Cooling Cardiac Arrest

Report:

Sinus rhythm 99/min

Intraventricular conduction defect c/c hypothermia

Nonspecific ST/T changes

Prolonged QT interval 0.40”

QTc 0.84”

Movement artefact V3

Comment:

The hypothermic humps are rather inconspicuous, but there once one looks for them (as one would, in this setting). They grew bigger as the temperature dropped further, from 34oC to 33.5oC (Fig 52a). The rate slowed down, to 88/min.

It is now accepted that out-of-hospital arrest patients recover more brains if promptly cooled46. This requires mechanical ventilation and paralysis, but I have for a long time ventilated all VF patients requiring intubation for 24 hours anyway, feeling (without proof) that it gives them a better cardiac outcome.

Fig 52b is her admission ECG. Diffuse and marked ST depression suggests main left disease.

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