Epinephrine/sodium chloride
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Epinephrine/sodium chloride Lack of drug effect in traumatic cardiac arrest, pulseless electrical activity and hypovolaemic shock: case report
A 62-year-old man exhibited a lack of drug effect during treatment with epinephrine and sodium-chloride for traumatic cardiac arrest, pulseless electrical activity or hypovolaemic shock. The man, who was veteran diver, expert marine animal handler and aquarium employee, was part of a team transferring stingrays. However, during transferring the animal to another tank, he was pierced in the chest by the barb of a stingray. His colleagues rescued him immediately from the aquarium and at that time he was found pulseless. They started bystander cardiopulmonary resuscitation (CPR) promptly and the emergency ambulance service was contacted. Upon the arrival of paramedics, he was found in traumatic cardiac arrest with an initial rhythm of pulseless electrical activity (PEA). He was rapidly evacuated to the nearest emergency department (ED) with continued en route CPR. Upon arrival in the ED, he was in PEA state, with a total downtime of 18min. Resuscitation was continued while the trauma team was activated. During the resuscitation, he received a total of 8 doses of IV epinephrine [adrenaline] 1mg each, sodium-chloride [saline] 1L [frequencies not stated] and 1 unit of emergency packed red cell transfusion. However, no return of spontaneous circulation was noted. A single puncture wound was observed over the right second intercostal space showing penetrating thoracic injury. The man underwent thoracotomy and a long barb was observed in the intrathoracic space. The resuscitation was terminated because there was no cardiac contractility or pericardial effusion or massive hemothorax to treat. He died due to aortic transection. An autopsy showed a stinger penetrating the right second intercostal space, which was transecting the pericardium, ascending aorta, descending aorta, diaphragm and left atrium, and was exiting from the posterior left seventh intercostal space. Lau HK, et al. Penetrating Thoracic Injury and Fatal Aortic Transection From the Barb of a Stingray. Wilderness and Environmental Medicine 31: 78-81, No. 1, Mar 2020. 803507251 Available from: URL: http://doi.org/10.1016/j.wem.2019.09.004
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Reactions 17 Oct 2020 No. 1826
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