Care after Return of Spontaneous Circulation

​BY TRAVIS SMITH, MD, & MATTHEW ZUCKERMAN, MDParamedics were called for a 42-year-old woman found at a motel by her significant other. The patient was alone at the time of EMS arrival. She was pulseless and apneic, so chest compressions were started, and the cardiac monitor showed pulseless electrical activity.Initial ECG showing STE in the anterior leads with ST depression in the inferior leads.The paramedics gave her 1 mg of epinephrine IV and 1 mg of naloxone IV without obvious response. A laryngeal mask airway was placed, and oxygen was delivered by bag valve mask. She received eight rounds of chest compressions before arrival at the emergency department with a total down time of about 20 minutes.The patient had palpable pulses when she arrived in the ED, and CPR was stopped. Her initial vital signs were a blood pressure of 120/70 mm Hg, heart rate of 97 bpm, temperature of 33.5°C, and SPO2 was 91% using LMA with bag valve on 100% FIO2.The woman appeared cachectic, her pupils were fixed and dilated, and she had no obvious external signs of acute trauma. Bilateral coarse rales were heard with bagged breaths, and she had no spontaneous respirations. The cardiac exam showed regular rate and rhythm without murmur. Her skin was cool and mottled.Bedside cardiac ultrasound showed no right heart dilation, pericardial effusion, or focal wall motion abnormalities. The FAST exam was negative for free fluid. The initial ECG showed ST elevation in the anterior leads w...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research