Pulseless electrical activity during electroconvulsive therapy: a case report

نویسندگان

  • Arun Kalava
  • Allison Kalstein
  • Sander Koyfman
  • Simon Mardakh
  • Joel M Yarmush
  • Joseph SchianodiCola
چکیده

BACKGROUND Arrhythmias resulting in cardiac arrest during electroconvulsive therapy have been reported. Most reported cases of cardiac arrest had asystole as the initial rhythm. Pulseless electrical activity as an initial rhythm of cardiac arrest during electroconvulsive therapy has never been reported. Also, thromboembolism after inflation of pneumatic tourniquet during lower limb surgery has been reported but never following tourniquet inflation during an electroconvulsive therapy. CASE PRESENTATION We report a case involving an 81- year- old female who presented to us for an electroconvulsive therapy for severe depression and developed pulseless electrical activity immediately after electroconvulsive therapy. She was successfully resuscitated and was later found to have bilateral pulmonary emboli with a complete occlusion of the right lower lobe pulmonary artery. The source of embolus was from her left lower extremity deep venous thrombus, which we believe, got dislodged intraoperatively after inflation of pneumatic tourniquet. Our patient not only survived the massive pulmonary embolus, but also showed significant improvement in her mental status compared to her pre-admission level at the time of discharge to a sub-acute rehabilitation centre. CONCLUSION We recommend that patients who are elderly and at high risk of thromboembolism should selectively undergo a preoperative doppler ultrasound for deep venous thrombosis. Also, selective application of tourniquet in the upper limb, to monitor for seizure activity, would reduce the incidence of pulmonary thrombo-embolism as embolic events are significantly less from deep venous thromboses of upper extremities when compared to lower extremities.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Pulseless electrical activity in a pediatric patient: a case report and review of causative factors and treatment.

Pulseless electrical activity, an arrhythmia that leads to cardiac arrest, is defined as the presence of organized electrical activity without a palpable pulse or arterial blood pressure. When this arrhythmia presents during anesthesia, it has become routine practice to initiate advanced cardiac life support according to the American Heart Association guidelines. This arrhythmia is usually asso...

متن کامل

Ultrasound Guidance of Thrombolytic Therapy in Pulseless Electrical Activity: A Case Report

A young man presented to the emergency room in extremis and deteriorated into a state of pulseless electrical activity. Bedside echocardiography by emergency medicine physicians was crucial to the clinical decision to implement thrombolytic therapy for suspected massive pulmonary embolus.

متن کامل

Recurrent pulseless electrical activity in a patient with coronary vasospasm and supravalvular aortic stenosis: a case report

BACKGROUND Pulseless electrical activity cardiac arrest is associated with poor outcomes and the identification of potentially reversible reasons for cardiac arrest is fundamental. CASE PRESENTATION We describe the case of a 46-year-old male with the rare coincidental finding of supravalvular aortic stenosis and coronary vasospasm leading to recurrent pulseless electrical activity cardiac arr...

متن کامل

Pulseless electrical activity in acute massive pulmonary embolism during thrombolytic therapy

We report a case of acute pulmonary embolism with hemodynamic instability diagnosed by a computed tomography pulmonary angiogram. The patient developed pulseless electrical activity during systemic thrombolytic therapy with recombinant tissue plasminogen activator. Successful return of spontaneous circulation was achieved after immediate cardiopulmonary resuscitation with chest compressions for...

متن کامل

Adriamycin induced pulseless electrical activity and cardiovascular collapse during general anesthesia for ventriculo-peritoneal shunt insertion. A case report.

We report a case of a 45-year-old female undergoing an emergency ventriculoperitoneal shunt surgery. The patient had brain metastatic lesions of breast carcinoma with associated hydrocephalus. She had received Adriamycin as a part of chemotherapy regimen for breast cancer. Her preoperative cardiovascular status was normal. Under general anesthesia, the patient had a sudden cardiovascular collap...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره 12  شماره 

صفحات  -

تاریخ انتشار 2012