Code Blue: Cocaine cardiac arrest

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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.







1039 PM:  Defibrillated at 300 J.





1040 PM:  CPR in progress after defibrillation






1041 PM: Intubated with 7.0 oral ET tube.  Positive color changes with end tidal CO2.    Bilateral breath sounds present with symmetrical chest rise.







1043 PM: Rhythm check.  Wide complex tachycardia/VT







1044 PM: Defibrillated 360 J.







1046 PM: CPR in progress







1050 PM: CPR resumed and Epinephrine 1mg IV given







1055 PM:  Rhythm check.  Wide complex tachycardia/VT.  Remains pulseless and apenic.







1056 PM:  Defibrillated 360 J







1058:  CPR in progress.   Positive pressure ventilations adequate.






1100 PM:  Rhythm check:  PEA.  Remains pulseless and apneic.  CPR restarted.  Epinephrine 1mg IV given.










1105 PM:  Rhythm check.  No further interventions.  Code ended






1110:  Asystole.  










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