Case 1

Ethan Krauspe, Richa Sheth

Case 1

70M with ESRD found unresponsive on the floor.

No pulse.

CPR in progress, IV Access Obtained

Labs

  • Acid-base: pH 6.98, HCO₃⁻ 12, pCO₂ 55.
  • Hyperkalemia signal: K⁺ 7.2, iCa²⁺ 0.98.
  • Context: lactate 9.2, hs-TnI 11k, glucose 98.

Rhythm:

Analysis:

Fine VF vs Coarse VF vs Asystole

Team interface prompt

The bedside nurse is recording events and knows the first rhythm seen on the monitor.

Ask:

“First rhythm? CPR start time? Next pulse check?”

Assign: timekeeper, compressor switch, defib, meds/pharm.

Teaching Points

  • No shock for asystole.

  • But, always confirm not fine VF

    • Enroll your colleagues help

    • If unsure, make the less bad error.

  • Calcium, bicarbonate, and insulin-glucose are cause-directed treatments for suspected hyperkalemia. They are not routine arrest medications.

Case summary

Label: Metabolic derangements / ESRD - asystole versus fine VF.

Key issue: confirm true asystole versus fine VF; hyperkalemia treatments are cause-directed, not routine arrest medications.

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