Figure 1: Extracorporeal membrane oxygenation (ECMO) system
Warmed H2O input
A Supplement to JEMS 19
Care is turned over in the ED and ACLS continues. The physician orders administration of 20%
intralipid. After an hour of efforts, the patient is
asystolic and resuscitation attempts are abandoned.
Case 3: Pediatric Drowning
Dispatch notifies you of a possible drowning at
a nearby city pool.
On arrival, you find a frantic mother who states
her 6-year old daughter was in the deep end of the
pool and was discovered motionless at the bottom after not being seen for nearly two minutes
before being pulled out by lifeguards.
Initial assessment reveals a young female with
central cyanosis and frothy sputum while lifeguards perform CPR. You take over and perform
excellent PALS care and return of spontaneous
circulation (ROSC) is obtained. You take her to
the nearby community hospital where she eventually succumbs to severe acute respiratory distress
syndrome after two days of mechanical ventilation in the pediatric ICU.
In 1930, John H. Gibbon, Jr., MD, conceived of
the use of temporary mechanical cardiopulmonary support while witnessing the hemodynamic
collapse and death of a female patient who had
developed massive pulmonary embolism following cholecystectomy.
offer this patient,” and authorizes field termination of resuscitation.
Case 2: TCA Overdose
A 31-year-old female is found locked in her bathroom by her mother with an empty bottle of pills
and vodka. By the mother’s estimate, the patient
has been in the bathroom for approximately 20
minutes before being discovered.
On arrival, you find an unconscious woman
with agonal respirations. She has a pulse but
is hypotensive with an initial blood pressure of
74/36 mmHg. A 12-lead ECG reveals a wide complex tachycardia at a rate of 104 beats per minute.
Assisted ventilations are given via bag-valve
mask, an IV is established and a bolus of crystalloid fluid is started. You perform intubation for
airway protection without difficulty as the patient
has no gag reflex.
The empty pill bottle reads amitriptyline
(Elavil). In consultation with medical control,
you initiate treatment for tricyclic antidepressant (TCA) overdose with two 50 mEq doses of
Transport to the ED is complicated by a tonic-clonic seizure followed by cardiac arrest with an
underlying rhythm of polymorphic ventricular
tachycardia (v tach). Chest compressions are initiated with repeat dosing of sodium bicarbonate,
bolus dose adrenaline and defibrillation.