Thursday, May 30, 2013

Code Blue: Sudden Cardiac Arrest

Sunrise, sunset
Sunrise, sunset
Swiftly fly the years,
One season following another,
Laiden with happiness and tears

Fiddler On The Roof
Sunrise, Sunset lyrics

A 70 year old is admitted with chest pain.   He has a history of cardiomyopathy and has a pacemaker/ICD.   His initial blood work showed negative troponins but his BNP was elevated at 839.   An echo from a previous admission estimated his EF to be 25%. A previous cath report showed that the patient had a 40% left main and 80% circumflex blockage.   As you are making rounds on his 2nd hospital day,  he suddenly loses consciousness and becomes apenic.  A code blue is called.

0810  Placed on monitor.  Initial rhythm accelerated idioventricular rhythm/ventricular paced.  However, the patient is pulseless and apenic.  PEA.  CPR initiated with positive pressure ventilations.

The arrows are markers that show that the monitor is sensing the patient's pacemaker.

0811 CPR in progress.

0812  Epinephrine 1mg IV given during CPR.

0813.  Remains pulseless and apenic during rhythm check.  Continuing CPR.  Ventilations with adequate chest rise.  MD arrives.  Update given.

0815  Vasopressin 40 units given.  CPR in progress.   

0819.   Epinephrine 1mg IV given.   CPR in progress.  New IV #20 in the left AC started.  Blood specimens obtained.

0821  Rhythm check reveals change in the patient rhythm to ventricular fibrillation

0821 Defibrillated at 200J with biphasic defibrillator.   CPR resumed after defibrillation.  

0823.  CPR in progress.   Intubated with 7.5 oral ET tube.  Positive bilateral breath sounds and end tidal CO2.

0825   Rhythm check remains in ventricular fibrillation.

0826  Defibrillated at 300J with biphasic defibrillator.  CPR resumed after defibrillation.

0827   CPR paused for rhythm and pulse check.  Idioventricular rhythm.   Patient remains pulseless and apenic.  CPR resumed

0829  Epinephrine 1mg given.   CPR in progress.  Positive pressure ventilations adequate through the ET tube with symmetrical chest rise.

0831  Bicarbonate 1 amp given.  CPR in progress.

0834   CPR paused for rhythm check.  Agonal rhythm.  CPR resumed

0835  CPR in progress.  Epinephrine 1mg IV given.

0837  Continuing CPR .  Positive pressure ventilations adequate.

0840  Rhythm check.  Patient remains pulseless and apenic.  Given his cardiac history the code is called.

0842.  Ending rhythm.

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