy levels.

As she was transferred to the Emergency department trolley, the second cycle had completed. Chest compressions were halted, no pulse was palpable and VF was confirmed on the monitor. A third shock was delivered to the patient.

What is the most appropriate immediate next action?

(Please select 1 option)

Give adrenaline 1 mg before the chest compressions have restarted

Give 300 mg IV amiodarone

Give adrenaline 1 mg after the chest compressions have restarted Correct

Medications are not recommended at this point in advanced life support

Give adrenaline after the next assessment of rhythm

Explanation

The Resuscitation Council (UK) guidelines on Adult Advanced Life Support emphasise the importance of minimal interruption to chest compressions. This follows an increasing body of evidence that minimal interruption of chest compressions is associated with improved outcomes.

The guidelines recommend the first dose of adrenaline (1 mg) after the third shock, but after chest compressions have restarted immediately.

This differs from the 2005 guidelines which recommended administering adrenaline immediately after the third shock. This was considered to introduce an extra delay in chest compressions. Although this seems a minor point, it illustrates one of the main changes to the new guidelines that chest compressions should be interrupted for as short a time as possible.

1 mg of adrenaline should be given after the third shock.

Although 300 mg amiodarone should be given after the third shock, it should be after adrenaline has been administered.

Answer Statistics

1

4%

2

34%

3

59%

4

2%

5

3%

Times answered: 283