Case Resolution: Paramedics start CPR and apply the defibrillator pads, which show fine ventricular fibrillation. He is shocked once at 200 joules. An IV is started, 1 mg of epinephrine is given, and the next rhythm check is asystole. The patient is intubated, more epinephrine is given, and his end-tidal CO2 drops to 10. A call is made to the base hospital, a consultation takes place, and the patient is pronounced dead at the scene.

Thank you to Jay Loosley, RN, superintendent of education for Middlesex-London EMS in Ontario, for his help on this review. Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine.

References for Further Reading

1. Ghali WA, Palepu A, Paterson WG. Evaluation of red blood cell transfusion practices with the use of preset criteria. CMAJ. 1994;150(9):1449-1454.
2. Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340(6):409-417.
3. Holst LB, Haase N, Wetterslev J, et al. Transfusion requirements in septic shock (TRISS) trial – comparing the effects and safety of liberal versus restrictive red blood cell transfusion in septic shock patients in the ICU: protocol for a randomised controlled trial. Trials. 2013;14:150.
4. Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;368(1):11-21.
5. Weiskopf RB, Viele MK, Feiner J, et al. Human cardiovascular and metabolic response to acute, severe isovolemic anemia. JAMA. 1998;279(3):217-221.
6. Litton E, Xiao J, Ho KM. Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials. BMJ. 2013;347:f4822.
7. Carson JL, Terrin ML, Noveck H, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;365(26):2453-2462.
8. Muñoz M, Gómez-Ramírez S, Cuenca J, et al. Very-short-term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery: a pooled analysis of observational data from 2547 patients. Transfusion. 2014;54(2):289-299.
9. Bloody Easy 3 – Blood Transfusions, Blood Alternatives and Transfusion Reactions: A Guide to Transfusion Medicine. Ontario Regional Blood Coordinating Network Web site. Accessed June 13, 2016.
10. American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006;105(1):198-208.
11. Agarwal R, Kusek JW, Pappas MK. A randomized trial of intravenous and oral iron in chronic kidney disease. Kidney Int. 2015;88(4):905-914.