A 62-year-old woman presents after being treated at the scene for pulseless electrical activity (PEA) with epinephrine, which improved her blood pressure and increased her heart rate from 50 to 65 beats/minute. However, she remained apneic and was successfully intubated in the field. She now has a pulse between 60 and 65 beats/minute, her blood pressure is 80/20 mm Hg, and she has persistent apnea unless ventilated. The paramedics report that she did not require sedation either before or after intubation. Her pupils are miotic but symmetrical.
Results on computed tomography (CT) of her head are normal, as are initial findings on a basic metabolic profile and bedside glucose determination. She was thought to be down about 3 minutes prior to the arrival of emergency medical services.
Her blood pressure has changed only minimally after a trial of normal saline bolus 500 mL.
The first treatment of choice for this patient is which of the following?
References:
Centers for Disease Control and Prevention. Opioid overdoses treated in emergency departments. Published 2018. Accessed August 20, 2018.
American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (This site blends the 2019 Focused Updates with the 2015 AHA Guidelines for CPR and emergency cardiovascular care). Part 10: Special Circumstances. (accessed on April 16, 2020)
Lavonas EJ, Drennan IR, Gabrielli A, et al. Part 10: special circumstances of resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(suppl 2):S501-S518.
Nikolaides JK, Thompson TM. Opioids (chapter 156). In: Wall R, et al. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed., 2018:1943-1946.
Szpilman D, Bierens J, Handley A, Orlowski J. Drowning*.* N Engl J Med. 2012;366(22):2102-2110.
Vanden Hoek TL, Morrison LJ, Shuster M, et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 suppl 3):S829-S861.
This question appears in Med-Challenger Emergency Medicine Review with CME
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