30 Year Old with Cardiac Arrest, PEA, then Cardiac Ultrasound

A 30 year old collapsed after complaining of chest pain intermittently.  He was unconscious.  First responders thought they palpated a thready pulse.When medics arrived, there was no pulse.  Full CPR was initiated with the LUCAS device.  The  patient was intubated, an ITD (ResQPod) was used.  Other standard cardiac arrest measures were undertaken.Here is the rhythm strip (these are two separate tracings):The initial rhythm is regular and wide complex, with concordant ST elevation, suggesting STEMI.  The next rhythm appears to be ventricular fibrillation.The patient could not be resuscitated, but was transported to the ED after about 30 minutes of full arrest.Upon arrival, as is customary, a very brief ultrasound was performed to assess ventricular function.What do you see?  See below, with arrowsWhite arrows outline a very large thrombus (clot) in the pericardium.  Red arrow points to a small amount of liquid blood in the pericardium.  Blue arrow points to the RV, where there is full stasis of blood flow.  Green arrow points to barely beating LVHere is one more brief view before chest compressions resumed:Here is a view during LUCAS chest compressionsOf course, chest compressions are not of any use when there is massive tamponade.  Even when the heart is fully beating on its own, it will arrest if there is severe tamponade because it cannot generate adequate pressures for myocardial perfusion.  So how would exte...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs