![]() Whole-body computed tomography scan showed bilateral costal fractures, contained intima rupture of the ascending aorta (Vancouver type 3), left scapular fracture with severe haematoma, and left humeral fracture. Four minutes later, spontaneous circulation returned, with slight thoracic movement and a palpable spontaneous pulse. After interdisciplinary re-evaluation, resuscitation was stopped. Table I medication and medical courseĪfter 30 min of resuscitation using the Autopulse (AutoPulse, Sunnyvale, California), 2 the capnographic curve deteriorated, ECG showed increasing abnormalities, and pupils were dilated with irregularities to the pupillary margins. Venous blood gas analysis showed a pH of 6.96, partial pressure of CO 2 of 11.9 kPa, haemoglobin 105 g litre −1, haematocrit 0.32, and normal electrolytes. Correct placement of both chest tubes was confirmed, and intra-abdominal and thoracic bleeding was excluded sonographically. As there was an unclear cause for the PEA (exclusion of 5Hs, 5Ts), 1 including hypothermia, hydrogen ion (acidosis), hypovolemia, hypo- and hyperkalaemia and hypoxia as well as cardiac tamponade, tension pneumothorax, coronary thrombosis and thrombosis as pulmonary embolism, toxin, a second chest tube was placed on the right to exclude missed injuries. Breath sounds were present bilaterally, with low end-expiratory CO 2 measurable with sufficient chest compressions. Immediate manual resuscitation was started. Despite immediate catecholamine and volume administration, PEA developed. Blood pressure dropped to 54/40 mm Hg with tachycardia. After detection of a normal capnographic curve, positive-pressure ventilation was initiated, and a left chest tube was inserted for flail chest. When admitted to the resuscitation room, in-line rapid sequence intubation was performed because of rapidly increasing respiratory distress. By medical history, the patient was taking antiplatelet therapy. On the way, Glasgow Coma Scale (GCS) dropped to 9 (M5, E1, V3) with unresponsive pupils. He received midazolam, ketamine, phenylephrine, tranexamic acid, and ventilator support by mask for transportation to hospital. Editor-We describe a unique case of a 67-yr-old male with high-energy thoracic trauma who developed pulseless electrical activity (PEA) after tracheal intubation.Īt the scene, the patient was conscious and immobilized on a vacuum mattress.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |