QUESTION NO 2 : List of options: Adrenaline (1:10,000), 1mg i.v Adrenaline (1:1000), 500 micrograms i.m Amiodarone, 300mg i.v Amiodarone, 900mg i.v Atropine, 3mg i.v DC cardioversion (100J) DC cardioversion (150J) Magnesium Sulphate, 8mmol i.v Precordial thump Withdraw active treatment Please select the most appropriate next step in the resuscitation of the following patients in cardiac arrest, according to the latest advanced life support algorithm(s) provided by the UK resuscitation council. You may choose each option once, more than once or not at all. A) A 50 year old man who is still in ventricular fibrillation having received two minutes of chest compression after his second DC cardio version attempt                      ---Please Select--- Adrenaline (1:10,000), 1mg i.v Adrenaline (1:1000), 500 micrograms i.m Amiodarone, 300mg i.v Amiodarone, 900mg i.v Atropine, 3mg i.v DC cardioversion (100J) DC cardioversion (150J) Magnesium Sulphate, 8mmol i.v Precordial thump Withdraw active treatment    B) A cardiologist visits a 65 year old man is in the coronary care unit after a myocardial infarction the previous day. Just as he was about to leave the patient, the patient collapses. His cardiac monitor shows a broad complex tachycardia and no pulse was palpable. What is the first thing the cardiologist should do for this patient?                      ---Please Select--- Adrenaline (1:10,000), 1mg i.v Adrenaline (1:1000), 500 micrograms i.m Amiodarone, 300mg i.v Amiodarone, 900mg i.v Atropine, 3mg i.v DC cardioversion (100J) DC cardioversion (150J) Magnesium Sulphate, 8mmol i.v Precordial thump Withdraw active treatment    C) A patient with refractory ventricular fibrillation at the end of two minutes of chest compressions after the third DC cardio version attempt                      ---Please Select--- Adrenaline (1:10,000), 1mg i.v Adrenaline (1:1000), 500 micrograms i.m Amiodarone, 300mg i.v Amiodarone, 900mg i.v Atropine, 3mg i.v DC cardioversion (100J) DC cardioversion (150J) Magnesium Sulphate, 8mmol i.v Precordial thump Withdraw active treatment    D) A 60 year old man suffers a cardiac arrest. He was initially in ventricular fibrillation and received three DC shocks (150J each) and one dose of adrenaline i.v. He was given two minutes of chest compressions after the third shock. The subsequent rhythm assessment identified pulseless electrical activity at a rate of 40bpm.                      ---Please Select--- Adrenaline (1:10,000), 1mg i.v Adrenaline (1:1000), 500 micrograms i.m Amiodarone, 300mg i.v Amiodarone, 900mg i.v Atropine, 3mg i.v DC cardioversion (100J) DC cardioversion (150J) Magnesium Sulphate, 8mmol i.v Precordial thump Withdraw active treatment    E) A 16 year old boy presents to the A&E department in cardiac arrest. He is found to have potassium of 2.8. His cardiac rhythm shows a broad complex regular electrical activity, rate > 140 beats per minute with varying amplitudes producing a sinusoidal wave like appearance. He has received five DC shocks and two doses of adrenaline.                      ---Please Select--- Adrenaline (1:10,000), 1mg i.v Adrenaline (1:1000), 500 micrograms i.m Amiodarone, 300mg i.v Amiodarone, 900mg i.v Atropine, 3mg i.v DC cardioversion (100J) DC cardioversion (150J) Magnesium Sulphate, 8mmol i.v Precordial thump Withdraw active treatment    F) A 20 year old woman was brought into the A&E department half an hour ago in cardiac arrest after a major road traffic accident in which she suffered major trauma and significant blood loss. She has been in pulseless electrical activity for the last 20 minutes, having received multiple doses of various medications. The team discuss the next step in her management which is most likely to be....                      ---Please Select--- Adrenaline (1:10,000), 1mg i.v Adrenaline (1:1000), 500 micrograms i.m Amiodarone, 300mg i.v Amiodarone, 900mg i.v Atropine, 3mg i.v DC cardioversion (100J) DC cardioversion (150J) Magnesium Sulphate, 8mmol i.v Precordial thump Withdraw active treatment

Question By Mr. Kasun Wanigasooriya MBCHB, MRCS.