Abstract
The ECG (see fig. 1 in the Question) shows a sinus rhythm of 97 beats per minute, a normal axis, a small QRS complex and only mild ST depression in all leads with slight elevation in aVR. Furthermore it shows a 4:1 ratio electrical alternans. During CPR, the patient suffered 3 left-sided and 5 right-sided rib fractures. As breathing caused negative intrathoracic pressure, the sternum collapsed shifting the heart to the left creating the 4:1 ratio electrical alternans. On intubation, a positive intrathoracic pressure was created causing the sternum to remain stable and the electrical alternans to disappear (Fig. 2). Although no definite cause for her out-of-hospital cardiac arrest has yet been found, a hereditary disease seems likely as her mother died suddenly of unknown cause at the same age. The patient made a full recovery. Fig. 2 ECG after intubation
Highlights
A previously fit and well 37-year-old woman collapsed on her doorstep
A police car arrived at the scene as first responder
An automated external defibrillator was connected and administered two shocks in between which cardiopulmonary resuscitation (CPR) was continued by the police officers
Summary
A previously fit and well 37-year-old woman collapsed on her doorstep. Her door neighbour started cardiopulmonary resuscitation (CPR).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
