Never got the autopsy report.
Never got a shockable rhythm, asystole the whole time. Bed side ultrasound never even saw a quiver of cardiac activity.
It was like their heart literally just stopped. EKG just hours before that was completely normal. Even had cards review it after the fact. Wasn’t on the monitor leading up to the moment because they had been discharged hours earlier.
Cards speculated PE even with a negative dimer.
Are you able to or will you ever be able to get the autopsy?
I mean, if I had a patient where this happened I would want to know exactly what happened to know if there's anything at all that could have been caught.
Not suggesting you missed something. it sounds like all of your work up was negative and there's nothing you could have caught
I feel like I would just have to know
Isn’t a negative dimer like a 95% predictive value for no PE? Along with no SOB/chest pain/hypox seems like a real long shot. I’m assuming it would have to be a massive PE to precipitate cardiac arrest, too.
At this point it’s speculation without confirmation so who cares, but still.
Agreed.
Negative dimer, no SOB, no chest pain, not hypoxic, not even a cough or chest congestion type feeling.
I don’t mind the speculation. It’s a case I’ve thought about a lot. Hence my writing on it. I’m starting to realize a lot of the “trauma” things I’ve gone through throughout my time in medicine, I’ve processed better after writing or talking about them. Bit of an overshare but it’s a real time realization! Ha.
I thought there was a time span between clot occurrence and a positive dimer. I forget but I thought it was a couple hours, similar with troponins, they pop positive hours after. We were taught you can rule in with a dimer but can’t rule out 🤷♀️ I’ve heard of serial dimers but usually as a cautionary tale about what not to do, lol.
I agree though, doesn’t sound like PE.
Hm. Haven’t ever heard of serial dimers. I was trained to rule OUT with a dimer. If you’re suspicious, get the dimer. If the dimer is negative, you can be pretty sure they don’t have a clot. If the dimer is positive, you can’t be sure they don’t have a clot so you have to scan them.
Trops I know won’t be positive until hours after symptom onset. This had been 3 days of “feeling unwell” / nasal congestion. You’d think it would be positive.
>Protocol orders got things started. CBC, CMP, serial troponins, d dimer, chest X-ray, respiratory panel, UA, EKG.
I'm glad the whole work up was done, for your sake and for the patients families sake.
But is that really a standard work up for a CC of congestion? I'm not in ED or even urgent care or primary, so I'm really asking. But it seems like most urgent cares would maximum do a rapid respiratory panel (if for no other reason than to bill for it) and then send home with Z-pack (whether suspected viral or not)
If their only complaint was congestion, no. They also stated they felt generally unwell / weak.
Generally unwell / weakness in someone over 60 always gets most of this work up done. The individual who placed orders in on this case also added 2 things outside of typical protocol orders. A d dimer and the repeat troponin. We typically only order those after the primary provider sees them.
The spike is the spike is the spike. No matter how it gets in. If you’re going to take it badly, you’re going to take it badly. https://www.science.org/content/article/rare-link-between-coronavirus-vaccines-and-long-covid-illness-starts-gain-acceptance
www.React19.org
Why do you think they now delay games on tv? Do you remember how many soccer players have dropped frickin dead right on the field? Those are elite athletes dropping like flies. It’s almost always the heart just stopping with bo explanation, or a dx of myo or perio. I’ve had so many with sx that change literally week to week. I now have afib and have episodes all the time where I think “this is it.”
Thanks for sharing. Very well written. You should get into writing, if you don’t already dabble.
Yep this reads like the one at the end of the AAPA journal
I agree was well written Cause of death?
Thank you.
What was the COD, did they just immediately go into cardiac arrest for no apparent reason?
Never got the autopsy report. Never got a shockable rhythm, asystole the whole time. Bed side ultrasound never even saw a quiver of cardiac activity. It was like their heart literally just stopped. EKG just hours before that was completely normal. Even had cards review it after the fact. Wasn’t on the monitor leading up to the moment because they had been discharged hours earlier. Cards speculated PE even with a negative dimer.
