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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 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 and aspirin.

EXAM:

  • BP is 80/68, pulse 124, respirations 28, temperature 99.0 and pulse-ox 99%
  • 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:

  • 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 and BP improved and patient woke up.  Was taken to the OR and survived.

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