Best case ever.

Best case ever.

Yes, this is EMK's Best Case Ever mini podcast series, and I'm decision making with Dr. Walter Himmel, Dr. Chris Hicks, and Dr. David Dyshensky, we. We have here Dr. Chris Hicks, who's going to give us his best case ever when it comes to diagnostic decision making.

Dr. Hicks, let it rip.

I chose this case because it was a cool resuscitation and had kind of a nice outcome in the end.

But there's a twist at the end that makes

it more memorable than maybe the event itself would suggest. The case was a 70-something-year-old

female. We had very little information about her. What we were told was she called paramedics because

she was feeling chest pain and shortness of breath. When they arrived, she was in extremis and then arrested.

This was a BLS crew.

So I don't know what that means they can't start IVs or start interventions.

They just started CPR and transported her rapidly to hospital.

They put on an AED, be it she had a non-shockable rhythm.

So she got to our hospital very, very quickly with good high-quality CPR, but really nothing else done. And I was the one doctor on in our resuscitation area to sort of undertake this. I know it sounds twisted, but that's just kind of, we all recognize, that's just kind of fun. That's meat and potatoes, P.E.A. arrest and you got a bunch of stuff you have to do. We were fortunate in that we had a few nurses. We had a bunch of paramedic students coincidentally just strolling through the department who ended up lining up to be CPR providers, and it was in the middle of the day, so we had a lot of help available if we wanted it. And so this was a process of getting her connected to a monitor quickly recognizing she had a

non-shockable rhythm that was PEA and required a few things in terms of vascular access, airway

management at some point and then some suggestion of what the diagnosis is going to be and how

we're going to treat it.

So we very quickly recognized one that we couldn't get access on her.

The nurses had tried a few times, but couldn't get any peripheral access.

So we ended up putting in a tibial interosseus with an ion drill.

And for the balance of the resuscitation, that's all we had.

She was waking up with chest compressions.

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