Tue28September1204PM 4

You are called to assess an unwell patient on the gastroenterology ward. The patient is a 69-year-old farmer who was admitted with melaena from a suspected upper gastrointestinal bleed.

When you review him, he is peri-arrest with the following vital signs:

HR 140/min

BP 70/40 mmHg

SO2 unrecordable

Temperature 36°C

Capillary refill time 5 seconds

You are looking through his notes when the nurse calls you back urgently as the patient is no longer responding to her. You are unable to palpate a femoral or carotid pulse, the cardiac monitor is showing sinus tachycardia of 140/min.

Which of the following is correct first line of management?

(Please select 1 option)

DC cardioversion at 200 J

Call intensive care for admission

Request blood transfusion

DC cardioversion at 100 J

Commence chest compressions Correct

Explanation

This man was peri-arrest when initially reviewed. However, he subsequently proceeds to go into full cardiac arrest. There is no palpable pulse, thus confirming cardiac arrest; although there is electrical activity on the monitor the patient has arrested and so this is pulseless electrical activity.

When at the bedside of an unwell patient it may be easy to overlook this and to be tempted to treat the rhythm on the monitor and not the patient.

Reference:

Resuscitation Council (UK). Adult advanced life support.

Answer Statistics

1

3%

2

1%

3

6%

4

2%

5

91%

Times answered: 280