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Defibrillation pads: Ventricular tachycardia at a rate of 180 bpm

RR: 0

BP: Unrecordable

SpO₂: Unrecordable

Blood glucose: 16.2 mmol/L

GCS: 3/15

Pupils: Size 3, reactive

Colour/appearance: Pale

Respiratory effort/rhythm: No effort

Pulses: Absent

Head to toe: Reveals nil obvious injuries/deformities, nil medical alerts

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.

Table 2.4 The 4 Hs and 4Ts – reversible causes of cardiac arrest

Hypoxia	Tension pneumothorax
Hypovolemia	Cardiac tamponade
Hyper/hypokalemia/metabolic causes	Thrombus
Hyper/hypothermia	Toxins