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Cardiac Arrest*

HISTORY:

A 62-year-old male is transported to the ED with dyspnea and diaphoresis.   His symptoms started about an hour prior to arrival.  He denies any chest discomfort, fever or leg swelling and states his symptoms started suddenly.  He has a history of hypertension and DVT years ago after a knee surgery.

EXAM:

BP is 80/68, pulse 124, respirations 28, temperature 99.0 and pulse-ox 99%.  The patient appears acutely ill with labored respiration and diaphoresis.  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:

  • EKG shows tachycardia and non-specific changes.
  • CXR looks normal
  • Suspecting a possible PE a CT scan of the chest is ordered and you debate whether or not to start empiric heparin  (see CT 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 does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

 

SCROLL DOWN FOR ANSWER, TO SUBSCRIBE OR TO MAKE COMMENTS

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ANSWER:

  1. What does the case image show?  The image shows a type A aortic dissection with acute hemopericardium causing tamponade.   Image below shows a higher cut.
  2. What should you do next?  You need to do a stat pericardiocentesis then call thoracic surgery.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

 

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 Tamponade from Dissection

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CASE CONCLUSION: Pericardiocentesis was done in the ED and the vital signs improved and patient woke up.  He was taken to the OR by thoracic surgery and survived.

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