Studio-A EMS Paramedic Podcast

Case Study – 63y/o Female with chest pain

October 29th, 2007

Submitted by Mark Fryou

You arrive on scene of a signal 9 to find a 63 year-old female on the floor in cardiac arrest. According to the patient’s husband, she complained of indigestion earlier.  Shortly after, she grabbed her chest, became unconscious, and slid out of her chair onto the floor. No CPR in progress upon your arrival.

Initial Assessment

• Patient is unresponsive
• Airway-clear
• Breathing-0
• Circulation-no carotid pulse
• ECG=V-fib 

Initial care of this patient includes?

• Immediate CPR for 2 minutes
• Defibrillation at 200 joules
• Immediate CPR for 2 minutes

Case progression
Additional treatment of this patient includes:

• IV or IO
• Epinephrine 1 mg IV/IO
• Secure an advanced airway when possible
• Defibrillation at 300 joules
• Immediate CPR for 2 minutes
• Amiodarone
• Defibrillation at 360 joules
• Immediate CPR for 2 minutes

Discussion
When caring for a cardiac arrest patient, initial efforts should be concentrated on resuscitation. Avoid packaging or moving the patient initially unless your safety is compromised or resuscitation efforts cannot be initiated because of the location of the patient.  Moving and preparing the patient for movement can lead to interruptions in CPR which reduces the likelihood that the patient will be resuscitated.

Remember, high quality CPR with minimal interruptions has a greater impact on patient outcome than advanced airways, medication, or other ACLS therapy. Please pay particular attention to the rate in which ventilations are delivered to your cardiac arrest patients. The American Heart guidelines now call for ventilations at 8-10 per minute.

Entry Filed under: Stories & Cases