Sun31October0735PM 8

A 73-year-old man is brought to the Emergency department in cardiac arrest. He was found by his carer unconscious on the floor.

On arrival of the paramedics he was in VF and received two shocks prior to arriving at hospital. He is intubated and has good IV access.

While in the Emergency department he has had a further five shocks at the recommended energy and the appropriate doses of adrenaline and amiodarone but despite this he remains in VF.

As part of the cardiac arrest team you are called to help. You look through his medications and find he is on bendroflumethiazide.

Regarding the management of this patient's cardiac arrest, which is the next most appropriate management option?

(Please select 1 option)

Magnesium sulphate IV This is the correct answer

Lidocaine IV

Increase dose of adrenaline

Increase shock energy

Repeat dose of amiodarone, at increased dose Incorrect answer selected

Explanation

Refractory VF is, of course, a worrying sign in a cardiac arrest situation.

It is worth considering other management options if repeated shocks are ineffective. Also it is always worth repeatedly reviewing the "4 Hs and 4 Ts" for any possible reversible causes.

Magnesium sulphate IV is recommended for the treatment of refractory VF, if there is anything to suggest the patient may be hypomagnesaemic (such as on medications which might cause this, that is, thiazides).

There is no indication for increasing doses of adrenaline or amiodarone, or increasing shock energy.

Amiodarone can be given again but this should be at the reduced dose of 150 mg.

Lidocaine is only recommended if amiodarone is unavailable, and/or has not already been given.

Therefore the most appropriate response here is magnesium sulphate IV.

Answer Statistics

1

58%

2

31%

3

2%

4

5%

5

7%

Times answered: 278