Code Blue: Sudden Cardiac Arrest
Sunrise, sunset
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.
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
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.
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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