Changing channels

--> UPDATED: 11/04/2010 - Patient Follow-Up Posted.  CLICK HERE FOR THE ANSWER

You are dispatched to a local restaurant for 27-year-old male who is unconscious. En route to the scene, dispatch gives you an update that the patient is in cardiac arrest At the time of EMS arrival, the patient is found supine on the floor in cardiopulmonary arrest.

Effective chest compressions are being performed by a nurse who had been having dinner with her husband. The patient is a server at the restaurant. His co-workers report that the collapse was witnessed and the patient had been behaving "normally" prior to the event. They are unaware of any significant medical history. The cardiac monitor is attached.

Paramedics deliver a shock at 150 J.

The post-shock rhythm is disorganized. CPR is continued per AHA guidelines.

The airway is captured with a King LT-D and asynchronous ventilations are delivered at a rate of 10/min with a good ETCO2 waveform.

An 18 ga IV is established in the left antecubital space. 1 mg of epinephrine 1:10,000 is given IVP.

2 minutes later an organized heart rhythm is noted on the monitor.

Vital signs are assessed. RR: 0 HR: 130 BP: 118/68 The patient remains comatose and therapeutic hypothermia is initiated using iced saline.

A 12-lead ECG is captured.

--> UPDATED: 11/04/2010 - Patient Follow-Up Posted.  CLICK HERE FOR THE ANSWER

About the author

Tom Bouthillet is a Fire Captain/Paramedic with Hilton Head Island Fire & Rescue, Editor-in-Chief of the, Chief Content Architect of, host of the Code STEMI web series at First Responders Network, a member of the Editoral Advisory Board of EMS World Magazine, and developer of the 12-Lead ECG Challenge smartphone app. He has taught nationally in the Critical Care Transport (CCEMT-P) program out of UMBC and his writings have been referenced in the American Heart Journal, the Journal of the American College of Cardiology: Cardiovascular Interventions and the EP Lab Digest. Contact Tom at

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