Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 175: A 38-Year-Old with Cardiac Arrest
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Dec 4, 2025 Delve into the intriguing world of cardiac arrest with a case of a 38-year-old experiencing pulseless electrical activity after intubation. Explore the arterial blood gas results that reveal respiratory acidosis and the critical decision-making involved in ventilation. Discover how auto-PEEP creates challenges in obstructive diseases, affecting venous return and leading to PEA. Gain insights on strategies that reversed the patient's condition and manage permissive hypercapnia for improved outcomes.
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Severe Asthma Case Presentation
- A 38-year-old woman with severe, steroid-dependent asthma arrived in respiratory failure after a viral-triggered exacerbation.
- Her ABG showed acute hypercapnic respiratory failure with pH 7.22 and PCO2 68 despite normal pulse oximetry on 100% O2.
Hyperventilation Can Precipitate PEA
- Shortly after intubation and assist-control ventilation, she developed pulseless electrical activity with no palpable pulses despite an organized rhythm.
- High minute ventilation (25 breaths/min × 500 mL = 12.5 L/min) can worsen expiratory flow limitation in asthma.
Auto-PEEP From Breath Stacking
- Auto-PEEP (intrinsic PEEP) develops when breaths stack and expiration is incomplete, raising end-expiratory alveolar pressure.
- Auto-PEEP can exceed 20 cm H2O in severe airflow obstruction and impair hemodynamics.