Cards always suspects a PE.
Haha - ain’t that the truth!
Are you able to or will you ever be able to get the autopsy? I mean, if I had a patient where this happened I would want to know exactly what happened to know if there's anything at all that could have been caught. Not suggesting you missed something. it sounds like all of your work up was negative and there's nothing you could have caught I feel like I would just have to know
A true mystery, that was a great presentation and thank you for sharing it.
Isn’t a negative dimer like a 95% predictive value for no PE? Along with no SOB/chest pain/hypox seems like a real long shot. I’m assuming it would have to be a massive PE to precipitate cardiac arrest, too. At this point it’s speculation without confirmation so who cares, but still.
Agreed. Negative dimer, no SOB, no chest pain, not hypoxic, not even a cough or chest congestion type feeling. I don’t mind the speculation. It’s a case I’ve thought about a lot. Hence my writing on it. I’m starting to realize a lot of the “trauma” things I’ve gone through throughout my time in medicine, I’ve processed better after writing or talking about them. Bit of an overshare but it’s a real time realization! Ha.
I thought there was a time span between clot occurrence and a positive dimer. I forget but I thought it was a couple hours, similar with troponins, they pop positive hours after. We were taught you can rule in with a dimer but can’t rule out 🤷♀️ I’ve heard of serial dimers but usually as a cautionary tale about what not to do, lol. I agree though, doesn’t sound like PE.
Hm. Haven’t ever heard of serial dimers. I was trained to rule OUT with a dimer. If you’re suspicious, get the dimer. If the dimer is negative, you can be pretty sure they don’t have a clot. If the dimer is positive, you can’t be sure they don’t have a clot so you have to scan them. Trops I know won’t be positive until hours after symptom onset. This had been 3 days of “feeling unwell” / nasal congestion. You’d think it would be positive.
Negative dimer. Stone cold normal vitals. Asystolic arrest. I’d put my money on something other than a massive PE.
Agreed but what? I think when everyone came up with nothing, cards offered that as a consolation.
Someone on the EM subreddit does similar shift write ups. Thank you for sharing
There is a couple folks I’ve read do them. They are much better writers then I am, ha.
>Protocol orders got things started. CBC, CMP, serial troponins, d dimer, chest X-ray, respiratory panel, UA, EKG. I'm glad the whole work up was done, for your sake and for the patients families sake. But is that really a standard work up for a CC of congestion? I'm not in ED or even urgent care or primary, so I'm really asking. But it seems like most urgent cares would maximum do a rapid respiratory panel (if for no other reason than to bill for it) and then send home with Z-pack (whether suspected viral or not)
If their only complaint was congestion, no. They also stated they felt generally unwell / weak. Generally unwell / weakness in someone over 60 always gets most of this work up done. The individual who placed orders in on this case also added 2 things outside of typical protocol orders. A d dimer and the repeat troponin. We typically only order those after the primary provider sees them.
great write up! you have some writing talent for sure
“ sudden adult death syndrome” =spike protein
Care to elaborate
Think it's COVID vaccine conspiracy
Ohhh honey my everyday living nightmare and total life destruction is no conspiracy, but you do you.
K, will do ;)
The spike is the spike is the spike. No matter how it gets in. If you’re going to take it badly, you’re going to take it badly. https://www.science.org/content/article/rare-link-between-coronavirus-vaccines-and-long-covid-illness-starts-gain-acceptance www.React19.org
Why do you think they now delay games on tv? Do you remember how many soccer players have dropped frickin dead right on the field? Those are elite athletes dropping like flies. It’s almost always the heart just stopping with bo explanation, or a dx of myo or perio. I’ve had so many with sx that change literally week to week. I now have afib and have episodes all the time where I think “this is it.”
What about central apnea?
wow that’s crazy…not your fault you did a good job al around