She did not have CPR. The paramedics reported difficulty in finding a pulse after collapse so it possibly correlates with profound hypotension. There were no recorded pre hospital arrhythmias.
Indeed the original collapse could have been an arrhythmia but unusual to become so acidotic and have a respiratory arrest without a cardiac arrest if so?
I don't think pulm oedema was a factor. Her lungs were clear after the initial bronchospasm and pre hospital BVM probably not effective enough to totally resolve that degree of pulm oedema yet still leaving the patient acidotic and hypercarbic. Also, she received 2.5L fluids over a short space of time which would quite likely have tipped her back into pulm oedema if this were present initially.
Also agree probably not DKA.
I think also not PE. I was not getting hung up on the elevated d-dimer being specific for PE but rather, emphasising that I do not think the negative CTPA in this case is likely to be a false negative given the size of a embolism needed to cause this degree of compromise.
I was more wondering about alternative explanations for a suddden collapse preceeded by dyspnoea and cyanosis resulting in coma and mixed acidosis but rapid full recovery with little active treatment other than oxygenation and ventilation?
-----Original Message-----
From: "John Ryan" <[log in to unmask]>
To: [log in to unmask]
Sent: 15/08/08 06:09
Subject: Re: Interesting Case
Has she bled somewhere to give the raised D dimer ? Was there CPR with
fractured ribs ?
I have read a paper recently on elevated d-dimer in Aortic dissection.
Whats with the 'possible transient PEA' ?. Was there no ambulance rythm
strip ? She has an abnormal heart, previous MI, on ACE inhibitor. Could
this not have been an arrythmia ?
Did she have glycosuria ? I suspect its not DKA. Maybe she decomepnsated
because of VT and the resultant cardiac failure cleared with positive
pressure ventilation and the normalisation of her rythm. What was her intial
CVP ? Perhaps the decompensation caused a NSTEMI. After all if she had a MI
10 yars ago (and she is in your catchment area David ;-) ) then her
coronary arteries are unlikely to have actually got better in the last 10
years, presuming she had no post MI intervention such as angioplasty
John Ryan
----- Original Message -----
From: "David Menzies" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, August 15, 2008 12:22 AM
Subject: Interesting Case
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