Case history

A 24 year old male surfer presented to the emergency department unconscious. Lifeguards had spotted him drifting out to sea on his surfboard. Upon return to the beach he was confused, unable to walk in a straight line, and shivering violently. He subsequently collapsed and paramedics were called. On arrival at the emergency department, the patient’s Glasgow coma score was 3, and he appeared cyanotic with a regular pattern of breathing at a rate of eight breaths per minute. His pulse was irregular at 36 beats per minute and his blood pressure was unrecordable. His rectal temperature was 27.8°C. As his airway was suctioned in preparation for orotracheal intubation, the patient’s cardiac rhythm changed to ventricular fibrillation. After a pulse check and precordial thump, defibrillation was performed at 150 joules and basic life support was commenced. Two further shocks were given at appropriate intervals and 1 mg of intravenous adrenaline (epinephrine) was administered.

Questions

• 1 What is the most appropriate next resuscitation step?

• 2 How should this patient’s low temperature be managed?

• 3 At what point should resuscitation be stopped if unsuccessful?