Sunday, May 21, 2017

Cardiac Arrest During Urgent Hemodialysis

During hemodialysis this patient became unresponsive, pulseless, and apneic.  A Code Blue was called and CPR initiated.  He was placed on the monitor/defibrilator and found to be in PEA.
These are the strips from the code.

A rhythm and pulse check after two minutes of CPR

Epinephrine 1 mg IV
 Rhythm and pulse check.  Remained pulseless.  No pulse by doppler.

CPR continued for PEA.  Sodium bicarbonate given for suspected metabolic acidosis.

Rhythm and pulse check.  Epinephrine 1 mg IV given

Rhythm and pulse check.  Continued CPR.  Repeat epinephrine

Rhythm and pulse check.  Remains in PEA

Epinephrine repeated. Continuing CPR

Rhythm check showed VT

Defibrillate 200 J

Refractory VT post shock.  Amiodarone 300 mg IV given.

Rhythm and pulse check after Amiodarone.  Strong central pulse present

Pulse present.  Continuing positive pressure ventilation
Pulse present.  Post cardiac arrest care.  Patient non-responsive.  H&H found to be low.  Unknown source.  GI bleeding? Not a candidate for therapeutic hypothermia.

Sinus rhythm.  Continues to have a strong central pulse.

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