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Subsequent developments

Mr Tanaka’s condition deteriorates and he requires emergency tracheal intubation. This is based on a recent blood gas. When you arrive on scene he has no palpable pulse. What immediate treatments does he need? The patients ABG results are in Essentials. Select one or more options and then select Confirm.
Benjamin Tanaka – a 58-year-old man.
Chest compression only CPR
 
Start CPR with continuous chest compressions at 100 min-1 and 10 ventilations min-1
 
Consider disconnecting ventilator and compressing chest to relieve any gas trapping once CPR started
 
Immediate transfer to ICU
 
Immediate insertion of large bore cannulae into both sides of the chest
 
Give IV hydrocortisone and IV magnesium to treat asthma
 
That’s not quite right.

That’s not quite right. The correct approach in this given circumstance is to start CPR according to ALS guidelines which can be found in chapter 12 of the ALS manual.

If dynamic hyperinflation of the lungs is suspected during CPR, compression of the chest wall and/or a period of apnoea (disconnection of tracheal tube) may relieve gas-trapping. Although this procedure is supported by limited evidence, it is unlikely to be harmful in an otherwise desperate situation.

Ventilation with 100% inspired oxygen during CPR will be necessary, but may be difficult to give because of increased airway resistance caused by asthma. In an intubated patient give chest compressions at 100-120 min-1 and ventilations at 10 min-1.

Dynamic hyperinflation increases transthoracic impedance. In VF, consider higher shock energies for defibrillation if initial defibrillation attempts fail.

That’s not right.

That’s not right. The correct approach in this given circumstance is to start CPR according to ALS guidelines which can be found in chapter 12 of the ALS manual.

If dynamic hyperinflation of the lungs is suspected during CPR, compression of the chest wall and/or a period of apnoea (disconnection of tracheal tube) may relieve gas-trapping. Although this procedure is supported by limited evidence, it is unlikely to be harmful in an otherwise desperate situation.

Ventilation with 100% inspired oxygen during CPR will be necessary, but may be difficult to give because of increased airway resistance caused by asthma. In an intubated patient give chest compressions at 100-120 min-1 and ventilations at 10 min-1.

Dynamic hyperinflation increases transthoracic impedance. In VF, consider higher shock energies for defibrillation if initial defibrillation attempts fail.

That’s right. The correct approach in this given circumstance is to start CPR according to ALS guidelines which can be found in chapter 12 of the ALS manual.

If dynamic hyperinflation of the lungs is suspected during CPR, compression of the chest wall and/or a period of apnoea (disconnection of tracheal tube) may relieve gas-trapping. Although this procedure is supported by limited evidence, it is unlikely to be harmful in an otherwise desperate situation.

Ventilation with 100% inspired oxygen during CPR will be necessary, but may be difficult to give because of increased airway resistance caused by asthma. In an intubated patient give chest compressions at 100-120 min-1 and ventilations at 10 min-1.

Dynamic hyperinflation increases transthoracic impedance. In VF, consider higher shock energies for defibrillation if initial defibrillation attempts fail.

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See chapter 12 of the ALS manual for further reading about Special Circumstances.

Mr Tanaka’s ABG results

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These are Mr Tanaka’s ABG results.
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Mr Tanaka’s ABG results.

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