Tuesday, 8 December 2009

Cardiovascular disorders in children

48 year old male... Post PEA cardiac arrest.


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
  • AMI
  • Coronary artery spasm
Please give your opinions on the above???



Questions:



  1. What does the ECG's show?
  2. What are the likely mechanism of this?
  3. What are the likely causes of this?
  4. What are the key issues in managing this patient?