44-year-old male admitted to ICU 2 weeks earlier having been found collapsed in the dialysis unit car park with a GCS 3, heart rate 30 bpm and temp 41.7oC. CPR was started in the ambulance with ROSC in ED 10 minutes later following treatment for K+ 8.1 mmol/L. Background included IDDM and end-stage kidney disease on haemodialysis 3x /week. Clinical findings included GCS 4 with roving eye movements, increased tone with extensor response to pain and upgoing plantar reflexes and the presence of an A-V fistula in his forearm.
Candidates were directed to examine him with a view to assessing his neurological prognosis and possible causes of the cardiac arrest
Discussion points included management of the initial arrest, neurological prognostication, pros and cons of tracheostomy and family discussion re prognosis