A Cook County Hospital Emergency Medicine Blog for up-to-date medicine and more.
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This week’s cheese post will review recent literature that examines the role of antiarrhythmic medications in shockable cardiac arrest. Although algorithmic, these data may suggest some nuance in your approach to the management of shockable rhythms can improve your chances of obtaining ROSC.
Vladimir Bernstein, MD
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Figure 1. Still images from point of care echocardiography of patient noting a dilated aortic root, early RV diastolic collapse in the context of a pericardial effusion, and an aortic dissection flap. Left: aortic root measuring 5.3cm; Right: early RV diastolic collapse with dissection flap
The Case:
A 40-year-old man with no known past medical history presented for evaluation of chest pain. According to the patient’s fiancée, the patient was experiencing chest pain one day prior to presentation. He continued to have chest pain and was seen at an urgent care clinic, where he was referred to the Emergency Department for an abnormal EKG and chest radiograph. While in the waiting room, the patient had a syncopal episode and was brought back to a station. The patient has no significant surgical or family history. He is a lifelong nonsmoker and occasional social drinker.
Vladimir Bernstein MD
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Background: The management of cardiogenic shock is complex, often requiring tandem use of vasopressors and inotropes to stabilize hemodynamics. But what inotrope is more effective, dobutamine or milrinone?
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