A 57 year-old man who arrested on the ward post-operatively was brought for resuscitation. The initial rhythm was ventricular fibrillation. Following defibrillation (1 x 200J biphasic), 1 mg adrenaline IV and 2 minutes of CPR he had an idioventricular rhythm with a rate of 40 but remained pulseless. CPR was continued for a further 2 minutes and 1.2 mg atropine was administered.
The patient then had return of spontaneous circulation and was intubated as he remained unconscious. He arrested again – this time the ECG monitor was suggestive of torsades de pointes (‘twisting of the points’), presumably because of the barn-door R-on- T phenomenon seen in the ECG. His post tubation arterial blood gas revealed the following: pH-7.403, pCO2-48.6 mmHg, pO2-176 mmHg, Bicarbonate-29.7 mmol/L, Sodium-130 mmol/L, Potassium-2.6 mmol/L, Chloride-98 mmol/L, Glucose-8.6 mmol/L, Lactate-1.8 mmol/L. What…
