# healthy young male cardiac arrest



## ExpatMedic0 (Jan 9, 2015)

Heres one for ya,
Were called to shortness of breath, male in his earlier 30's, caller is distressed and requesting an ambulance. Upon arrival to his apartment a few minutes later, we find him pulseless and apenic. After starting CPR we gather a medical history from the family, he went to the doctor yesterday for shoulder pain, and has no known other medical history. Air seems to be going in with a BVM but once the backup crew arrive I jumped the gun on endotracheal intubation, mainly for the laryngoscopy in case we missed a foreign body airway obstruction based on his chief complaint prior to arrest, I didn't see anything but was unable to pass the ET through his cords, so I tossed a Combi Tube in and got excellent chest rise and fall 02/co2. We worked him for like 30 minutes, asystole the whole time.
I was thinking a PE, any input or feedback on what this could have been?


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## DesertMedic66 (Jan 9, 2015)

Did he have any of the common risk factors for PE?


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## ExpatMedic0 (Jan 9, 2015)

Recent travel is the only one I could gather, on a commercial airliner for a short distance. The only reason I threw PE out there was because he has no medical history, takes no meds, ect, so it was a "until proven otherwise" in my head. In all honestly it could be just about anything, but curious what others have to say.


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## DesertMedic66 (Jan 9, 2015)

As you stated there could be a lot of things that caused it. PE is defiantly going to be on my list as well.


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## cprted (Jan 9, 2015)

PE related to air travel is pretty rare.  Just read a study that found an incidence rate of 1.5 cases per million people who had flown over 3000 miles.  So I doubt a short commuter hop would have been enough for this guy to form a significant thrombus.  Also you state his CO2 and O2 was good during compressions ... if he had a PE significant enough to cause him to arrest, I'd expect there to be more impairment of gas exchange in the lungs.  Obviously not definitive by any stretch of the imagination but leads me to think of other etiologies. 

What about other socio/economic history?  Smoker?  Lifestyle?  Has he had his lipids checked? Blood pressure?  Family cardiac history?

Could be a red herring, but the complaint of shoulder pain bad enough for a 30 year old to go to the doctor makes me think more along the lines of an MI.  I'd also put undiagnosed congenital heart defect above PE.


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## teedubbyaw (Jan 10, 2015)

cprted said:


> Could be a red herring, but the complaint of shoulder pain bad enough for a 30 year old to go to the doctor makes me think more along the lines of an MI.  I'd also put undiagnosed congenital heart defect above PE.



That was the big red flag I saw, too.


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## zzyzx (Jan 11, 2015)

Could be a few things, but aortic dissection would be my best guess.


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## JPINFV (Jan 11, 2015)

Hypertropic cardiomyopathy.
One of a dozen lipid disorders.
Drug abuse (Meth... it's always meth). 
Connective tissue disorders that give a higher risk of dissection/aneurysm.


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