Evaluated and attempted to treat reversible causes as below:
Hypovolemia – appeared euvolemic on exam, IVF fluids administered via multiple IV/IO access sites
Hypoxia – pt ventilated with 100% O2 w/ symmetric breath sounds, good chest rise
Acidemia – iStat obtained, no evidence of significant acidosis that would likely benefit from bicarb
Hypo/hyperkalemia – iStat obtained, no no evidence of significant hyper-kalemia that would likely benefit from medical interventions
Hypothermia – pt warm on skin exam, no hx suggestive of hypothermia, normal temp by RN
Tension Pneumothorax – unlikely given breath sounds bilaterally, bedside US shows normal lung sliding (unable to upload images given emergent situation)
Tamponade – unlikely given no evidenc pericardial effusion nor evidence of tamponade on cardiac US, no dilated neck veins, no hx suggestive of patient having pericardial effusion.
Toxins – unlikely given no toxidromic picture on exam, no hx of toxin ingestion
Thrombosis, pulmonary – unlikely given no hx suggestive of high risk for VTE, no unilateral LE swelling.
Thrombosis, coronary – unlikely though patient does not meet our threshold for empiric thrombolytics given history, findings on exam, and futility of thrombolytics given prolonged time without pulse
Additionally, given prolonged time without pulse, exceedingly unlikely benefit from any empiric treatment for any of the above etiologies in the context of a non-high pretest probability for that etiology to the patient’s arrest.
MDM (with A/P):
Patient presented without pulse. Per protocol of ACLS, patient was resuscitated. Reversible causes evaluated and treated if likely to provide benefit. After resuscitation, patient had no pulse and no cardiac motion on cardiac US. As such, patient further resuscitation attempts would be futile and likelihood of neurologically intact recovery essentially non-existent. As such, resuscitation was ended.
Attempts to include family in code and discussion were made. SW consulted and assisted with contacting family and to provide assistance with bereavement, resources for religious or other social support.
Given limited history (patient unable to provide history and limited collateral able to be obtained given emergent attention to patient required), etiology of cause of death can be conclusively stated. Suspected to have cardiac arrest.
COUNSELLING: Discussed sequence of events, code, and outcome of death with family educated on diagnostics. All questions and concerns answered and addressed.