Abstract
The patient was a 70-year-old woman who experienced breathing discomfort and requested emergency assistance. When placed in the ambulance, she had pulseless electrical activity (PEA), but spontaneous circulation returned after cardiopulmonary resuscitation (CPR) performed by emergency medical personnel for about 1 minute, and she was brought to our hospital. When she arrived, PEA had recurred, but spontaneous circulation returned after CPR by hospital staff members for 8 minutes. Contrast-enhanced CT of the chest showed emboli in both pulmonary arteries, and a diagnosis of pulmonary embolism was made. Because the patient's circulatory dynamics and respiratory status had both stabilized, she was admitted to the ICU with the intention of performing anticoagulation therapy alone. However, 6 hours after admission, she had lapsed into a state of shock. Echocardiography showed that the evidence of right heart strain was tending to improve. Abdominal ultrasonography revealed an echo-free space in the abdominal cavity. Contrast-enhanced CT of the abdomen showed massive hemorrhagic ascites and a lacerated liver, the diagnosis was hemorrhagic shock secondary to liver damage caused by sternal compression. When a patient has received CPR it is necessary to treat the underlying disease while constantly bearing in mind the possible development of complications associated with resuscitation.
