This case is written by Dr. Peter Dieckmann and Dr. Marcus Rall of the TuPASS Centre for Safety and Patient Simulation in Germany.
Why it Matters
Electrical Storm is a rare complication of a cardiac arrest. When it is present, the typical therapies for aborting VF are not sufficient. This case reviews the tailored management of this situation, including:
- Administration of iv beta-blockade (https://canadiem.org/beta-blockers-in-cardiac-arrest/)
- Attempting dual sequential defibrillation
- Consideration of ECMO (if available)
Clinical Vignette
“Arrest arriving in 1 minute. Doctor to resuscitation room STAT.
Paramedic report: “This is a 55 year old male we picked up at an office tower down the street. Apparently he was complaining of feeling unwell all morning and then collapsed at lunch. A colleague started CPR and we were called. The AED delivered 3 shocks. His colleagues say he’s healthy and they’re unsure about meds or allergies. His boss called his wife and she’s on her way.” CPR is ongoing.”
Case Summary
A 55 year-old male is brought to the emergency department with absent vital signs. He collapsed at his office after complaining of feeling unwell. CPR was started by a colleague and continued by EMS. He received 3 shocks by an AED. His downtime is approximately 10 minutes. The team is expected to perform routine ACLS care. When the patient remains in VF despite ACLS management, the team will need to consider specific therapies, such as iv beta blockade or dual sequential shock, in order to abort the electrical storm.
Download the case here: Electrical Storm
Cardiac U/S for the case found here:
(Ultrasound image courtesy of McMaster PoCUS Subspecialty Training Program)
ECG for the case found here:
(ECG source: https://lifeinthefastlane.com/ecg-library/anterior-stemi/)
CXR for the case found here:
(CXR source: https://emcow.files.wordpress.com/2012/11/normal-intubation2.jpg)
EM Sim Cases 
