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A 69-year-old woman with a permanent pacemaker became nauseated at a luncheon, vomited, and collapsed. Paramedics arrived within three minutes and found her pulseless, in ventricular fibrillation, and with agonal respirations. She was intubated; defibrillation restored sinus rhythm, but she remained hypotensive. Assessment revealed a distended, barrel-like abdomen that was tense and tympanic to percussion. Ventilation through the endotracheal tube was difficult. When brought to the emergency department, the patient was unresponsive and hypotensive and had bilateral decreased breath sounds and cyanotic, pulseless legs. A chest film revealed an elevated diaphragm, cardiac compression, and centralization of the abdominal organs, confirming . . . [Full Text of this Article] |
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