Age: 69.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Anaphylactic reaction, Angioedema, Cardiac arrest, Cardiac pacemaker insertion, Catheterisation cardiac
Clinical narrative: 69 YO M CARDIAC ARREST. PT HAD JUST RECEIVED HIS COVID VACCINATION AND WAS PULLING INTO THE OBSERVATION AREA WHEN HE LOST CONTROL OF HIS TRUCK, BECAME UNCONSCIOUS AND CRASHED INTO A LIGHT POLE. THIS OCCURRED IN FRONT OF THE STANDBY MEDIC UNIT AND OTHER FIRE DEPT STAFF. PT WAS IMMEDIATELY REMOVED FROM THE VEHICLE AND THE PATIENT WAS DETERMINED TO BE IN CARDIAC ARREST. CPR WAS INITIATED WITHIN SECONDS OF BEING REMOVED FROM THE VEHICLE. EMS WAS IMMEDIATELY AVAILABLE AND THE PATIENT WAS DEFIBRILLATED FOR WHAT APPEARED TO BE A SINE WAVE VT/COURSE VF WITHIN ONE MINUTE OF HIS ARREST. PT WAS PLACED ONTO A BACK BOARD AND MOVED TO AMBULANCE IN A PULSED VT AND WAS AWAKE AND RESPONSIVE. ONCE IN THE BACK THE PT WAS WIRED INTO THE FOUR LEAD AND WAS SYNCHRONIZED CARDIOVERTED AT 100 J WITH A CONVERSION TO A PULSED JUNCTIONAL RHYTHM WITH A RATE OF ABOUT 58. THIS RHYTHM CHANGED INTO A SINUS TACH AT ABOUT 100 BPM. IV ACCESS WAS OBTAINED AND 100 MG LIDO BOLUS WAS ADMINISTERED WITH A 2:1 LIDO DRIP HUNG. AMBULANCE BEGAN TRANSPORT TO ER. OVER NEXT SEVERAL MINUTES PT BEGAN HAVING VENTRICULAR ECTOPY IN THE FORM OF PVCs COUPLETS AND EVENTUALLY 4-5 BEAT RUNS OF VTACH WHILE ON PHONE WITH ER MD. DISCUSSED GIVING ANOTHER BOLUS OF LIDO AND INCREASING DRIP TO 3:1 DUE TO INCREASING VENTRICULAR ECTOPY. THE ER PHYSICIAN CONCURRED AND ANOTHER 75 MG LIDO BOLUS WAS GIVEN FOLLOWED BY INCREASING THE DRIP RATE TO 3MG/MINUTE FOLLOWING THE SECOND LIDO DOSE AND DRIP ADJUSTMENT THE PATIENT'S VENTRICULAR ECTOPY RESOLVED AND THE PATIENT REMAINED IN A SINUS RHYTHM / SLOW SINUS TACH THROUGHOUT TRANSPORT AND TRANSFER OF CARE TO THE ER. A 12 LEAD WAS OBTAINED JUST PRIOR TO ARRIVAL IN ED THAT SHOWED SINUS TACH WITHOUT VENTRICULAR ECTOPY BUT WHAT APPEARS TO BE PACs, FLIPPED T WAVES IN a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