Русский
Clinical case of complete atrioventricular block complicated by Morgagni-Adams-Stokes syndrome at the prehospital stage
DOI: https://dx.doi.org/10.18565/pharmateca.2023.14.95-99
I.G. Trukhanova, S.Kh. Sadreeva, D.S. Zinatullina, I.A. Polyakov, D.P. Alcova
Samara State Medical University, Samara, Russia
Background. The study of this clinical case is necessary in order to increase the knowledge of emergency medical service (EMS) field personnel in dealing with patients with extreme bradycardia due to the lack of a developed algorithm for action in such cases. The use of available medications (eg, atropine) should be a deliberate manipulation, taking into account the option of atrioventricular block. This will allow to develop a personalized approach already at the prehospital stage and reduce the risk of life-threatening complications.
Description of a clinical case. When a 72-year-old woman lost consciousness at home, a general paramedic team was called and arrived within 4 minutes. The patient underwent several chest compressions and an electrocardiogram (ECG) was recorded: atrial contraction rate ~100 per minute, complete absence of ventricular electrical activity for ~5.8 seconds. Measures: artificial ventilation, chest compressions, catheterization of a peripheral vein and administration of atropine 1 mg/ml – 2 ml, aminophylline 2.4% – 10 ml. Preliminary diagnosis: 3rd degree atrioventricular block, Morgagni-Adams-Stokes syndrome. To correct hypoxic encephalopathy, 250 mg of ethylmethylhydroxypyridine succinate was administered intravenously. Before transportation, the patient’s condition worsened: ventricular contraction rate (VFR) was 23–25 per minute, blood pressure was 70 and 40 mmHg. ECG: atrial flutter. A infusion of dopamine 40 mg/ml, 6 μg/kg per minute was started. It was possible to restore sinus rhythm with a heart rate of 100 per minute and stabilize hemodynamic parameters.
Conclusion. To improve the quality of emergency medical care provided to the population, it is necessary to constantly improve the qualifications of EMS field personnel. The administration of atropine should not only be formally indicated, but also a deliberate manipulation. It is necessary to create clinical guidelines to regulate the general approach to emergency care.
Description of a clinical case. When a 72-year-old woman lost consciousness at home, a general paramedic team was called and arrived within 4 minutes. The patient underwent several chest compressions and an electrocardiogram (ECG) was recorded: atrial contraction rate ~100 per minute, complete absence of ventricular electrical activity for ~5.8 seconds. Measures: artificial ventilation, chest compressions, catheterization of a peripheral vein and administration of atropine 1 mg/ml – 2 ml, aminophylline 2.4% – 10 ml. Preliminary diagnosis: 3rd degree atrioventricular block, Morgagni-Adams-Stokes syndrome. To correct hypoxic encephalopathy, 250 mg of ethylmethylhydroxypyridine succinate was administered intravenously. Before transportation, the patient’s condition worsened: ventricular contraction rate (VFR) was 23–25 per minute, blood pressure was 70 and 40 mmHg. ECG: atrial flutter. A infusion of dopamine 40 mg/ml, 6 μg/kg per minute was started. It was possible to restore sinus rhythm with a heart rate of 100 per minute and stabilize hemodynamic parameters.
Conclusion. To improve the quality of emergency medical care provided to the population, it is necessary to constantly improve the qualifications of EMS field personnel. The administration of atropine should not only be formally indicated, but also a deliberate manipulation. It is necessary to create clinical guidelines to regulate the general approach to emergency care.
About the Autors
Corresponding author: Igor A. Polyakov, Samara State Medical University, Samara, Russia; iigor_70@mail.ru
