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Prehospital POCUS: Why I love it! Real Clinical Scenario.
10 Lug73 yrs old male found unconscious by his wife. CPR started by a neighbour with pre arrival CPR instructions provided by dispatcher. We found him in asystolic cardiac arrest. Established mechanical chest compressions (MCC), ventilated through an 8.0 ET tube, placed an intraosseus access, 10 min of ALS and 2 mg of epinephrine later, on the monitor appears an organised rhythm at 40 bpm (narrow junctional shape), NO CENTRAL PULSE. After 2 min (CPR still going) same rhythm stil NO CENTRAL PULSE but this time, during the MCC pause, a subcostal view of the heart was obtained (sorry for the quality of the images but were recorded during the code and I’m not an expert but just an ultrasound user)
As you can see the heart is moving and the right ventricle is almost the double of the left one. Due also to the clinical history of a recent surgical knee replacement the most probable origine of the cardiac arrest is PE. We decided to continue chest compressions, but to stop epinephrine at 1 mg dose, starting push doses of 0,1 mg till the return of a central pulse. After 5 min a strong carotid pulse appeared and this is the ultrasound view of the heart at that moment
The patient arrived to the hospital sedated and paralysed in assisted pressure control ventilation. You can see on the monitor the rest of vital signs.
No follow up yet.
You can read more about PEA and Pseudo-PEA on MEDEST
Forget ACLS guidelines if you are dealing with Pulseless Electric Activity. Part 1.
Forget ALS Guidelines when dealing with PEA. Part 2.
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Tag:ACLS, Advanced Cardiac Life Support, arresto cardiaco, cardiac arrest, ecografia, emergency medicine, medicina d'urgenza, PEA, POCUS, point of care ultrasound, pulseless electric activity