Code Blue: Cocaine cardiac arrest

- April 15, 2013

Life is pleasant. Death is peaceful. It's the transition that's troublesome.

Wise Phrase by Isaac Asimov

1016 PM: A 27 year old female is dumped out of a car in the entrance to the ER. The car drives off. She is unresponsive with agonal breathing. She is placed on a stretcher and rushed to the trauma room. During her assessment she is noted to have a white powdery substance around her nostrils. Her pupils are constricted and nonreactive. Her skin is hot and dry. The peripheral pulses are weak with delayed capillary refill. Positive pressure ventilations are started and she is placed on the monitor.

1022 PM: An IV is established and blood specimens are obtained. Spontaneous respirations and her pulse is now absent. CPR is initiated and Epinephrine 1mg IV is given

1026 PM: CPR continues with positive pressure ventilations. IV fluid bolus started.

1029 PM: A rhythm check after two minutes.

1030 PM: No pulse. PEA. CPR is restarted and Epinephrine 1mg IV given

1033 PM: Rhythm check after 2 minutes. No pulse. PEA

1035 PM: Rhythm change noted. Ventricular tachycardia. Defibrillated with 200 J

1036 PM: CPR restarted. Epinephrine 1mg IV is given. Rhythm check. Polymorphic ventricular tachycardia. Remains pulseless and apneic. IV fluid bolus in progress.