Cardiac arrest after STEMI and importance of early cardiopulmonary resuscitation in non hospital setting-time is life/myocard

Abstract

INTRODUCTION: In 23 % of cases, sudden cardiac death can be the first manifestation of coronary artery disease. In these cases pulseless VT and VF are the most common causes for cardiac arrest. Early appropriate resuscitation - involving early defibrillation and appropriate implementation of post-cardiac arrest care lead to improved survival and favorable neurologic outcomes. AIM: Case of successful CPR for out of hospital cardiac arrest (home visit), importance of timely and adequate implementation of CPR by EMS staff. MATERIALS AND METHODS: A descriptive overview of data, dispatcher's Protocol, Physician's Protocol and Patient's Discharge Note. CASE PRESENTATION: At 10:29 pm the emergency crew was dispatched to the scene for 73 y/o woman who was suffering chest and left arm pain. Crew arrived at the patient's residence 4 minutes after the call. The patient's daughter states that her mom had SOB and chest pain that radiated to left arm just 30 minutes prior emergency crew arrival. Ther patient did not have any other cardiac risk factors apart from her age and history of oh da izvini hypertension. During immediate examination the patient's vital signs are stable. (BP 140/80, saturating 95% on room air, pulse 90/min.) Physical exam revealed decreased breath sounds billateraly. The patient was in her bed , dyspneic, awake and alert. During the physical exam, the patient lost her consciousness, and became apneic and pulseless. The patient was immediately moved from the bed to the floor and CPR was started and iv lines were placed. Defibrillator pads (AED) were placed and the recorded rhythm was recognized as ventricular fibrillation (VF). DC shock of 150J was delivered. After defibrillation cardiac monitor registered short asystole and later on short self terminated atrial fibrillation. The patient was lethargic for very short period of time, there were visible spontaneous respirations. Her pulse was palpable and her blood pressure was 135/65. The patient was immediately transferred to clinical center. While being transported to hospital, the patient was given 6 L of oxygen by nasal canula and NS 500 ml. During the patients transport an ECG showed sinus rhythm of 85 bpm with ST segment elevation of 2 mm in III and avF and ST segment depression of 2 mm in I, avL.At the hospital, the patient was transfered to CCU. CONCLUSION: Early CPR and early defibrillation are very important to preserve brain function and function of the other organs. As we can see, immediate CPR followed by early defibrillation dramatically improves survival and favorable neurological outcomes.

Keywords

• cpr
• out of hospital cardiac arrest
• defibrillation