COVID-19: STEMI with VF Arrest

This is the third COVID-19 case that we are publishing to provide simulation tools to healthcare providers during the 2020 Coronavirus pandemic. It involves an unexpected cardiac arrest in a suspected COVID positive patient.

This case was written by Drs. Krista Dowhos and Alim Nagji for use to assess and improve team preparedness to care for a COVID positive patient in cardiac arrest.

Dr. Krista Dowhos is a 2nd year Family Medicine resident at McMaster’s Kitchener-Waterloo distributed campus. She is passionate about medical education, especially simulation-based medical education and the production of infographics for knowledge translation in Emergency Medicine.

Dr. Alim Nagji is an ER staff physician at Joseph Brant Hospital (JBH) and St. Joseph Healthcare Hamilton. He is the Director of Emergency Medicine Clerkship for McMaster University and the Director of Simulation Learning and Clinical Teaching Unit for JBH. He has interests in medical education, simulation and global health. Send him your favourite meme on twitter (@alimnagji)

Why It Matters

Outbreaks of novel respiratory illnesses occur with some regularity (e.g. Severe Acute Respiratory Syndrome (SARS) and Middle-East Respiratory Syndrome (MERS)). With world travel being a modern reality, disease spread can happen quickly requiring careful infection control practices. COVID-19 (aka 2019-nCoV) was first detected in Wuhan, China in December 2019 and has since been declared a pandemic by the WHO (see this link for further information).

The COVID-19 worldwide pandemic has overwhelmed healthcare systems in many countries and led to catastrophic loss of life. Many healthcare providers have been exposed and infected in the course of their work and protocols to protect providers have been rapidly evolving. Simulation is being used to test and improve systems in place for infection control, PPE, and management of exposure to COVID-19.

This simulation case tests the response to an unexpected cardiac arrest, and the ability of the staff to stay safe while caring for a critically ill patient. At the time of publishing, there is not a single consensus approach to code blue in the suspected or confirmed COVID-19 patient. However, in this case, we explore an approach that maximizes the protection of healthcare providers.

Clinical Vignette

A 50-year old woman presents to the emergency department with 1.5 hours of chest pain and left arm heaviness. She works at a long term care facility where she has been caring for COVID-19 positive patients. She has had two days of mild URTI symptoms. She looks moderately unwell and has been placed in a resuscitation room with droplet/contact precautions.

Case Summary

This 50-year old woman presents with typical cardiac chest pain and high suspicion for COVID-19. Her ECG shows an anterior STEMI. The team will start performing the initial work-up and management of a patient with STEMI. While this is occurring, the patient suffers a VF arrest. The team will need to go through the ACLS algorithm while taking all precautions required in caring for a patient with suspected COVID.

Download the case here: COVID STEMI and VF Arrest

ECG for the Case

Source: https://litfl.com/anterior-myocardial-infarction-ecg-library/

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