Conclusion to 60 year old male CC: Sudden cardiac arrest | EMS 12 ...
This is the conclusion to 60 year old male CC: Sudden cardiac arrest .
As you may recall the resuscitation was implemented using the choreographed or "pit crew" model.
This is characterized by:
Leadership Skills and competencies Teamwork and communication Best practices RehearsalSpecial emphasis is placed on:
Minimally interrupted chest compressions Controlled ventilations Defibrillation Appropriate timing (e.g., pre-charging the defibrillator, shocking every 2 minutes, miminizing delays between stopping compressions and shocking)This is not meant to miminize the importance of the chain-of-survival, including early activation of 9-1-1 and bystander CPR. Those links were intact for this case and that is extremely important.
As you might recall return of spontaneous circulation (ROSC) was achieved, the patient was loaded for transport, and a 12-lead ECG was captured.
Let's take another look.
The obvious question (and the one I usually ask) is whether or not this 12-lead ECG shows STEMI.
However, before we look at that, let's review some important comments from:
Regional Systems of Care for Out-of-Hospital Cardiac Arrest – A Policy Statement From the American Heart Association . Circulation Up to 71% of patients with cardiac arrest have coronary artery disease, and nearly half have an acute coronary occlusion. There is a high incidence (97%) of coronary artery disease in patients resuscitated from OOHCA who undergo immediate angiography and a 50% incidence of acute coronary occlusion. However, the absence of ST elevation on a surface 12-lead electrocardiogram after resuscitation of circulation from cardiac arrest is not strongly predictive of the absence of coronary occlusion on acute angiography (emphasis added). A case series of patients with unsuccessful field resuscitation suggested that in such patients, VF is more likely to be due to coronary disease than is asystole or pulseless electric activity.
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