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ОСТАНОВКА СЕРДЦА В РЕЗУЛЬТАТЕ ЭЛЕКТРОТРАВМЫ: СЛУЧАЙ ИЗ ПРАКТИКИ
РАЧАНА БАРДИА, САРАВАНА КУМАР, СЕИД АХМЕД АДИЛ Многопрофильные клиники доктора Мехти, Ченнаи, Индия
В статье приводится описание успешной реанимации пациента с остановкой сердечной деятельности вследствие электротравмы, получившего неотложное лечение в экстренном отделении, согласно протоколам ATLS.
Ключевые слова: электротравма, осложнение, остановка сердца, лечение, протокол ATLS.
A CASE OF CARDIAC ARREST FOLLOWING ELECTROCUTION: A CASE REPORT
RACHANA BARDIA, SARAVANA KUMAR, SYED AHMED ADIL
Dr. Mehta'sMultispeciality Hospitals, Chennai
The article describes the successful resuscitation of a patient with cardiac arrest due to electrical injury and who received emergency treatment in the emergency department according to ATLS protocols.
Key words: electric trauma, complication, cardiac arrest, treatment, ATLS protocol.
INTRODUCTION
Electrical injuries make up a small portion of thermal injuries and are responsible for considerable morbidity and mortality. When electric current passes through tissues, it causes tissue injury. In heart, it produces arrhythmia, cardiomyopathy, myocardial infarction and death due to cardiac arrest. A patient suffering from an electrical injury should first be considered a trauma victim and initial assessment and treatment of serious life-threatening injuries must be as per ATLS guidelines.
This case report presents an electrocuted unresponsive patient who was brought to ER within 30 mins following electrical injury.
CASE PRESENTATION AND APPROACH
A 38 yr old unresponsive male brought to ER, after electrocution by washing machine, in Cardiac arrest -Ventricular Fibrillation. Following ACLS (shockable rhythm) guidelines immediate Cardio Pulmonary Resussitation(CPR) delivered and advanced airway secured. Post Return Of
RHYTHM ON ARRIVAL : VENTRICULAR FIBRILLATION
RHYTHM DURING RE-ARREST : PULSELESS VENTRICULAR TACHYCARDIA (TORSADES DE POINTES)
Test Result
BLOOD GAS ANALYSIS-ABG
PH 6.804-
P02 129.3 *
PC02 116.0*
PCOT/2 116.0
POT/2 129.3
BE(B) -19.3
BE (ACT) -21.2
BE(ECF) -16.7
BB 28.7
S02 (C) 91.8
НСОЗ STD 10.3
CTC02(B) 19.0
НСОЗ ACT 17.8
CTC02(P) 47.8
AG 23.3
P/F RATIO 615.5
ABG ON ARRIVAL : SEVERE METABOLIC AND RESPIRATORY ACIDOSIS
Shoshilinch tibbiyot axborotnomasi, 2019, XII (4)
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Остановка сердца в результате электротравмы: случай из практики
Spontaneous Circulation (ROSC) patient went into Cardiac arrest again. CPR restarted, reversible causes of arrest revealed severe metabolic acidosis. IV Fluids and Sodium Bicarbonate given. ROSC achieved. Patient shifted to ICU for further management.
MANAGEMENT AND OUTCOME
In ICU Speciality opinions obtained. Patient treated symptomatically with Cardio&Neuroprotective drugs, Low Molecular Weight Heparin, dual ionotrope infusion, iv fluids with hemodynamic monitoring, and other supportive medications as per specialist opinion.
In first 24 hrs, GCS improved, sedation stopped, ionotropes tapered. Patient gradually recovered from
cardiomyopathy, Severe LV Dysfunction, Cardiogenic shock, Metabolic Acidosis, B/L diffuse cerebral dysfunction, Acute Kidney Injury, Hyperkalemia and Rhabdomyolysis and successfully discharged in 6 days. Patients blood and cardiac parameters reviewed on 2nd and 10th day post discharge and was normal.
CONCLUSION
This case presentation shows successful complete recovery of an electrocuted, cardiac arrested, otherwise healthy man, who presented to ER early, revived using ACLS guidelines, managed fluids balancing his cardiac status as well as shock, acidosis and rhabdomyolysis and rendering patient a complete recovery.
ЭЛЕКТРОЖАРОХДТ НАТИЖАСИДА ЮРАК ТУХТАШИ: АМАЛИЁТДАН МИСОЛ
РАЧАНА БАРДИА, САРАВАНА КУМАР, САИД АХ,МАД АДИЛ Доктор Мехтининг куп тармоцли клиникалари, Ченнай, Х,индистон
Ма^олада электрожародат натижасида юрак фаолияти тухтаган беморга шошилинч тиббий ёрдам булимида ATLS протоколига мувофи^ утказилган муваффа^иятли реанимация долати ёритилган. Калит сузлар: электрожароцат, асоратлар, юрак тухташи, даволаш, ATLS протоколи.
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Вестник экстренной медицины, 2019, XII (4)
