The ALS Algorithm Case 2

The paramedics present an 86-year-old man with chest pain, partially responsive to oxygen and sublingual nitrate. The paramedics have given the patient aspirin; his pre-hospital ECG shows equivocal ST changes in the anterior leads. He survives a brief VF cardiac arrest en route.

The patient’s ECG on arrival clearly shows ST elevation anterolaterally. He has a further VF arrest, unresponsive to three shocks delivered as per the ALS algorithm.

In the case of this patient, what IV agents (and doses) should now be considered?

In the case of the 86-year-old man, what other intervention might you consider?

In the case of the 86-year-old man, after a further 10 minutes, you are unclear as to whether the rhythm is fine VF or asystole. How should this affect your management?

In the case of the 86-year-old man, what should influence the decision to withdraw resuscitation in this scenario?