The patient in cardiac arrest
Andrew Stewart in Pocket On Call, 2015
The majority of in-hospital cardiac arrests are either pulseless electrical activity or asystole, and only a very small percentage survive to discharge. One aspect of on-call medical work is responding to cardiac arrest calls across the hospital. In essence, the majority of cardiac arrest management is very straightforward. This chapter suggest that the UK Resuscitation Council sets out specific guidelines for the management of cardiac arrest under the umbrella term advanced life support, the basic algorithm. It is well worth committing this to memory before starting out as an F1. In essence, the majority of cardiac arrest management is very straightforward. There is no substitute for undertaking an official advanced life support course, but the following tips will hopefully be of benefit when starting out on the wards. As an F1 medical students' role will usually involve chest compressions or establishing IV access.
Case 27
David Gray, Andrew R. Houghton in Making Sense of the ECG: Cases for Self-Assessment, 2009
Further reading Making Sense of the ECG: Cardiopulmonary resuscitation, p 250; Pulseless electrical activity, p 260. Resuscitation Council (UK). Resuscitation guidelines. 2005. Available at: www.resus.org.uk
Spontaneous tension pneumoperitoneum presenting as an out of hospital cardiac arrest: A case report and review of the literature
Published in Acta Clinica Belgica, 2016
Roel De Smet, Peter De Paepe, Walter Buylaert, Said Hachimi Idrissi
Objectives: It is known that tension pneumoperitoneum (TPP) can lead to cardiopulmonary arrest but it does not figure in the advanced life support algorithms. Therefore we discuss a case of TPP together with the literature review of its aetiology and treatment. Patient: We describe an out of hospital cardiac arrest due to a spontaneous TPP secondary to a perforated duodenal ulcer. Conclusion: Emergency personnel should consider the possibility of TPP in a patient with a distended abdomen and a cardiac arrest, even in the absence of known traumatic and iatrogenic causes for TPP. We believe that TPP should be added as a reversible cause for pulseless electrical activity in the resuscitation guidelines.
High dose insulin in toxic cardiogenic shock
Published in Clinical Toxicology, 2009
Joel S. Holger, Kristin M. Engebretsen, John J. Marini
Objective. To report the successful use of high dose insulin (HDI) in previously unreported insulin dosing ranges in a patient with severe myocardial toxicity due to an amitriptyline and citalopram overdose. Case Report. A 65-year-old female presented in respiratory arrest, which was followed by bradycardic pulseless electrical activity after ingesting multiple medications. After a prolonged resuscitation, the patient was maintained only on infusions of norepinephrine (40 mcg/min), vasopressin (4 units/h), insulin (80 units/h), and sodium bicarbonate. Due to a deteriorating clinical condition and limited prognosis, the insulin infusion was titrated incrementally upwards to 600 units/h (6 units/kg/h) over a 5 h time period while simultaneously completely weaning off both vasopressors. She developed brisk pulses and warm extremities, and her cardiac output nearly tripled. After 2 days of stabilization the insulin was slowly tapered, and the patient recovered. Discussion. HDI as a single cardiovascular agent significantly improved clinical and cardiovascular parameters after the failure of vasopressor therapy in severe cardiovascular toxicity. Higher doses of insulin than previously recommended may be needed in toxic poisonings when severe myocardial depression is present.
Death following intentional ingestion of e-liquid
Published in Clinical Toxicology, 2015
Betty C. Chen, Steven B. Bright, Amit Raj Trivedi, Matthew Valento
Context: Electronic cigarette (e-cigarette) use is growing within the United States, resulting in both intentional and unintentional exposures to concentrated liquid nicotine or “e-liquid.” Nicotine has been culpable for severe poisoning and deaths in the past. However, sources of nicotine have traditionally been from cigarettes, cigars, or pesticides. Fatalities due to liquid nicotine are rare, and fatalities following ingestion of e-liquid are even scarcer. Case: We present a case of a 24-year-old woman who intentionally ingested up to 3000 mg of liquid nicotine intended for e-cigarette use. She was found in pulseless electrical activity and had return of spontaneous circulation (ROSC) after undergoing approximately 10 min of cardiopulmonary resuscitation with a blood pressure of 74/53 mmHg and a pulse rate of 106 beats/min. Despite aggressive supportive care, she ultimately died after she was found to have multiple acute infarcts, consistent with severe anoxic brain injury, on magnetic resonance imaging. The patient’s toxicologic testing, obtained shortly after ROSC, was notable for plasma nicotine and cotinine levels each >1000 ng/mL. Discussion: This fatality highlights the potential toxicity associated with suicidal ingestion of liquid nicotine.