Case History/Examination:
A 33-year-old Hispanic male with a history of bipolar disorder and
schizophrenia was admitted to the emergency department (ED) with acute
hypoxemic respiratory failure in 2022. Notably, he had a history of
substance abuse, primarily cocaine, although he had been abstinent for
approximately four months, continuing amphetamine use.
Upon arrival in the ED, the patient experienced cardiac arrest with
Pulseless Electrical Activity (PEA). Immediate and comprehensive
resuscitative efforts, in line with Advanced Cardiovascular Life Support
(ACLS) guidelines, were initiated. These included endotracheal
intubation and intravenous Epinephrine administration. Despite these
interventions, return of spontaneous circulation (ROSC) was achieved
after only 20 minutes.
The patient’s post-resuscitation period was marked by severe cardiogenic
shock and a recurrence of cardiac arrest, again presenting with PEA. The
combined efforts of the ED and ICU teams successfully resuscitated him.
He was then admitted to the Intensive Care Unit (ICU) and required
multiple intravenous vasopressor drips and inotropic agents to maintain
hemodynamic stability.