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Electrical Injury and Prolonged Cardiac Arrest: A Case Report of Complete Neurological Recovery
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Abstract [+]
Introduction
Sudden cardiac arrest continues to have a high mortality rate. Out of hospital cardiac arrest (OHCA) has a poor outcome compared to those occurring in a healthcare setup due to lack of awareness and appropriate resources. The most common rhythm abnormality in OHCA is ventricular fibrillation which requires early defibrillation, ideally on the location.
Case Report
A 19-years male was witnessed by lay bystanders to have become unresponsive following contact with an electric lighting pole on the road median in Chandigarh. A passer-by medical resident detected no pulse and initiated chest compression. Since there was no immediate return of spontaneous circulation and aetiology suggested a defibrillate rhythm. The patient was taken in the car and rushed to a tertiary care centre, 10-minutes away. Cardiopulmonary resuscitation (CPR) was interrupted during transport for lack of adequate personnel. Ventricular fibrillation was noted and shock was delivered along with inotropes. Around 26-minutes into the resuscitation, the patient had the return of spontaneous circulation. After post-cardiac arrest care in intensive care unit (ICU), he was extubated and discharged home in 1-week with full neurological recovery.
Discussion
Recovery of full neurologic function could be explained by the alternating presence of stable and unstable cardiac rhythms and in part at least brought about by immediate attempts at resuscitation. The report seeks to review these aspects of emergency care besides highlighting the need for both immediate and accurate emergency medical services such as lay responder training, public access defibrillation and responsive transport systems for such patients.
Keywords
Sudden cardiac arrest; Out of hospital cardiac arrest; Ventricular fibrillation; Early defibrillation; Electrical injury.
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Current Issue
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Prothrombin Complex Concentrates in Post-traumatic Hemorrhage: A Review
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Prothrombin complex concentrates (PCC) has long been used to reverse vitamin K antagonists (VKA)-induced coagulopathy rapidly and safely. However, its use in trauma-induced coagulopathy (TIC) in patients not using VKA drugs is yet to be elucidated. This article is a narrative review and analysis of the most recent literature to analyse consequences, and intended effects associated with this treatment modality in TIC. Utilization of PCC was addressed in the literature data found by searches of databases. The indications, efficacy and outcomes associated with the use of the product were reviewed in the articles. Some studies point out promising results with respect to PCC use to overcome the VKA-related coagulopathy in victims of trauma. PCC may be a viable option for resuscitation in emergency and critical care in the management of severe hemodynamic deterioration induced by trauma, despite contradictory findings in the literature.
Keywords
Blood coagulation factor; Trauma; Hemorrhagic shock; Exsanguinating hemorrhage.
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Editor-in-Chief
Chien-Chang Lee, MD, ScD
Director Department of Emergency Medicine National Taiwan University Hospital Yunlin Branch No 579, Sec 2, Yunlin Road, Douliou 640, Taiwan
Associate Editors
COL (RET) John McManus, MD, MBA, MCR, FACEP, FAAEM
EMS Fellowship Director Professor Department of Emergency Medicine Georgia Regents University Augusta, Georgia Area USA
Imoigele P. Aisiku, MD, MSCR, MBA, FACCP
Assistant Professor Department of Emergency Medicine Harvard University Brigham and Women’s Hospital 75 Francis Street Boston, MA 02115, USA
Robert Jude Strony, DO, RDMS, RVT
Staff Physician Emergency Department Geisinger Medical Center 100 North Academy Avenue Danville, PA 17822, USA