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Cardiac Arrest*

HISTORY:

  • A 62-year-old male is transported to the ED with chest pain, dyspnea and hemoptysis.   His symptoms started about an hour prior to arrival.   The patient appears ill.
  • He denies any fever or leg swelling and states his symptoms started suddenly.
  • He has a history of hypertension and DVT years ago.
  • His only current medications are benazapril, metoprolol and aspirin.

EXAM:

  • BP is 80/68, pulse 124, respirations 28, temperature 99.0 and pulse-ox 99% on face mask.
  • The patient appears acutely ill with labored respirations and is diaphoretic.  Head and neck exam is notable for JVD and the upper torso and face appear plethoric.   Lungs have a few scattered ronchi, but are otherwise clear.  Heart is tachycardic without extra sounds.  The abdomen is non-tender and the legs have no edema.

TESTS:

  • Suspecting a possible PE a CT scan of the chest is ordered and you debate whether or not to start empiric heparin.
  • EKG shows tachycardia and non-specific changes.
  • CT images (see image below)

Chest Pain and Hypotension CT

COURSE:

  •  The patient’s nurse tells you he is unresponsive.  You rush to the bedside and note the patient to be in PEA at a rate of 145.

QUESTIONS:

  1. What should be your first intervention?

 

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ANSWER:

  1. Pericardiocentesis: You need to do a stat pericardiocentesis.  The image shows a type A aortic dissection with acute hemopericardium causing tamponade.   Images below show a higher cut and a similar level cut with different windowing.

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 Tamponade from Dissection

 

Cardiac Tamponade from Aortic Dissection CT

 

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