what caused this cardiac arrest?
Its almost the end of august and the time when our newest qualified doctors have been in post for about a month. One of this brigade is my cousin and he has just been to see me this afternoon to discuss this case -which to be fair I struggle with. Here are the details he recounts
95 year old lady admitted with urosepsis treated appropriately and apparently getting better, noted to be in AF on admission, echo shows good lv function
seen on the ward round on wednesday - no concerns
seen on thursday ward round- nursing staff report poor urine output, BP stable Heart rate 105bpm , ecg requested by ward team
5pm Thursday - ecg seen and shows heart rate of 80bpm, T waves appear tall and tented
The new F1s are unable to acquire a venous or an arterial gas and call the oncall SHO
SHO attends 40 mins later also has difficulty and calls the reg. no urine output still . bladder scan shows bladder is empty
reg attends at around 8:30, obtains venous blood and asks for a CXR
CXR shows pulmonary oedema and bloods return with a potassium of 6.6. Whilst they are trying to treat all of this patient has cardiac arrest and cannot be resuscitated.
When asked my F1 cousin can not recall the blood pressure, serum creatinine, eGFR or lactate but is sure that the ecg did not show any ischaemic change.
My first thoughts were that this is an ischaemic event either cardiac or intrabdominal. Any other thoughts?
sadian
Source: Doc2Doc BMJ Cardiology - Category: Cardiology Authors: sadian Source Type: forums