Mortality High in Cardiac Arrest from Hanging

​BY GREGORY TAYLOR, DO, & ​​LAURIE WALLACE, DOA 27-year-old man with a significant past medical history of depression, multiple suicide attempts, intravenous heroin abuse, and hypertension presented to the emergency department with cardiac arrest. The patient had hanged himself with a bungee cord in his family's basement, and had been hanging for approximately 15 minutes before EMS was called. The patient was unresponsive on EMS arrival, with an initial rhythm of pulseless electrical activity (PEA). Return of spontaneous circulation (ROSC) was achieved en route following five rounds of epinephrine and cardiopulmonary resuscitation (CPR). Estimated down time was 45 minutes.The patient went back into PEA at the ED. The King airway was replaced with an endotracheal tube, and ROSC was achieved after two rounds of CPR. Vitals included a blood pressure of 60/42 mm Hg and heart rate of 113 bpm, and he was afebrile. The patient remained unresponsive, with a Glasgow coma score of 3 and fixed and dilated pupils.He was ill-appearing and exhibiting mottling to all extremities, with a horizontal abrasion to the base of his neck consistent with a ligature mark from hanging. A central venous catheter was subsequently placed, and vasopressors were initiated. He went into sustained ventricular tachycardia 10 minutes later, followed by ventricular fibrillation, and was subsequently defibrillated. He was given 150 mg of amiodarone, followed by an amiodarone infusion. Repeat vital...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research