Clinical Cases in Paramedicine. Группа авторов

      1 Describe your primary survey for this patient.Danger: No danger.Response: None.Circulation: No pulse, commence CPR and remove any clothing on patient’s thorax area and place the defibrillation pads and analyse rhythm, shock if advised.Airway: vomit is present, requires suctioning that clears airway.Breathing: No breaths.

      2 Describe how you would manage your crew and others on scene. What roles would you allocate and would an early sit rep be of benefit?As lead paramedic you should allocate roles and ensure they are maintained. As airway clinician you should assist with removal of clothing and placement of the defibrillation pads onto the patient’s chest to ensure quick automatic analysis of the rhythm. The son is performing quality compressions, so asking him to assist and continue would be appropriate if he is willing. Compressions can then be managed by your partner.The airway then needs to be cleared with suctioning and a correctly sized OPA placed (describe your sizing technique). Then you need to ensure the ratio of 30 compressions to every 2 breaths is maintained and the rate is between 100 and 120 bpm, with appropriate compression depth (1/3 of chest wall). Rhythm checks completed every 2 minutes.An early sit rep is vital in any high‐acuity case. In this case a request for another crew to assist with resuscitation would be appropriate, as would a request for an intensive care paramedic.

      1 Discuss other interventions that could be considered after 6 minutes.Other interventions include gaining IV or IO access and adrenaline administration (after second unsuccessful shock) every 3–5 minutes. The placement of an advanced airway should not interrupt CPR, with waveform capnography being considered.

      2 List the reversible causes of cardiac arrests. Taking into account the history, what is the reversible cause that is most likely to be causing the patient’s condition and what additional treatment could be considered? (Think of a higher scope of practice.)Cardiac arrest caused by hyperkalemia is most likely. Other reversible causes (see Table 2.4) include a build‐up of potassium, which can cause suppression of electrical activity of the heart and can cause the heart to stop beating. This patient has renal failure and has missed his dialysis appointments, indicating that this is the likely cause. To treat a suspected hyperkalemia we need to shift the potassium back into the cell and protect the myocardium. This is achieved by administering calcium gluconate, which will stabilise the myocardium. Sodium bicarbonate 8.4% should be considered as a buffer to treat the metabolic acidosis. These interventions often require the presence of critical care paramedics, so early identification and activation are vital and it helps to think ahead.

      1 Australian and New Zealand Committee on Resuscitation (2016) ANZCOR Guideline 6 – Compressions. https://resus.org.au/guidelines/ (accessed 8 December 2019).

      2 Australian and New Zealand Committee on Resuscitation (2016) ANZCOR guideline 8 – Cardiopulmonary resuscitation. ANZCOR. https://www.hpw.qld.gov.au/__data/assets/pdf_file/0010/5203/anzcorguideline8cprjan16.pdf (accessed 30 June 2020).

      3  Australian and New Zealand Committee on Resuscitation (2017) ANZCOR Guideline 11.2 – Protocols for adult advanced life support. https://www.nzrc.org.nz/assets/Guidelines/Adult‐ALS/ANZCOR‐Guideline‐11.2‐Protocols‐June17.pdf (accessed 30 June 2020).

      4 Brugada, J., Katritsis, D.G., Arbelo, E. et al. (2020) 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. European Heart Journal, 41(5): 655–720. doi: 10.1093/eurheartj/ehz467

      5 Burns, E. (2019) ECG findings in massive pericardial effusion. Life in the Fast Lane, 16 March. https://litfl.com/ecg‐findings‐in‐massive‐pericardial‐effusion/ (accessed 30 June 2020).

      6 Burns, E. (2019) Pericarditis. Life in the Fast Lane, 16 March. https://litfl.com/pericarditis‐ecg‐library/