You working as a double Paramedic crew on a day shift. You just finish your meal break when you are allocated to a reported agonal/ineffective breathing at a local food spot. The address is only 5 minutes away. As you are responding, control updates you that there is a CCP backing you up with an ETA of 20 minutes.
You arrive on scene a see a group of people huddled around the front of the restaurant. You grab your equipment and make your way through the crowd. On the floor your see a 20-ish year-old female with bystander CPR ongoing. The patient is not responding to CPR and looks pale in the face. You lean down and check airway, which looks clear, and confirm there is no breathing or pulse palpable.
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You get the bystanders to step back while you take over chest compressions and charge the defib. Your colleague starts taking out equipment and asks if anyone saw what happened, to which no one knows. You defibrillate the patient and look to ventilate the patient while your colleague takes over compressions. You get no air movement. You investigate the airway again and can’t see anything obvious, but you find it strange there is no movement whatsoever.
What actions can you do to further investigate and gain air entry
Looking into the airway, you see a grape lodged in the trachea. You grip your forceps and manage to remove it intact. You can see nothing else blocking the airway. You attempt another ventilation of the patient and now have air entry, but not as best you’d like. You attempt the airway manoeuvres and stepwise approach with an NPA and OPA. These still fail to gain good ventilation. What is the next step in the stepwise airway approach
You place an SGA and now have good ventilations. You quickly auscultate the chest and hear equal bilateral air entry. Is wave-form capnography recommended where an SGA has been placed
You are at the next cycle of assessment and look at the defib screen. You are presented with this rhythm. What is it and what do you do
You administer a second shock to the patient. You swap with your colleague and continue chest compressions while they look to gain IV access. With an SGA in place, can continuous chest compressions to ventilations be done
Your colleague has gained IV access and starts preparing medications. Under the shockable algorithm, when is Adrenaline 1:10000 and Amiodarone indicated
You approach your next rhythm check and see an NSR rhythm on screen. You palpate and feel a pulse. You confirm you have a ROSC with the patient and start your ROSC care. Your colleague maintains ventilation of the patient, while you assess and take observations. Working through; there’s no catastrophic haemorrhage, airway is managed with the SGA, you assess breathing through FLAPS and find no deficits. SPO2 maintains at 96%, capnography at 5.1 kPa. On circulation, heart rate is 94 bpm, blood pressure is 64/38. In a ROSC patient, what systolic blood pressure should you aim for
You administer fluids but have no increase to the systolic. What medication can be considered in small doses to support circulation if fluids fail to increase blood pressure
What is the initial dose of Adrenaline 1:10000 in this circumstance
Following fluids and Adrenaline 1:10000, the systolic is now 105 mmHg. Your further observations, assessments, and 12 lead ECG are all within normal parameters. You start to extricate the patient to the Ambulance, ready for transport to the ED. In the context of this scenario, what was the reversible cause