Appendix

Question 1

Mechanism of action of adrenaline for cardiac arrest

Answer 1

Alpha-adrenergic - systemic vasoconstriction, increases coronary and cerebral perfusion pressures
Beta-adrenergic - increase coronary and cerebral blood flow but also increase myocardial oxygen consumption and ectopic ventricular arrhythmias, transient hypoxaemia, impaired microcirculation and increased post-cardiac arrest myocardial dysfunction

Question 2

Mechanism of action of amiodarone

Answer 2

Membrane-stabilising antiarrhythmic. Increases duration of action potential and refractory period in atrial and ventricular myocardiu,. Slows AV conduction. Mild negative inotropic effect causing peripheral vasodilation through non-competitive alpha blocking effects

Question 3

Options for fibrinolysis

Answer 3

Tenecteplace 500-600mcg/kg
Alteplase 50mg IV bolus if cardiac arrest with known or suspected PE, consider repeat dose during prolonged CPR attempt

Question 4

Side effects of adenosine

Answer 4

Nausea, flushing, chest discomfort

Question 5

Adrenaline dose for cardiac arrest vs anaphylaxis vs periarrest bradycardia

Answer 5

Cardiac arrest - 1mg 1 in 10,000 IV
Anaphylaxis - 500 mcg IM 1 in 1000
Bradycardia - 2-10mcg/min

Question 6

Amiodarone dose in peri-arrest tachyarrhythmia

Answer 6

300mg IV over 10-60 minutes then infusion of 900mg over 24 hours

Question 7

Verapamil mechanism of action

Answer 7

Calcium channel blocker
Slows conduction through AV node

Question 8

Digoxin mechanism of action

Answer 8

Cardiac glycoside, slows ventricular rate but increasing vagal tone, decreasing sympathetic activity by suppression of baroreceptors and prolonging AV node refractory period

Question 9

Nitrates mechanism of action in ACS

Answer 9

Vascular smooth muscle relaxation - acts on venous more than arterial, reducing left ventricular distastolic pressure. Dilate coronary arteries and relieve spasm in coronary smooth muscle.