![]() ![]() Pulseless electrical activity (PEA), also known as electromechanical dissociation, is a clinical condition characterized by unresponsiveness and impalpable pulse in the presence of sufficient electrical discharge. A lack of ventricular impulse often points to the absence of ventricular contraction, but the contrary is not always true. A high index of suspicion should be adopted for patients who undergo a prolonged period of CPR, including frail patients with underlying health conditions such as chronic lung disease. In our case, conservative management was elected, given the patient's significant persistent cardiovascular instability unsuitable for interhospital transfer. The surgical intervention appears to be indicated in large hernias, incarceration, or those causing pain and respiratory compromise. A common complication was surgical emphysema in several of the articles, as was in our case. In our case report, the herniation was away from the fracture site at the lateral chest wall. The most common injury pattern was anterior rib fractures leading to anterior lung herniation. The literature provides only 13 articles on lung herniation due to CPR. In addition to this case report, a literature review was carried out, given the rarity of this pathology. She was managed in the ICU with ventilatory and cardiovascular support for four days until she suffered a second cardiac arrest, where resuscitation was unsuccessful. The CT following the return of spontaneous circulation (ROSC) demonstrated multiple bilateral anterior rib fractures and herniation of the right lung through the right lateral thoracic wall. A 74-year-old female with a background of chronic obstructive pulmonary disease (COPD) suffered a sudden pulseless electrical activity (PEA) cardiac arrest while being managed in the acute medical ward. This article presents a case in which a patient presented to the hospital with sepsis secondary to community-acquired pneumonia. Lung herniation is a rare complication following cardiopulmonary resuscitation (CPR) and is defined as a protrusion of lung parenchyma through the thoracic wall. The American College of Emergency Physicians (ACEP) and National Association of Emergency Medical Services Physicians (NAEMSP) both recommend emergency medical services systems and have written protocols that allow for termination of resuscitation efforts by emergency medical services providers for a select group of patients in which further resuscitative measures and transport to the local emergency department would be considered futile. In out-of-hospital cardiac arrest, prolonged resuscitation efforts in a patient who presents in asystole are unlikely to provide a medical benefit. Termination of resuscitation efforts should be considered in these patients, in consultation with online medical direction, as allowed by local protocols. Victims of sudden cardiac arrest who present with asystole as the initial rhythm have an extremely poor prognosis (10% survive to admission, 0 to 2% survival-to-hospital discharge rate). Asystole represents the terminal rhythm of a cardiac arrest. Additionally, pulseless electrical activity (PEA) can cease and become asystole. Asystole typically occurs as a deterioration of the initial non-perfusing ventricular rhythms: ventricular fibrillation (V-fib) or pulseless ventricular tachycardia (V-tach). ![]() Asystole, colloquially referred to as flatline, represents the cessation of electrical and mechanical activity of the heart. ![]()
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