Question

A 58 year old man experiences sudden cardiac arrest at home while watching football with his family. The patient’s son witnesses his father collapse, calls 911 and reports the incident. The dispatcher coaches the son in hands only chest compressions on his father. The police arrive within two minutes and apply an AED to the father which advises to defibrillate. One shock is delivered and the police officer takes over compressions. Two minutes later the fire department arrives and takes over cardiopulmonary resuscitation from the police officer. A second shock is advised by the AED and the patient is again defibrillated. The BLS crew administers oxygen at 15 LPM to the BVM while assisting ventilations and performing compressions.

Paramedics arrive from the local ambulance service and initiate intravenous access and endotracheal intubation while the fire crew continues high performance CPR. At the end of this two minute cycle of CPR the patient’s rhythm is analyzed and determined to be ventricular fibrillation. A third shock is delivered. CPR begins again and the paramedics administer 1 mg of epinephrine. On the next rhythm check, after two minutes of CPR, the rhythm is determined to be a sinus tachycardia with a pulse. The patient remains unconscious and the EMS personnel prepare the patient for transport.

In route the patient is assessed and found to have a strong pulse at 115 beats per minute but he remains apneic. His ventilations are assisted via an advanced airway at 12 per minute with a BVM attached to 100% oxygen at 15 LPM flow. His blood pressure is 86/52 with a GCS of 3. The patient has no significant medical history other than mild hypertension for which he takes Lisinopril.   They arrive at the hospital in five minutes, approximately 10 minutes after the patient collapsed.

Question 1 pts

What prehospital factors are present in this scenario that indicate this patient has an improved chance of survival from his sudden cardiac arrest?

On arrival to the Emergency Department, report is given to the medical and nursing staff. The patient remains unresponsive, with a strong pulse, continues to be apneic with assisted ventilations and a low blood pressure. The IV is infusing a crystalloid solution and the advanced airway is positioned correctly. Arrangements are made to transfer the patient to the cardiac catheterization lab for an emergent angiography and intervention. The ED begins targeted temperature management with a core body temperature between 32 and 36 degrees Celsius to continue for 24-48 hours and restrict oxygen administration to maintain oxygen saturations between 94 and 99% in preparation for transfer to the cardiac catheterization lab.

Question 2 pts

What are the advantages and disadvantages to targeted temperature management in the post cardiac arrest victim? Explain your answer.

  

Question 3 pts

What are the advantages and disadvantages to titrated oxygen administration in the post cardiac arrest victim? Explain your answer.

Answer 1

1- prehospital factors that are present in this scenario that indicates this patient has an improved chance of survival from his sudden cardiac arrest are-

a-  strong pulse at 115 beats per minute.

b-  The patient has no significant medical history other than mild hypertension.

2- Advantages of Targeted temperature management are-

i- It minimizes post-anoxic injury.

ii- It improves neurological outcome.

iii- Maintain specific body temperature.

Disadvantages of Targeted temperature management are-

i- it is a bit complex

ii- should be done for at least 24 hours.

iii- increase in temperature is results in worse neurologic outcome.

3- Advantages to titrated oxygen administration-

i-better control of oxygenation

ii-better monitoring

iii-early hospital discharge

Disadvantages to titrated oxygen administration-

i- shortness of breath

ii-headache

iii-coughing