Tuesday, 8 December 2009
EMS called to an 48 year old male, found collapsed on the floor with a GCS of 3, clinical presentation & observations are showed as follows:
- Resps 6 per min
- Pale and diaphoretic
- HR: - 74
- BP: - 70/49
- GCS - 3
- Sp02: 89%, 100% achieved after ventilation using B.V.M
- Blood sugar: - 4.1 mmol/I
- Not on any regular meds, and no relevant medical Hx
- Patient been fit & well up to this time
Patient was ventilated using a B.V.M on 100% O2, IV access obtained, carotid pulse was felt: which was absent, CPR was then commenced on the patient and BLS & ALS skills performed... 1st ECG capture as shows below:
ECG - 1: Patient in PEA.
ECG - 2 capture follows the one above, after return of circulation, post arrest, note the patient's blood pressure now on the top of the ECG strip.
12 - lead ECG capture on route to hospital after return of spontaneous circulation (ROSC).
This patient is now fully recovered and left hospital a week later, the medical staff at the hospital, gave the following explanations on what could have happen to this patient, do you agree with their thoughts:
- Some sort of Angina episode
- Coronary artery spasm
Please give your opinions on the above???
- What does the ECG's show?
- What are the likely mechanism of this?
- What are the likely causes of this?
- What are the key issues in managing this patient?