TY  - CHAP
M1  - Book, Section
TI  - Cardiac Arrest and Anoxic Brain Injury
A1  - Malhotra, Rishi
A2  - Lee, Kiwon
PY  - 2012
T2  - The NeuroICU Book
AB  - A  62-year-old  man  with  past  medical  history  of  hypertension  was  in  a  heated  argument  with  his  son  when  he  suddenly  complained  of  dizziness  and  collapsed  to  the  floor.  The  son  called  911,  and  paramedics  arrived  on  the  scene  in  8  minutes.  The  patient  was  pulseless  and  cardiopulmonary  resuscitation  (CPR)  was  initiated.  He  was  found  to  have  ventricular  fibrillation  (VF).  A  200-joule  biphasic  shock  was  delivered  without  success.  Chest  compressions  were  continued  and  intravenous  (IV)  vasopressin  40  units  was  given.  After  five  cycles  of  chest  compressions  and  breaths,  a  360-joule  (maximum  for  this  unit)  biphasic  shock  was  delivered,  with  conversion  to  a  wide-complex  rhythm  at  120  bpm.  The  blood  pressure  (BP)  was  120/70  mm  Hg.  Amiodarone  300  mg  was  given  IV.  Estimated  time  from  collapse  to  return  of  spontaneous  circulation  (ROSC)  was  15  minutes.  He  was  intubated  at  this  point  and  then  transported  to  the  emergency  department  (ED)  of  a  local  hospital.On  arrival  at  the  ED,  the  patient  was  in  a  narrow-complex  sinus  rhythm  at  89  bpm,  his  BP  was  149/85  mm  Hg  (without  pressors)  with  a  temperature  of  36°C.  Spo2  100%  on  a  Fio2  of  0.5.  His  electrocardiogram  (ECG)  did  not  reveal  any  ST-T  changes,  or  bundle  branch  blocks.  The  QTc  was  normal  and  there  were  no  Brugada-type  changes.  Initial  labs  were  remarkable  only  for  a  negative  troponin  I  (TnI).  An  echocardiogram  revealed  concentric  left  ventricular  hypertrophy  with  high  ejection  fraction  and  no  regional  wall  motion  abnormalities.  The  chest  radiograph  was  clear.  A  computerized  tomographic  (CT)  scan  of  the  head  was  unremarkable.The  patient's  initial  neurologic  examination  showed  no  response  to  verbal  stimulation  and  no  eye  opening  to  noxious  stimulation.  He  had  reactive  pupils,  trace  corneal  reflexes,  weakly  present  horizontal  oculocephalic  reflexes,  no  gag  reflex,  and  a  weak  cough  reflex.  Upon  noxious  stimulation,  he  had  extensor  posturing  of  the  arms  and  triple  flexion  in  legs.  The  Glasgow  Coma  Scale  (GCS)  score  was  4.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/16
UR  - neurology.mhmedical.com/content.aspx?aid=1101642982
ER  -