Cardiac Arrest in a Patient With Pulseless Electrical Activity

Vital Signs

• Temperature: 95.7 °F, axillary

• Blood Pressure: 80/40 mmHg while CPR being performed

• Pulse: could not be palpated

• Respiratory Rate: Ambu-bagged at ten breaths per min

• Pulse Oximetry: 88% on 100% oxygen with Ambu-bag

Focused Physical Exam

A limited exam was done in the setting of cardiac arrest. It showed a pale, elderly appearing male undergoing chest compressions and bag-valve ventilation. No spontaneous activity was present, and the patient was pulseless. No other examination was performed during CPR.

Interventions

The patient was intubated emergently to secure the airway. A total of two rounds of CPR were performed, and a total of two ampules of 1 mg (1:10,000) epinephrine were administered. A sine wave pattern was seen on the cardiac monitor during CPR ( Fig. 14.1 ). Return of spontaneous circulation (ROSC) was achieved after 5 min, and normal sinus rhythm was restored. Examination after the achievement of ROSC showed that the patient was responding appropriately to painful stimuli. A stat electrocardiogram (EKG) was obtained and showed peaked T waves in the precordial leads ( Fig. 14.2 ). Stat point-of-care (POC) electrolytes were obtained, which showed hyperkalemia with a potassium level of 7.2 mmol/L. Intravenous (IV) calcium gluconate, IV insulin and dextrose, albuterol nebulization, and 40 mg IV Lasix were administered. A stat basic metabolic panel was obtained and confirmed the POC electrolyte derangements. Serum magnesium and troponin levels were unremarkable. The glucose level was normal. He was transferred to the intensive care unit for further monitoring.