37/m Liver Failure

jefftherealmccoy

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Just had a great one-
37/M talking with his girlfriend starts mouthing that he's going to pass out, not able to speak, just mouthing the words. Falls, hits the ground, stops breathing. We arrive, no bystander CPR, we work him. Asystole at first, after a round of epi, we intubated him, good end tidal, got him into V-Fib. Shocked him 4 times, amiodarone, more epi, no ROSC. Had great end tidal all the way into the hospital and they called it after about 20 minutes.

My question is this-
Anyone ever had someone just collapse like this from liver failure? That is the only history we could get from the hysterical girlfriend on scene. No report of chest pain prior. Didn't hear anything about cardiac enzymes while at the hospital, so he could have just had the big one. But I'll never know for sure.

Thoughts?
 

Carlos Danger

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I can't imagine how liver failure would directly cause that type of presentation. However, liver failure is a complex process that is associated with problems in almost every other organ system. So it could have been just about anything.

FWIW, cardiac enzymes will be elevated after CPR and defib, whether this was a primary cardiac event or not.
 
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Arovetli

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Perhaps ruptured varices
 

chaz90

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I'm just thinking that many people in liver failure have many other comorbidities that come along with it. It's not the kind of disease that often presents in isolation. Perhaps the girlfriend wasn't able to tell you about other history due to her distress. Any signs of drug use? Kind of a long shot, but I'm wondering if the liver failure was caused by hepatitis secondary to drug addiction due to his young age (of course only one of a hundred things it could be).
 
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jefftherealmccoy

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just remembered while talking to another EMT on scene, the guy was a diabetic as well. that's about it. sugar was in the 250 area, but that's all the history we could both come up with.

no signs of drug use, no track marks at least. Girlfriend denies drug use.
 

VFlutter

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How was the ETCO2?

I agree there was most likely significant comorbidites that precipitated the liver failure or as a result of the liver failure. It could be any number of causes for arrest. Most complications of liver failure tend to develop relatively slow (ie encephalopathy, ascities, coagulopathy) as opposed to acute deteriation.

I am going to go with massive saddle pulmonary embolus. I like Zebras
 
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jefftherealmccoy

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ETCO2 was around 20 initially but with efficient CPR and slowing the bagging down we got it up to 35. I thought the same thing about slow development of conditions that normally come with liver failure. Just wondered if there was something we missed that could have come along with it to drop him dead or if he just keeled over because of a massive, coincidental MI.
 

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