An elderly woman with dyspnea, asystolic arrest, resuscitated

911 was called for a very elderly dialysis patient for acute onset of dyspnea.On arrival, medics found the patient with agonal respirations. Chest compressions were started and 2 doses of epinephrine givne, and she was found to be in asystole, which then changed to PEA at some point, then to ventricular tachycardia. A King airway was placed.This is her prehospital ECG:What do you think?My thoughts are below.On arrival, she was hypertensive and tachycardic. Due to concern for hyperkalemia, Calcium was given empirically. Cardiac ultrasound showed poor LV function and normal RV size. K returned at 5.8 mEq/L (not high enough to be responsible for all of this).An ED ECG was obtained:What do you think?ECGs:Prehospital:--There is sinus tachycardia.--The large R-wave in V1, with wide S-wave in V5 and V6 shows late forces toward V1 and away from V5 and V6, and is therefore diagnostic of right bundle branch block (RBBB).--The large inferior S-waves, with a small q- and large R-wave in aVL are diagnostic of left anterior fascicular block.--(Bifascicular block, RBBB and LAFB).--Importantly, the PR interval is normal. If prolonged, there would beso-called trifascicular block.These findings alone are very suggestive ofLAD or left main occlusion. Every such case I have ever encountered was in a patient with either left main occlusion or LAD occlusion and the patient was near death or post-arrest.This is a very bad sign, and the ST Elevation in these cases ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs