Answer Happy

CASE STUDY: Jack Reacher Location ED Introduction It is 0705hrs and you are working a morning shift in the Emergency Department. During handover you hear the Batphone (emergency phone) ring indicating an emergency case is enroute via ambulance.... Situation 54 year old male - Cardiac arrest with CPR in progress Arrest witnessed by partner at approximately 0650hrs who immediately called 000 and commenced CPR Currently monitoring in ventricular fibrillation (VF). X1 attempt defibrillation as per ANZCOR guidelines - 200 biphasic UNSUCCESSFUL No IV access currently insitu Down time: approximately 15 minutes Estimated Time of Arrival (ETA) to ED = 2 minutes.
Background- limited history available at this time PMH: TIDM, HTN, NSTEMI 2018 Drugs: Metoprolol 25mg BD, aspirin 100mg PO Daily Allergies: unknown Assessment/Observations from ambulance staff: - A-airway adjunct insitu = guedels airway size 100mm B-ventilated via bag valve mask C-monitoring in Ventricular Fibrillation D-GCS 3/15 E1V1M1, Pupils fixed and dilated size 5mm E-temp 36.9, diaphoretic +++ F-Nil G - Glucose 6.8mmol/L
On arrival to the ED this is the initial rhythm: ਆਈ ਹੈ, ਪਰ ਆ ਹੀ
An arterial blood gas is taken at the start of the resuscitation: 7.282 55.1 69.7 mmHg mmHg 17350 - 7460 350 - 45.0 1 | 750 - 100 1 23.3 -1.2 mmol mmoll. 1-30 - 30 1 Blood Gas Values .PH 1 pco, Ipo Acid Base Status CHCO, IP st) Basec Electrolyte Values ck Na* cca Ca"(7.4% CH Metabolite Values 1 Glu 1 clac 2.2 mmol 3.4 - 5.5 1 1136 - 146 1 115 - 1.30 ] 137 1.08 1.01 100 mmol. mmo mmol/l mmol/l 94 - 107 1 60 2.7 mmoll mmoll ! 1 39.58 05 - 20 1 1