Extreme shock and cardiac arrest in COVID patient

This is a 30-something healthy patient presented with COVID pneumonia who presented to the ED.  He was moderately hypoxic.  He had the following EKG recorded:Low voltage, suggests effusion.(see Ken ' s discussion of low voltage below)There is a QS-wave in V2.There is minimal, probably normal STE in V2-V6.A bedside cardiac ultrasound was normal, with no effusion. He had troponins ordered, and the first returned at 72 ng/L (Abbott Architect hs cTnI; URL for males = 34 ng/L).  An elevated troponin in a COVID patient confers about 4x the risk of mortality than a normal one.He was admitted on oxygen and was doing fairly well with saturations of 100% on 2 L nasal cannula. By the next day, the hs-cTnI was up to 1827 ng/L.  A Rising TroponinThat afternoon, he complained of increased shortness of breath and was noted to have oxygen saturations in the 70s, prompting a mini code to be called. The physicians found him to be in shock, with very poor O2 saturations.  He was intubated and then went pulseless.  He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock.  Bedside echo at this point showed a flat and collapsible IVC, so he was given fluids, and also pressors.  He lost pulses again, and after chest compressions again had ROSC and was put on more pressors.  Lactate was 20, POC Cardiac US showed EF estimated at 30%, and formal echo showe...

Source: Dr. Smith's ECG Blog - November 12, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs