Shih Ying-Tai, Chua Chai-Hock, Hou Sheng-Wen, Lin Li-Wei, Chong Chee-Fah
Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan.
Department of Cardiovascular Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan.
Turk J Emerg Med. 2018 Feb 26;18(2):82-84. doi: 10.1016/j.tjem.2018.02.003. eCollection 2018 Jun.
A 74-year-old male with chronic kidney disease presented to the emergency department with asystole. Mechanical chest compression was started immediately using a piston-type thumper device. The initial potassium level was 7.7 mEq/L and bedside point-of-care ultrasound (POCUS) revealed no pericardial fluid. With standard resuscitation and anti-hyperkalemia treatment, return of spontaneous circulation (ROSC) was achieved within 10 minutes of compressions. At 15 minutes post-ROSC, the patient went into pulseless electrical activity. A repeated POCUS discovered massive pericardial fluid suggesting the presence of cardiac tamponade. Bedside pericardiotomy was performed followed by open thoracotomy. Laceration of the right ventricular wall adjacent to the fracture site of sternum was found, implicating that it was the complication of mechanical chest compression. After surgical repair and intensive post-operative care, the patient survived with full conscious recovery at day 6 of admission. Our case emphasizes the importance of POCUS in resuscitation, especially when the patient's condition deteriorates unexpectedly.
一名患有慢性肾脏病的74岁男性因心搏骤停被送至急诊科。立即使用活塞式胸外按压装置开始进行机械胸外按压。初始血钾水平为7.7 mEq/L，床旁即时超声（POCUS）显示无心包积液。经过标准的复苏和抗高钾血症治疗，在按压开始后10分钟内实现了自主循环恢复（ROSC）。在ROSC后15分钟，患者进入无脉电活动状态。再次进行POCUS检查发现大量心包积液，提示存在心脏压塞。遂进行床旁心包切开术，随后进行开胸手术。发现右心室壁在胸骨骨折部位附近有裂伤，表明这是机械胸外按压的并发症。经过手术修复和术后重症监护，患者在入院第6天存活且完全恢复意识。我们的病例强调了POCUS在复苏中的重要性，尤其是当患者病情意外恶化时。
