A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Conclusions: outpatients with witnessed cardiac arrest and primary PEA carry a high probability of Massive Pulmonary Embolism________________Case Continued:" Initial ROSC EKG showed what appeared to be in atrial fibrillation with inferior ST elevations, depressions in aVL, concerning for STEMI. "He had multiple cardiac arrests with ROSC regained each time. " Endotracheal tube re-intubation was confirmed multiple times, bilateral breath sounds, yet O2 saturation remained in the 50s and 60s. I was able to visualize the ETT on initial intubation pass through the cords however given his continued hypoxemia, I felt it best to replace the tube to ensure no cuff malfunction or iatrogenic cause of his low O2. I spoke with cardiology regarding his EKG findings, who did not feel as though patient was a cardiac catheterization candidate at that time. "Repeat ECG:This is classic PE morphology, with T-wave inversions in V1-V4 and also in lead IIILimited ED US showed a dilated right ventricle and right lower extremity DVT." Decision was made to push tPA after approximately 25 minutes of CPR, and after approximately 25 minutes after tPA was given, O2 saturation increased to 97%, and the patient was no longer cyanotic, converted to normal sinus rhythm with anterior lateral T wave inversions with ST depressions. "" After approximately 1 hour of total intermittent CPR time, final ROSC achieved....Patient did have extremity movement during central line placement. On epinephrine and no...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs