Sudden death in a young adult woman

Abstract

0 Dr Carlo Musso: This case involves a 30-year-old woman who was apparently well, in her normal state of health playing softball, when after sliding into second base, stood up and then immediately collapsed. Her husband witnessed the incident, ran to her, and found her to be unresponsive and apneic. He began cardiopulmonary resuscitation (CPR) and had bystanders call 911. The paramedics arrived approximately four minutes later and determined that she was in full cardiac arrest with pupils fixed and dilated. She was found to be in a coarse ventricular fibrillation and underwent immediate defibrillation at 200 W/s, which converted her into asystole. She was orally intubated, and 1 mg of epinephrine was given via the endotracheal tube without a change in the rhythm. A peripheral intravenous line was started and 1 mg atropine and 1 mg epinephrine were administered. Soon after, the patient’s rhythm was noted to be in an accelerated idioventricular fibrillation that quickly deteriorated to ventricular fibrillation. She was defibrillated again with 200 W/s into a questionable supraventricular tachycardia with a rate of about 150 beats per minute and with a palpable carotid pulse. She was loaded into the ambulance and transported to Denver General Hospital’s emergency department, arriving approximately 20 min after the initial witnessed event. Her total down-time without a blood pressure was near 15 min according to the prehospital records. Immediately upon arrival, her vital signs were found to be a blood pressure of 124BOmm Hg and a heart rate of 150 beats per minute. She was being ventilated with 100% oxygen at a rate of 20 breaths per minute, and her rectal temperature was 38.1 “C. She was totally unresponsive to any painful stimuli. Her physical examination was remarkable for a l-cm hematoma over her right eyebrow, fixed and dilated pupils at 5 mm, and a colostomy present in the right lower quadrant of her abdomen. Within about five minutes, her pupils became minimally reactive. The cardiac monitor revealed a sinus tachycardia at a rate of 125. Further history was obtained from her husband revealing that she had experienced a headache for almost a week, associated with eye pain, for which she was being treated with acetaminophen and codeine. Her medical history was significant for the colostomy or ileostomy performed several years ago for severe colitis.