This week's free board review question...
A 23-year-old woman is found with a suicide note on a park bench in the winter with a core body temperature of 82.4°F. During transfer from the ambulance to the hospital gurney, her cardiac monitor suddenly demonstrates the following (see Figure).
What is the most appropriate therapy?
Active core rewarming and cardiopulmonary resuscitation (CPR) until temperature is 30°C (86°F), then attempt defibrillation.
Administer 3 defibrillation attempts; if unsuccessful, administer sodium bicarbonate, cardiopulmonary resuscitation (CPR), active core rewarming, and reattempt defibrillation after 5 minutes of CPR.
Administration of an antidysrhythmic (e.g., amiodarone) followed by defibrillation.
A single attempt of regular energy defibrillation followed by active core rewarming; subsequent defibrillation attempts during rewarming may be reasonable.
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