Clinical Cases in Paramedicine. Группа авторов

      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/ (accessed 30 June 2020).

      7 Burns, E. (2019) Superventricular tachycardia (SVT). Life in the Fast Lane, 30 March. https://litfl.com/supraventricular‐tachycardia‐svt‐ecg‐library/ (accessed 30 June 2020).

      8 Chaubey, V.K. (2014) Spodick’s sign: A helpful electrocardiographic clue to the diagnosis of acute pericarditis. Permanente Journal, 18(1): e122. doi: 10.7812/TPP/14‐001

      9 Deakin, C., Brown, S., Jewkes, F. et al. (2015) Prehospital resuscitation. Resuscitation Council (UK). https://www.resus.org.uk/resuscitation‐guidelines/prehospital‐resuscitation/ (accessed 30 June 2020).

      10 Jensen, J.K., Poulson, S.H. & Molgaard, H. (2017) Cardiac tamponade: A clinical challenge. E‐Journal of Cardiology Practice, 15(17). https://www.escardio.org/Journals/E‐Journal‐of‐Cardiology‐Practice/Volume‐15/Cardiac‐tamponade‐a‐clinical‐challenge (accessed 30 June 2020).

      11 Queensland Ambulance Service (2018) Clinical practice guidelines: Cardiac/tachycardia – narrow complex. https://www.ambulance.qld.gov.au/docs/clinical/cpg/CPG_Tachycardia_narrow%20complex.pdf (accessed 30 June 2020).

      12 Resuscitation Council (UK) (2014) Treatment of hyperkalaemic cardiac arrest. Renal Association. https://renal.org/wp‐content/uploads/2017/10/HYPERKALAEMIA‐CARDIAC‐ARREST‐ALGORITHM‐MARCH‐2014.pdf (accessed 30 June 2020).

      13 Stoppler, M. (2019) Hyperkalemia (high blood potassium). MedicineNet. https://www.medicinenet.com/hyperkalemia/article.htm (accessed 30 June 2020).