Figure 1
DrAM80
Emergency Medicine
Priority call: Cardiac Arrest
A man in his thirties sustained a seizure after swallowing a considerable amount of cocaine (3.5 g est.), goes to develop a respiratory arrest then cardiac arrest. (Well, as he was chased by the police)
Out of hospital CPR, Intubated and ventilated on scene
Downtime time before arrival to ED is 45 min. No ROSC.
In ED: ROSC
- A/B: intubated with good air entry and no signs of PTX, SaO2: poor trace
- C: HR 70, very wide QRS almost like sine wave, BP 130/70, good radial
- D: chewing on the tube only with fixed and dilated pupils
- ABG (units in kPA): pH 6.6, PO2 20, BE-30, Lactate unrecordable, high K 6.14
- ECHO: good cardiac activity with no effusion or big clots
Two IV access with 0.9% sodium chloride running
Temp 34.8
Then,
He develops a tachyarrhythmia, had a seizure for seconds --> flat line / PEA. CPR Commenced with one adrenaline IV given for two minutes. ROSC in 2 minutes.
- C: HR 70, very wide QRS BP 110/78
- D: fixed and dilated pupils
You are the lead of this Resus case.
How would you proceed?
What treatment could you give?
Would you call it a day?
Please let me hear your thoughts.