27 male acute retrosternal typical chest pain wtbreathlessness since 1 hr. Vitally stable wt chest clear. Suddenly patient collapses wt was resuscitated wt DC given for ventricular fibrillation but not revertin by dc.electrolytes normal wt bicarb correction given for metabolic acidosis. Patient died within 20minutes.

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One should try to find out few treatable potential cause of cardiac arrest. American Heart mentioned 5H and 5H Hypovolemia,Hypoxia,Hydrogen ion (acidosis),Hyper-/hypokalemia and Hypothermia. Toxins,Tamponade(cardiac),Tension pneumothorax,Thrombosis (coronary and pulmonary) In this case we can consider coronary thrombosis, tension pneumothorax ( due to spontaneous pneumothorax?) and toxin ( some poisoning). However in such a short course and young age really difficult in given scenario.

Too good sir. very very helpful . 5h 5t

ECG showing Ventricular fibrillation. its Shockable rhythm. ACLS protocol should be followed immediately. Agree with Jeetendra sir, should look for 5H & 5T's which are reversible causes of cardiac arrest(VF/Pulseless VT,PEA & asystole). If we look at the history, it points towards ACS leading to ventricular arrhythmias. And within a short span of 20 minutes , there is nothing more to do except resuscitation. Only after Stabilising the patient we can think of causes.

we can defibrillate the patient by clinical assessment also if there is high suspicion of VF/pulseless VT. What we should do, when a patient arrives in severe distress-- 1.connect monitor/defibrillator 2.quick assessment ,vitals 3. go for ECG . (if no monitor available or getting delayed due to some problem, just charge the defib )& be there beside the patient whole doing ECG , look for arrhythmias. even if single lead shows changes of VF/VT don't wait for further leads , go for defibrillation immediately. if in doubt about rhythm( whether shockable or not) look at the patient, he is never comfortable, mostly unconscious. check central pulse for maximum 10 sec, if absent , its shockable rhythm. 4. sometimes patient comes & before any assessment can land into arrhytmias/cardiac arrest. here also no need to wait for ECG , go for Defibrillation f/b CPR acc to ACLS.care of ABC. in any case like this , early intervention is the most important thing. 6. just be careful, to look for absence of central pulse, in a patient who comes in seemingly cardiac arrest like state viz , hypoglycemia, shock etc. Inexperienced practitioners can do such mistakes(not always but is possible). just giving this elaboration so that students can learn about importance of early intervention. correct me if any mistake is there.

We rarely find the ECG of ventricular Fibrillation... Bcoz instead of wasting time in taking ECG, we could have Defibrillated the Pat.... In ventricular Fibrillation...every second counts....if we use that second by defibrillating the Pat, followed by CPR in cycles...their is increase chances of survival... watever is the cause for vf...

correct we rarely get a 12 lead ECG in vf. only rhythm strip should be obtained.& immediate Defibrillation.

I agree with Dr sandeep , pulmonary embolism could be the likely cause for cardiac arrest in this case

Absolutely correct sir. May I ask with your permission , why you are suspecting Pulmonary embolism as the likely cause more than ACS/MI?

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The case indicates towards pulmonary embolism.

ecg show V.F

pulmonary embolism more likely

Ecg is on monitor....PM findings...cardiomegaly early gross myocrdial infarction of left ventrixle.

It must have been Left Main disease

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pea with fibrillation

acute myocardial infarction

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