75 y male Brought unconscious No pulse No sign of life Declared dead Attenders told ecg was only done at nearby center And they shifted patient to our hospital and it took more than 1 hour . Interpret ECG and discuss what could have been done to save his life !!



ECG-VF alternating with VT Since VF was identified an hour ago it’s futile to attempt anything.After one hr of VF which is practically a asystole it is very difficult to revive and even if you succeed reviving the quality of life is debatable. It will only add up to the misery and financial burden to the patient’s attenders.However connect the patient to a cardiac monitor,if VF you can attempt defibrillation if asystole it’s no point going ahead in view of a documented VF an hr ago and patient presenting with no pulse and no respiration What could have been done in the earlier hospital was: After confirming VF and absence of carotid pulse CPR as per ACLS guidelines should have been immediately started and Defibrillated. If persistent VF drugs like adrenaline/vasopressin,Amiodarone could have been considered. Upon return of carotid pulse patient could have been intubated if needed and started on vasopressors if needed. Searched for reversible causes and corrected if any. A good CPR and defibrillation could have changed the scenario possibly.

This is right and is documented to be successful if pulseless VT/VF treatment started within few seconds to minutes, here the patient is already beyond resuscitation

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Ventricular fibrillation .immidiate cardiac ablation ie defibrilation with other life saving measures as per situation with maintaining ionic balance and maintain bp with inotrps and spo2.

Sir, If the patient is declared dead then why are you giving the advice of life saving measures you mentioned? Sorry, I can't understand

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Polymorphic VT. CPR, DC Shock, iv Adrenalin 1 mg every 3 - 5 min, M. O2 10 - 12 L / min, iv inj Amiodarone 300mg bolus with 10 ml NS, 1 mg/min for 6 hours then maintenence dose of, 0.5 mg/ min for 18 hrs and may be continued with the same dose if required. Fluid RL + NS 1 : 1 2 Lit bolus stat and sos, then 6 hrly. ABG 4 hrly, CBG, CBC etc PH, FLUID AND ELECTROLYTES balance.

Sir you are prescribing to a dead pt.

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V fib, could have been the terminal event, difficult to say that it was the cause of death., but normally we try DC shock to resuscitate the pt.along with dextrose & soda bi carb.

CPR...DFib.....Its VFib

This ECG is suggestive of ventricular fibrillation. At the first medical centre patient must have been checked for signs of life and enquired for the duration of unconsciousness. Immediate CPR and DC cardioversion in time by a staff trained in BLS and cardio version could have saved his life.

Attempt should always be made to save patients in shockable rhythm... start ACLS.. shock as early as possible ... this is the current AHA Advice

Since it's a Torsade de pointes VF the first hospital should have asked for offending drugs,DC version attempted and IV inj MGSO4 should have been given along with other resuscitation

VF, defibrillation and cpr should've been done in prev hospital

Polymorphic VT with torsede pointis,DC synchronised shock and inj amiodarone 150 mg iv stat

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