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.