By Nigel Lane
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A. Continue aspirin B. Discontinue aspirin C. Discontinue aspirin for one week then restart D. Discontinue aspirin until repeat endoscopy in six weeks E. Switch to clopidogrel 11. A middle-aged man presented to the emergency department with mild epigastric pain and a single episode of coffee-ground vomit. He had no past medical history and was not on any medication. On examination his heart rate was 70 beats per minute and regular. His blood pressure was 132/80 mmHg, respiratory rate 12, and oxygen saturation 99% on air.
E. three shocks in sequence with minimal delays) should be considered, namely: 1. VF/VT occurring during cardiac catheterization 2. VF/VT occurring early after cardiac surgery (where early is defined as still in hospital) 3. VF/VT arrest where the patient is already connected to a manual defibrillator. Although there is no evidence to support the use of stacked shocks, it is the opinion of the Resuscitation Council that chest compressions are unlikely to improve the already high chance of restoring spontaneous circulation when shocks are delivered very early in these special circumstances.
Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Critical Care Medicine 2013; 41/2: 580–637. Mouncey P, Osborn T, Power G et al for the ProMISe Trial Investigators. Trial of early goal-directed resuscitation for septic shock. New England Journal of Medicine. 2015; 372: 1301–1311. aspx Yearly D, Kellum J, Huang, D et al. A randomized trial of protocol-based care for early septic shock. The ProCESS investigators. The New England Journal of Medicine, 2014; 370: 1683–1693.