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What we're going to do now is look at an advanced life support scenario where a patient goes into a cardiac arrest but remains in a persistent shockable rhythm. You will be able to see that we manage the airway, we manage the rhythm. And also look at the drugs that we would use in a typical prolonged cardiac arrest scenario. So we imagine our patient suddenly becomes unresponsive, and I'll manage the scenario from here with my colleague, Duncan. Patient has become unresponsive. Hello? Hello? Can you hear me? Can you hear me? Unresponsive.

Yeah. Got it mate.

I will get the paddles on.

Okay, connecting the paddles. Okay. If you can just pass CPR for me, confirming that it is ventricular fibrillation. If you can continue chest compressions, please, while I charge the monitor. I'm charging the machine, I won't shock yet. Stand clear, oxygen away, shocking now. Straight back on the chest, please. Okay. We're gonna manage his airway now, Duncan, so...

Can you just pass me a nasal, and then take over?

Okay.

Just gonna take a number through airway right here.

Okay, ready, over to you.

Okay. 30.

Okay.

25, 29, 30. 25, 30. At the end of this cycle, we'll be at two minutes. 29, 30. I'm assessing the rhythm, confirm that it's still VF. If you continue CPR, while I charge the monitor. I'm charging but I won't shock. Stand clear, oxygen away.

Clear.

Shocking now, straight back on the chest. This is looking like a prolonged arrest, Duncan, so perhaps we should consider upgrading their airway.

Yeah.

Is it okay as it is, or do you want to upgrade it?

I'll upgrade it. We can upgrade it.

25, 30. Okay, we'll get some IV access now 'cause we're going to be coming on to our third shock in a minute. Shots out. Right, we've got IV access, Duncan. It's coming up to two minutes, so we'll re-assess the rhythm for that third shock. Please stand clear. It's confirmed that it is still in VF. I'm gonna charge the machine. Can you keep chest compressions? I'll charge but I won't shock. Stand clear, oxygen away.

Clear.

I'm clear, shocking, that's the third shock. So I'm administering adrenalin, 1 in 10,000, 1 milligram IV, and also 300 milligrams of amiodarone IV. And I'm going to prepare a 20 ml flush to push all through.

I am not happy with his airway so we need to upgrade. Can you take over compressions for me?

Yep, yep.

Just get two breaths in, and I'll upgrade the airway. Count me down.

25, 29, 30. I'll just have a listen to make sure that we've got... Can you continue chest compressions on?

24, 26, 27, 28, 29, 30.

Air entry. Air entry. So now we are gonna continue to our fifth shock.

26, 27, 28, 29, 30.

Accessing the rhythm. I can see that the patient is still in VF, so I will deliver our fifth shock. I'll charge the machine. Okay, I am charging, but I won't shock. Stand clear, oxygen away, shocking the patient, and straight back on the chest. After the fifth shock, and the delivery of the second half dose of amiodarone, we would be making a decision now about travelling to a hospital to get the patient to resus in the nearest A&E department. Before leaving, we would just clarify with ourselves that we have given due consideration to the reversible causes of cardiac arrest. Given the scenario leading up to this patient's arrest, we suspected that he's thromboembolic. Should we get a spontaneous return of circulation, we'll take the patient directly to a heart attack centre for PPCI.