Question: Rhythmic chaos amidst brain death

This Spot the Diagnosis article refers to ‘Answer: Rhythmic chaos amidst brain death’, by A. Prashanth et al., https://doi.org/10.1093/ehjacc/zuae095. A 30-year-old male suffered a road traffic accident and sustained severe traumatic brain injury (CT brain shown in Figure 1A). The patient had an apnoea test positive and was planned further for organ harvest. His blood work revealed a total count of 25 910 cells/cu·mm, creatinine of 0.9 mg/dL, sodium of 157 mmol/L, and potassium of 2.4 mmol/L. The patient was administered levothyroxine 200 μg (via nasogastric tube), intravenous hydrocortisone 200 mg, vasopressin infusion 2.4 mL/h, and noradrenaline infusion at 0.20 μg/kg/min. The patient developed sudden tachycardia (140/min) but maintained a blood pressure of 120/70 mmHg on inotropes. A 12-lead ECG was obtained and is shown below (Figure 1). Baseline 2D echocardiography showed normal chamber dimensions with severe hypokinesia of all the basal and mid-segments, with relatively preserved contraction of apical segments, including the left ventricular apex. The left ventricular ejection fraction was 28%, with moderate mitral regurgitation and normal pulmonary artery pressure. (A) CT brain following road traffic accident showing severe traumatic brain injury (extensive haemorrhage, cerebral oedema, and midline shift). (B) Twelve-lead electrocardiogram during tachycardia. In the management of a patient with severe traumatic brain injury who is being prepared for organ donation and develops a sudden arrhythmia, which of the following strategies should be prioritized? Administer intravenous amiodarone to control the arrhythmia while ensuring haemodynamic stability for organ viability. Initiate synchronized cardioversion to restore normal sinus rhythm and monitor for further arrhythmias. Correct any electrolyte imbalances, particularly potassium and magnesium, to stabilize cardiac function and maintain organ viability. Check for genetic testing (RYR, CASQ2) and aconite levels to rule out underlying causes of ventricular arrhythmias. Consult with an electrophysiologist to further evaluate the arrhythmia before proceeding with any interventions. None Declared. Data sharing does not apply to this article as no new data were created or analysed in this study.