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Out-of-hospital cardiacarrest (OHCA) mostly occurs in crowded public places outside hospitals, such as public sports facilities, airports, railway stations, subway stations, and shopping malls. ECMO support therapy for patients with cardiacarrest can be considered when economic conditions permit.
I suspect this is Type 2 MI due to prolonged severe hypotension from cardiacarrest. The patient's heart had significant recovery: Echo : Estimated LVEF 32%, apical wall motion abnormality with diastolic distortion (LV aneurysm), suggestive of old MI. A followup ECG was recorded 2 days later: No definite evidence of infarction.
I would do bedside ultrasound to look at the RV, look for B lines as a cause of hypoxia (which would support OMI, and argue against PE), and if any doubt persists, a rapid CT pulmonary angiogram. There was 100% proximal LAD occlusion with TIMI 0 flow, and cardiacarrest in the cath lab.
An elderly patient with a ruptured abdominal aortic aneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL." A bedside ultrasound was done by the emergency physician, using Speckle Tracking. What do you think? Unfortunately, that video is unavailable.
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