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In cardiac arrests out-of-hospital, the presenting rhythm is shockable i.e. VF /pVT in about 25% of cases and non-shockable cases are in the remainder i.e. asystole in about 50% of cases and PEA in about 25% of cases. For in-hospital cardiac arrests, the numbers are 18.1% for shockable and 73.1% for non-shockable rhythms.

It is 30:2.

Team leaders need experience, not simply seniority. It is available to everyone with training and is not restricted to those with leadership traits.

Most cardiac arrests in hospital are not sudden or unpredictable events: in approximately 80% of cases there is deterioration in clinical signs during the few hours before cardiac arrest i.e. hypoxia and hypotension. The cardiac arrest rhythm in this group is usually non-shockable i.e. PEA or asytole.

A history of sustained acute chest pain typical of Acute myocardial infarction, acommpanied by acute ST-segment elevation or new left bundle branch block (LBBB) on a 12-lead ECG, is the basis for the diagnosis of STEMI.

This includes tracheal intubation, rhythm check, delivering shock using manual defibrillator…etc.

High quality chest compressions: depth of 5-6cm, rate of 100-120 compressions / min, allow the chest to recoil completely after each compression, take approximately the same amount of time for compression and relaxation, minimise any interruptions to chest compression (hands-off time).

The three main insertion sites for IO access recommended for us in adults are the proximal humerus, proximal tibia and distal tibia.

5 back blows should be given intiially followed by 5 abdominal thrusts and repeat. If patient becomes unconscious, start CPR. Encourage those with mild choking with effective cough to cough and check for deterioration to ineffective cough or until obstruction relieved.

During apnea, the absence of spontaneous breathing, failure to inflate the lungs despite attempted positive pressure ventilation signifies complete airway obstruction.

In a normal ECG, the QRS complex duration is typically shorter than 0.12 seconds. This indicates rapid conduction of the depolarizing impulse through the normal conducting system to both ventricles.

When external defibrillation is necessary, the priority is to restore life, and concerns about implanted devices such as pacemakers, implantable cardioverter-defibrillators, or other electronic devices are secondary. The current resuscitation guidelines should be followed, and awareness of the presence of an implanted device allows for additional measures to optimize the outcome.

A ring magnet placed over an ICD can deactivate its defibrillation function, but it does not disable the pacemaker function if the device has that capability.

Non-invasive pacing may be used to maintain cardiac output temporarily while expert help to deliver longer-term treatment is obtained i.e. transvenous pacing.

Give adenosine 6mg rapid IV bolus. If unsuccessful, give 12 mg. If unsuccessful, give 18mg. Monitor ECG continuously. If ineffective with adenosine,consider verapamil or beta-blocker. Lastly if still ineffective, synchronised DC shock up to 3 attempts.

Evidence of life threatening signs: shock, syncope, myocardial ischaemia and heart failure.

These factors contribute to the development of hyperkalaemia.

The post-resuscitation phase starts at the location where the return of spontaneous circulation (ROSC) is achieved. Once stabilized, the patient needs to be transferred to the most appropriate high-care area (e.g., intensive care unit, coronary care unit) for continued monitoring and treatment.

All established monitoring should continue throughout the patient’s transfer to maintain ongoing assessment of vital signs and organ function. It is essential to secure all cannulae, catheters, tubes, and drains to prevent dislodgment or complications during the transfer. A full reassessment of the patient’s condition should be conducted immediately before the transfer to ensure stability and readiness for the journey. Portable suction apparatus, an oxygen supply, and a defibrillator/monitor should accompany the patient and the transfer team to address any emergent needs during the transfer.

Hyperventilation, characterized by excessive tidal volumes, respiratory rate, or both, can lead to haemodynamic instability. Rapid and excessive removal of carbon dioxide (hypocarbia) induced by hyperventilation causes cerebral vasoconstriction, which can reduce cerebral blood flow and potentially lead to cerebral ischaemia. It is important to avoid excessive ventilation and maintain appropriate carbon dioxide levels to optimize cerebral perfusion. The use of mechanical ventilators can help prevent hyperventilation by controlling tidal volumes and respiratory rate, minimizing the risk of hyperventilation-induced complications.

The statement is true. Respiratory failure Type II, also known as hypercapnic respiratory failure, is characterized by low arterial partial pressure of oxygen (PaO2) ( 7 kPa or 45 mmHg). This type of respiratory failure is commonly seen in conditions such as chronic obstructive pulmonary disease (COPD), where there is impaired ventilation and carbon dioxide retention.

When someone is dying from an irreversible cause, CPR is unlikely to work but can subject them to an undignified death, or even cause suffering and prolong the process of dying.

The statement is true. If a person lacking capacity has a valid and applicable Advance Decision to Refuse Treatment (ADRT) refusing CPR, it is legally binding and must be respected.

The statement is true. While it is encouraged for all team members to participate in debriefing sessions, it should not be mandatory. Participation should be voluntary to respect individual preferences and needs.

Religious representatives from the patient’s denomination or faith are often present in hospitals to provide support and guidance during times of illness and death.

This is an ECG reading of Ventricular Tachycardia.

This is an ECG reading of Mobitz type 1 (Wenckebach) AV Block:

This is Asystole which is non-shockable rhythm.

Immediate general treatment for ACS includes: aspirin 300mg (orally/crushed/chewed), glyceryl trinitrate (spray/tablet) unless hypotensive, oxgen (only give if SpO2 is less than 94%), morphine IV, titrated to avoid sedation and respiratory depression, and given with anti-emetic.