MCQs

Question 1

STEMIs are always accompanied by chest pain

Answer 1

False - elderly, diabetics and renal disease can be others

Question 2

STEMIs rarely cause VF

Answer 2

False - during acute phase there is a substantial risk of VF

Question 3

STEMI can present with ST depression in V1-V3

Answer 3

True - posterior STEMI

Question 4

STEMI can present with new LBBB on ECG

Answer 4

True

Question 5

When transcutaneous pacing what current should electrical capture occur?

Answer 5

50-100mA

Question 6

Is transcutaneous pacing successful in hyperkalaemia?

Answer 6

No - it can often prevent it

Question 7

When transcutaneous pacing can movement artefact inhibit the pacemaker?

Answer 7

Yes - if artefact on ECG, this may be interpreted by pacemaker and inhibit

Question 8

In transcutaneous pacing does electrical capture and generation of QRS complex ensure return of pulse?

Answer 8

No - QRS complex does not guarantee myocardial contractility. Absence of a pulse would mean PEA.

Question 9

Where should electrodes be placed for 3 lead ECG

Answer 9

Over bone - minimises artefact

Question 10

What is the normal PR interval

Answer 10

0.12-0.20

Question 11

Normal QRS duration

Answer 11

<0.12 (3 small squares)

Question 12

Is there immediate entry of water into lungs if drowning?

Answer 12

No - initially laryngospasm and breath holding preventing water entry

Question 13

How many minutes of submersion is likely to have a good outcome?

Answer 13

Less than 10 very high chance
More than 25 min low chance of good outcome

Question 14

Is there a role for prophylactic abx in drowning?

Answer 14

No

Question 15

ECG confirms asystole - do you shock?

Answer 15

No

Question 16

Is soda bic recommended for PEA/asystole?

Answer 16

No - not routinely

Question 17

Adrenaline in PEA/asystole
What dose and when?

Answer 17

1mg IV asap

Question 18

How common is PEA/asystole vs VF/VT as first rhythms in arrest?

Answer 18

VF/pVT in 20% of arrests

Question 19

Rhythm seen in hypovolaemia

Answer 19

PEA

Question 20

When you decide a patient should be for CPR, should you discuss this with patient and why?

Answer 20

Yes - deciding for CPR implies a risk of death or cardiac arrest. Failing to discuss deprives patient opportunity to refuse CPR

Question 21

How to approach DNACPRs with ICDs

Answer 21

Some people may not want CPR but would still choose to receive shocks from ICD - so a DNACPR does not mean this needs turned off

Question 22

Adrenaline effects

Answer 22

Alpha and beta-adrenergic

Question 23

Is adrenaline associated with benefits in cardiac arrest?

Answer 23

Long-term - no
Short-term - documented in some studies which warrants its continued use

Question 24

Alpha-adrenergic effects of adrenaline

Answer 24

Systemic vasoconstriction , increases coronary and cerebral perfusion pressures

Question 25

Beta-adrenergic effects of adrenaline

Answer 25

(Ionotropic, chronotropic) Can increase coronary and cerebral blood flow Also increases myocardial O2 consumption, transient hypoxaemia and ventricular arrythmias

Question 26

How does asystole look on trace?

Answer 26

Not completely straight

Question 27

Best way to estimate HR

Answer 27

Count R to R waves that occur in 30 large squares and x10

Question 28

55-year-old women presents with a 1 h history of crushing central chest pain, nausea and sweating. Her pulse rate is 38 min-1, BP 75/45 mmHg. The ECG monitor shows sinus bradycardia - what is treatment?

Answer 28

Atropine 500mcg IV

Question 29

What dose of adrenaline infusion for bradycardia?

Answer 29

2-10mcg per min IV

Question 30

When does oxygen need to be removed during defib?

Answer 30

When a mask/nasal cannula is being used. LMA/definitive airway does not need removed and you can continue at 10 breaths min

Question 31

What type of metabolic disturbance occurs in cardiac arrest?

Answer 31

Mixed metabolic and respiratory acidosis The best treatment is chest compressions, second to this is ventilation

Question 32

Effects of bicarb physiologically

Answer 32

Generates CO2 which diffuses rapildy into cells resulting in 1) Exacerbates intracellular acidosis 2) Produces negative inotropic effect on ischaemic myocardium 3) Effects sodium 4) Produces left shift in the oxygen dissociation curve which inhibits release of oxygen into tissues

Question 33

Treatment to be considered for arrhythmias due to TCA overdose

Answer 33

Soda bic

Question 34

When is PCI recommended (STEMI)

Answer 34

If presents with <12 hrs chest pain and STEMI or LBBB Aim to PCI within 120 minutes

Question 35

Initial J of shock in arrest?

Answer 35

At least 120J

Question 36

A patient is collapsed and has agonal breathing - what should you do?

Answer 36

Commence CPR

Question 37

Disturbance causing arrest in acute severe asthma

Answer 37

Hypoxia

Question 38

IV treatment in asthma and dose

Answer 38

Mag sulph 2g IV (helps bronchodilation)

Question 39

Adrenaline dose anaphylaxis

Answer 39

0.5mg IM

Question 40

Treatment and doses for hyper K

Answer 40

10ml 10% calcium gluconate

Question 41

Defibrillation energies in asthma should..

Answer 41

Be higher - hyperinflation increases impedance

Question 42

How should fine VF be treated??

Answer 42

If it is not certain whether the ECG shows asystole or very fine VF, do not spend time attempting to distinguish the rhythm. If the rhythm appears to be VF give a shock, and if it appears to be asystole continue chest compressions. Avoid excessive interruptions in chest compressions for rhythm analysis.