85yo with Tachy Brady

85yo patient presented with syncope.

PMHx nil. Nil meds 

was watching TV at home. Son heard a bang. Found patient on the floor, unconscious. CPR commenced. Almost immediate ROSC.

MAS:

GCS 15, HR 90-130 SVT, AF, ST

BP 127/92 sats 92%

Pt had been well prior to the event. He was now alert and coherent complaining of chest and back pain. 

ECG:

So you do a RUSH exam and saw this in the cardiac US:

You look at the lungs: a few B lines anteriorly, nil effusion

Peritoneum:

So you look at the aorta:

You call vascular and anaesthetics. The patient is transferred to theatre and undergoes a stent under LA. He is currently awake and talking on the ward. 

You just saved a life. 

Don't forget to do a RUSH exam on undifferentiated hypotension, syncope and cardiac arrest.