The ALS Algorithm Case 1

An 82-year-old man presents to the ED with a 4-day history of general malaise and vomiting.

He has a background history of stroke. His routine medications include:

• Aspirin
• Perindopril
• A statin

The paramedics indicate his BP on arrival was 80 systolic with little response to 500 ml of normal saline.

He has remained semi-conscious en route.

A nursing colleague is running off an ECG when another colleague reports there is no recordable BP. The patient now appears to show no signs of life.

In the case of this patient, what two interventions take immediate priority?

In the case of the 82-year-old man, you elect to inspect the patient’s ECG.

Click on the ECG to enlarge.

Address the following two points:

• What does it show?
• What is the likely underlying cause to his PEA?

In the case of the 82-year-old man, what interventions does he require apart from those routinely delivered in the ALS algorithm?