Code Blue: Refractory Ventricular Fibrillation

Nothing beside remains.  Round the decay

Of that colossal Wreck, boundless and bare

The lone and level sands stretch far away.

Ozymandias   By Percy Shelley 

A 69 year old admitted with chest pain.


0908

CPR rhythm

 CPR in progress with positive pressure ventilation


0910

Defibrillaton at 200 J

Ventricular fibrillation on monitor
Defibrillate at 200 J
Post shock rhythm idioventricular rhythm
No pulse
Resume CPR



0914

Defibrillation at 300 joules

Epinephrine 1mg IV given
CPR in progress
Rhythm check ventricular fibrillation
2nd shock at 300 joules
Post shock rhythm idioventricular rhythm
No pulse, continuing CPR


0918

Vasopressin 40 units IV given
Continuing CPR
Intubation with 8.0 oral ET tube
Tube placement confirmed with positive end tidal CO2 and auscultation
Rhythm check: ventricular fibrillation
Defibrillation at 360 J
Pulseless idioventricular rhythm, resumed CPR



0925

Epinephrine 1mg IV given
CPR in progress with positive pressure ventrilations via ET tube
Rhythm check ventricular fibrillation
4th shock at 360 joules
Post shock rhythm idioventricular rhythm
No pulse, continuing CPR




0931

Amiodarone 300mg  IV given
CPR in progress
Rhythm check: ventricular fibrillation
5th shock at 360 joules
Post shock rhythm idioventricular rhythm
No pulse, continuing CPR




0938

Epinephrine 1mg IV given
Epinephrine drip at 2mcg/min started
Continuing CPR
Rhythm check ventricular fibrillation
6th shock at 360 joules
Post shock rhythm idioventricular rhythm
No pulse, continuing CPR




0942

Epinephrine 1mg IV given
Epinephrine drip increased to 4mcg/min
Continuing CPR
Rhythm check ventricular fibrillation
7th shock at 360 joules
Post shock rhythm idioventricular rhythm
No pulse, continuing CPR


0945
Continuing CPR.
Epinephrine drip at 10mcg/min
Idioventricular rhythm on monitor
Remains pulseless and apneic
Code ended