Oxford Medical Education

Cardiac Arrest Questions

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November 15,
2014

Common cardiac arrest and advanced life support (ALS)

questions for medical finals, OSCEs and MRCP PACES

Question 1: Recognising cardiac arrest

Outline your initial approach to an unconscious individual
On finding an unconscious individual, follow the three SSS’s: safety, shake, sho
Safety: ensure it is safe to approach
Shake: ask the patient “Are you alright?” whilst gently shaking their arm
Shout: if the patient responds, assess them from an ABCDE perspective; if
they do not respond, shout for help and put out a cardiac arrest call

What would you do if there was no response?

Open the airway with a head tilt/chin lift manoeuvre, palpate the carotid pulse and
look, listen and feel for breathing for 10 seconds
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 If there is a risk of a cervical spine injury, open the airway using a jaw thrust whilst
an assistant applies manual in-line stabilisation (MILS)
If there is no pulse, no signs of life, or if in any doubt, commence cardiopulmonary
resuscitation (CPR) immediately in a ratio of 30 compressions to 2 ventilation

Question 2: Initial cardiac arrest management

Once cardiac arrest has been identified, what procedure should be initiated without
delay?
If the patient is in cardiac arrest (or there is any suspicion that they might be in
cardiac arrest) CPR should be started immediately.

Question 3: compressions in advanced life support (ALS)

In what ratio are compressions and ventilations initially performed during CPR in ALS?
30 chest compressions to 2 breaths (30:2)

How does the ratio of compressions to breaths change after establishment of a definitive
airway in ALS?
Once a definitive airway has been established, compressions and ventilation can
occur simultaneously with no break in compressions.

Question 4: timings in advanced life support (ALS)

During advanced life support, what duration should CPR continue for between rhythm
checks?
Two minutes.
Do not stop CPR to do a rhythm check before 2 minutes is up.

Question 5: rhythms in advanced life support (ALS)

Which are the shockable rhythms?
Shockable rhythms in cardiac arrest are ventricular tachycardia (VT) and ventricular
fibrillation (VF)

Which are the non-shockable rhythms?

Any other rhythm is not shockable. This includes asystole, p-wave asystole, and a
rhythm compatible with life but with no pulse (PEA)

Question 6: adrenaline in advanced life support (ALS)

What is the dose of adrenaline given in cardiac arrest?
1mg adrenaline 1:10,000 (10ml) iv. Follow immediately with a 20 ml flush.

When is adrenaline given in shockable rhythms?

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 Immediately after the third shock

When is adrenaline given in non-shockable rhythms?

As soon as intravenous (IV) or intraosseus (IO) access has been obtained

Question 7: other medications in advanced life support

(ALS)
When, and at what dose, is amiodarone given in cardiac arrest?
Immediately after the third shock in a shockable rhythm – at the same time as
adrenaline. It is not indicated in a non-shockable rhythm.
The dose is 300mg iv

Question 8: reversible causes of cardiac arrest

What are the reversible causes of cardiac arrest?
The reversible causes are remembered by the “4 Hs and 4 Ts”
Hypoxia: ensure a patent airway and give high flow oxygen
Hypovolaemia: commence IV fluid resuscitation
Hypo/hyperkalaemia and other metabolic derangements: check the VBG for
any metabolic derangements and correct accordingly. Look at previous
bloods for likely magnesium concentrations or correct empirically.
Hypothermia: check the patient’s temperature and if low re-warm to 32-34 oC
Tension pneumothorax: auscultate the patient’s lung fields during
ventilations and perform needle decompression if required
Tamponade (cardiac): obtain a beside echocardiogram (echo) and perform
pericardiocentesis as indicated
Toxins: check the patient’s drug chart and/or enquire about recent
medications or overdoses in the collateral history
Thrombosis (pulmonary or cardiac): obtain a bedside ultrasound and identify
symptoms and risk factors in the collateral history

Question 9: Hyperkalaemia in cardiac arrest

How would you alter the management of cardiac arrest in a patient with hyperkalaemia?
The management of the immediate arrest would essentially be the same as for any
arrest. However, as soon as hyperkalaemia was suspected, treatment should be
commenced:
Calcium chloride 10 ml of 10% IV
Insulin-dextrose IV infusion (10 units of actrapid in 50 ml of 50% dextrose)
Sodium bicarbonate 50 ml of 8.4% IV
The reasons for the hyperkalaemia should be sought and treated post-arrest.

Click here to download free teaching notes on advanced life

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Click here to download free teaching notes on advanced life
support: Emergency – Cardiac arrest
Perfect Advanced Life Support revision for medical students, finals, OSCEs and MRCP
PACES

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