ARDS after Full Arrest due to Cocaine

Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.

A 53 yo AAF with PMH of chronic liver disease, CRI, HTN, cocaine abuse was found unresponsive by her son. She was intubated on the scene by EMS and brought to ER. She had widely dilated non responsive pupils on admission but she was breathing above the set rate on the ventilator. The family wanted a full code status.

The etiology of cardiac arrest was thought to be cocaine-induced arrhythmia since the urine was positive for cocaine.

Dr. Randhawa presents the case. Click to listen.

this is an audio post - click to play

Initial EKG (left): Sinus rhythm at 79 bpm, left axis deviation, 1st AVB, inverted T waves in 1, aVL, ST depression in 1, V4-6, ST elevation in V1-3.

Follow-up EKG (right): Junctional rhythm at 60 bpm, Left axis deviation, ST depression V4-6.

What happened?
Patient had bilateral infiltrates on admission secondary to possible aspiration. Later, she developed ARDS.

Baseline CXR 4 years ago; Progression from early ARDS to full-blown ARDS

Lung infiltrates on CT chest; CT chest - lung windows

Anoxic encephalopathy on CT head

Family decided to withdraw the life support and the patient expired soon afterward.

Final diagnosis:
ARDS after cardiac arrest due to cocaine
Anoxic encephalopathy

Published: 04/12/2005

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