78yo female calls 911 because she feels unwell with palpitat | Figure 1

MSarto

Registered Nurse

Case Description

78yo female calls 911 because she feels unwell with palpitations and slight chest pressure. Upon arrival of EMS, the patient starts to fade in/out of consciousness. Shocks given X 4 with persistent tachyarrhythmia. Presents to ER with a similar rhythm. Sedated patient and Repeated shocks X 1 with Amiodarone 150mg IV X 1 with little effect initially. Shock re-delivered with MgSO4 2g IV. Patient converted to junctional escape rhythm seen in the third image. Stat transfer to cathlab once stabilized. In Angio, RCA 100% occlusion noted but patient kept having runs on non-sustained VT; initiated lidocaine IV.

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