Handover on Emergency Department
As a doctor in the ED, you have received a patient after resuscitation from the EMT. You examine the patient.

What do you think of first?
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At this duration of CPR, I anticipate development of cerebral edema. I will administer mannitol for edema prevention and hyperventilate the patient.
The brain has been without oxygen for a prolonged period and currently requires maximum oxygen delivery. In the artificial lung ventilation, I will set the FiO2 to 1.0 aiming for the highest SpO2 and p(a)O2 possible.
I am trying to maintain adequate perfusion of the brain and other organs - I continue administering norepinephrine and fluid bolus with goal MAP over 65 mmHg.
65
years
185
cm
95
kg
man
RR
14 /min
HR
125 /min
SpO2
94 %
BP
72/45 (54) mmHg
temperature
36 °C
GCS
3
AVPU
U
CRT
5 s
EKG
rythm: sinus
action: regular
frequency: 125 bpm
axis: 125°
PR: 180 ms
QRS: 95 ms
QT: 320 ms
deep Q wave in III. lead, deep S wave in I. lead, negative T wave in III. lead, ST without denivelation
Examination
Current condition: A 65-year-old man collapsed in the bathroom; telephone-assisted urgent resuscitation lasted for 10 minutes, with an initial rhythm of PEA. ALS was continued, and 3 mg of norepinephrine was administered according to protocol, with ROSC achieved after another 10 minutes. The patient was intubated and transported on artificial lung ventilation with circulation stabilized on a moderate dose of norepinephrine.

A — OTI 8.0, fixation on 23 cm
B — symmetrical, bilateral vesicular, ventilation mode: VCV, Vt 600 ml, 14/min., PEEP 6 cmH20, FiO2 0.7, EtCO2 2,7
C — capillary refill time prolonged 5 s, norepinephrine 0.3 mcg/kg/min
D — GCS 1-1-1, pupillary response 2/2, photoreaction absent, analgosedation fentanyl+midazolam from EMT
E — 2x IV cannulation on upper right extremity, calf edema — lower right extremity, increased jugular vein distention
Glycaemia
Gly
6,5  mmol/L
Glycaemia
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