You are working as a double Paramedic ambulance crew, you receive a call to a 64-year-old male, not conscious, not breathing, CPR being instructed. The address is 7 minutes away. You start making your way to the address. On route, control radio to update that CPR is in progress, a back-up vehicle is around 20 minutes away.

As you pull up to the address, you see a member of the public frantically waving their arms at you. You exit the Ambulance and grab all the kit you will need for the ALS.

You are shown into the living room where the patient is laying on the floor in cardiac arrest, a woman is doing CPR. It is explained that the patient has a significant cardiac history, with previous MI and stents, he had a sudden onset of chest pain before collapsing this evening.

Your colleague sets down the kit and takes over from the chest compressions. What is the first important action you do?

You attach the defibrillator and this is the rhythm you see. What do you do?

You tell everyone to stand clear, then you charge up the defibrillator and deliver the first shock. Your colleague gets back on the chest. You’re using a bag valve mask but are finding it very difficult to maintain a good seal or ventilation. Within the shockable algorithm of an ALS scenario, what could be your best next action?

You successfully secure the airway with a more advanced airway adjunct as per your clinical choice. You are coming up to your second rhythm analysis. This is what you see, what is the name of this rhythm?

You ask everyone to stand clear again and deliver the second shock. Your colleague is looking tired so you swap with them. You take over chest compressions and your colleague starts the next task. Ideally within the context of an ALS scenario where the airway was secure and 2 shocks had been delivered, what would the next action be in order to follow the ALS algorithm?

Your colleague gains IV access, and it is time for another rhythm check. The rhythm is still VF. Your colleague shouts clear and delivers the third shock. They take over the CPR. Within the ALS algorithm, what are your next actions following the third shock?

What dose of Amiodarone is given in this scenario context?

You administer the drugs and now start working through the 4H’s and T’s. In the context of the scenario and given the patients’ history, what is the likely reversible cause of the arrest?

You come to the end of the 3rd cycle and again VF is on the screen, so you deliver the fourth shock. As you do that, your back-up has arrived as you hear voices calling through the front door. A Para-Tech crew has come to back you up. Your colleague gives a quick handover of the situation as you are continuing chest compressions. You come to the end of the cycle and check the rhythm.

You see this with a pulse, what does this indicate?

You quickly start to implement your post ROSC procedures and gain obs on the patient. You conduct a 12 lead and this is what it shows. What does this indicate that the patient has had?

You complete your post ROSC protocols and move the patient into the ambulance ready for transport. All observations are maintaining. Given the suitability of the patient with a PPCI centre nearby, where would you ideally take the patient, circumstances allowing?