Cardiogenic Shock, Acute Dysrhythmias and Post-Resuscitation Care in ICU — WACS Viva & Clinical Scenarios (ICU & HDU)

Exam-style cardiogenic shock, acute dysrhythmias and post-resuscitation care in icu viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 26-year-old P2+0 female (ASA IVE) is admitted to ICU 2 weeks postpartum with severe breathlessness, orthopnea, bilateral lower limb edema, blood pressure 82/50 mmHg, pulse 135 bpm (sinus tachycardia), and oxygen saturation 84% on room air. Bedside echocardiography reveals a globally hypokinetic dilated left ventricle with an ejection fraction of 20%. Formulate your resuscitation, invasive monitoring, and pharmacological stabilization plan.
• SCENARIO 2: A 60-year-old male (ASA IVE) with a history of diabetes undergoes resuscitation in the emergency department for an anterior STEMI-associated ventricular fibrillation arrest. He achieves return of spontaneous circulation (ROSC) after 18 minutes of CPR and 3 defibrillation shocks. He is comatose (GCS 4/15), intubated, blood pressure is 80/45 mmHg on adrenaline infusion, and heart rate is 110 bpm. Discuss your initial 24-hour ICU neuroprotection and hemodynamic protocol.
• SCENARIO 3: A 68-year-old female (ASA IIIE) on day 2 post-emergency resection of an obstructed bowel develops sudden-onset palpitations, severe chest tightness, blood pressure 75/40 mmHg, and oxygen saturation 88%. The 12-lead ECG demonstrates atrial fibrillation with a rapid ventricular response of 175 bpm and narrow QRS complexes. Detail your step-by-step acute emergency stabilization and anti-arrhythmic strategy.
• SCENARIO 4: A 48-year-old male (ASA IVE) with severe organophosphate poisoning develops profound sinus bradycardia (heart rate 28 bpm) resistant to high-dose intravenous atropine, with an unrecordable blood pressure and altered mental status. Outline your immediate emergency interventions, including electrical pacing techniques.