A previously fit and well 24 year old man sustained an isolated C5-C6 spinal injury following  a  diving  accident  resulting  in  a  tetraplegia.  The  spinal  fracture  was surgically fixed the following day and the patient was extubated on Day 6 of his ICU admission. Within 4 hours of extubation, the patient developed respiratory distress requiring urgent rapid sequence induction and reintubation. The patient sustained a cardiac arrest soon after intubation.

18.2.   Outline how you would determine the cause of the cardiac arrest.

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College Answer

•     Capnograph to check tube position and reintubate if not in the right position
•     Urgent serum K
•      ECG
•      CTPA
•      Echo
•     CXray


A systematic approach to this question would resemble the following:

A) confirm ETT position with capnography

B) ABG to assess adequacy of oxygenation

...and CXR to rule out pneumothorax

C) ECG to assess cardiac causes (eg. STEMI)

... and TTE to assess for presence of cardiac tamponade, and to evaluate chamber filling (thus investigating hypovolemia)

D) BSL to assess blood glucose

E) ABG to assess serum potassium levels

CTPA is mentioned because PE is considered as a differential for this cardiac arrest in the college answer to the first part of this three-part question.