Thursday, 25 February 2010

57 yom CC: Cardiac arrest

Here's another interesting case submitted by a reader who wishes to remain anonymous.

While we're on the subject, I'd like to thank my readers for the interesting case studies that have been coming in!

This is what the Web 2.0 experience is all about! We're learning a lot from each other and that's the difference between editing a blog and writing a book.

EMS is called to a seizure patient. According to the patient's girlfriend, he had been feeling weak and vomiting about an hour earlier. She states that he had a "short seizure" after which he was unresponsive. She didn't call 9-1-1 right away because the patient has a history of seizures.

After the patient was unresponsivee for longer than usual she contacted 9-1-1. When asked by EMS personnel, she estimates that the patient had not been breathing for 3-5 minutes prior to EMS arrival. She did not attempt CPR.

The patient is a 57 year old male.

Past medical history: CVA, NIDDM, and seizures

Medications: Tylenol, Trileptol

Pulselessness was confirmed and chest compressions were initiated.

The combo-pads were attached.

Here is the initial rhythm (with CPR artifact).


It was confirmed as asystole a short time later.


CPR was continued. The airway was managed with an OPA and BVM. An 18 ga IV was established in the LAC and run w/o. Epinephrine and atropine were administered.

A rhythm change was noted on the monitor.



A weak carotid pulse was palpated although radial pulses were absent and a BP could not be auscultated.

The patient was relocated to the ambulance. The patient was intubated with an ETCO2 in the mid 50s.

A 12-lead ECG was captured.


The paramedics left the scene en route to a PCI-hospital.

At this point the patient had radial pulses but for some reason the paramedics were still unable to auscultate a blood pressure.

The rhythm continued to be irregular and polymorphic.



Another 12-lead ECG was captured.


Some significant asystolic pauses were noted on the monitor.


As the last 12-lead ECG was captured the patient lost pulses.


By now the ambulance was arriving at the PCI hospital. CPR was resumed. Another round of epinephrine was given and the patient re-gained pulses.

The ED staff identified the prehospital 12-lead ECGs as showing "STEMI".

Do you agree? Why or why not?

Should it matter at this point? In other words, should the patient be cathed anyway (assuming the patient is stable enough for a cath)?