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Case Presentation
History of present illness: A 55-year-old man was at his office desk when his coworker noticed him frothing from the mouth and subsequently losing consciousness. The coworker activated 911 and immediately began cardiopulmonary resuscitation (CPR). When the emergency medical service (EMS) arrived, the initial rhythm demonstrated ventricular fibrillation (VF). Advanced cardiac life support (ACLS) was implemented, and return of spontaneous circulation (ROSC) was achieved in 10 minutes. However, there were repeated episodes of VF requiring multiple defibrillation attempts along with repeated episodes of CPR, and the patient remained unresponsive. While en route to the nearest hospital, he was orally intubated and a 12-lead electrocardiogram (ECG) was performed, revealing ST-segment elevations in the anterior precordial leads.
Past medical history: Hypertension (HTN), diabetes mellitus type 2 (DMT2).
Past surgical history: No surgeries in the past.
Family history: Father with a history of HTN. Mother with a history of DMT2.
Social history: Current active smoker: 1 pack per day for 20 years, no illicit drug use.
Allergies: No known drug allergies.
Home medications: Amlodipine, metformin, rosuvastatin.
Physical examination:
Blood pressure: 80/50 mmHg
Heart rate: 100 bpm
Respiratory rate: 24 rpm
Temperature: 97.4°F
SpO2: 98% on mechanical ventilation
GA: Orally intubated, sedated
HEENT: Normocephalic, atraumatic
Lungs: Bilateral normal vesicular breath sounds, no wheezes or crackles
Heart: S1 and S2 normal in intensity; no audible murmurs, rubs, or gallops
Abdomen: Soft, nontender, nondistended
Extremities: No pedal edema
Neurologic: Unresponsive
The patient also required multiple episodes of defibrillation in the emergency department. Subsequently, he was transferred to the cardiac catheterization laboratory. Emergency medical personnel initiated therapeutic hypothermia (TH) for him by placing water blankets, cooling caps, and a cooling catheter that remained in place during the cardiac catheterization procedure. A selective coronary arteriogram revealed complete occlusion of the proximal left anterior descending (LAD) coronary artery, which was revascularized using a drug-eluting stent (DES). On arrival to the cardiac intensive care unit (CICU), TH was continued for about 24 hours, and the patient was slowly rewarmed. Initially, he remained comatose. By day 5, he was awake, alert, and interactive and was ultimately discharged home.
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KEY POINTS
Cardiac arrest is often a sudden and catastrophic event that needs prompt attention to hypoxia, hypovolemia, hypothermia, pneumothorax, myocardial infraction, tamponade, and pulmonary embolism.
Early resuscitation with airway management, early CPR, defibrillation, and ACLS support are required to improve survival.
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COMPONENTS OF RESUSCITATION DEVICES
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Cardiopulmonary arrest consists of sudden cessation of the circulatory system leading to global ischemia (Figure 1-1). Out-of-hospital arrest occurs at home in the majority of the cases, with middle-aged men as the main victims. Early initiation of resuscitation efforts by trained personnel has shown outcome benefits. Resuscitation consists of the following components.
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