Case 2

Ethan Krauspe, Richa Sheth

Case 2

58F with history of CAD s/p multiple remote DES, HLD, T2DM, Active smoker now admitted for UTI with sepsis.

Telemetry alarms “code blue” on hospital day 2.

On initial assessment, pulses are absent.

Labs

Glu152 mg/dL , hs-TnI 121 ng/L (ULN 50), Lac 6.5 mmol/L

ABG Result Reference Range
pH 7.18 7.35–7.45
pCO₂ 48 mmHg 35–45 mmHg
pO₂ 64 mmHg 80–100 mmHg
HCO₃⁻ 16 mmol/L 22–26 mmol/L
Na⁺ 137 mmol/L 135–145 mmol/L
K⁺ 4.9 mmol/L 3.5–5.0 mmol/L
Cl⁻ 103 mmol/L 98–106 mmol/L
iCa²⁺ (ionized) 1.10 mmol/L 1.12–1.32 mmol/L

Rhythm Check

Post-ROSC EKG

Post-ROSC EKG

Next step?

Teaching Points

  • Time to first shock is critical in VF

  • Role of antiarrhythmics is adjunctive, not primary

  • VF/VT: Think.. acute MI (sudden, chest pain), electrolyte derangements, drug toxicity

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