We present a case of a 45-year-old female who presented to a community hospital with an anterior STelevation myocardial infarction (STEMI) that subsequently developed prolonged ventricular fibrillation (VF) refractory to repeated defibrillation and antiarrhythmic medications. Primary percutaneous coronary intervention was performed in the patient with VF but supported only by the Lund University Cardiac Arrest System (LUCAS). Despite a total VF time of 127 minutes, the patient was eventually discharged neurologically intact with a normal left ventricular function. For the right patient, this case illustrates the utility of the LUCAS device, especially at community hospitals without immediate venoarterial extracorporeal membrane oxygenation or ventricular assist device capability.

The role of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and associated autoimmune phenomenon behind pathology development has been a scientific mystery since the onset of the pandemic in 2020. Early on, scientific studies showed coronavirus disease 2019 (COVID-19) being linked to many pathological consequences including blood clots, neurocognitive dysfunction, and cardiomyopathy. We present a case of acute hypothyroidism in an 88-year-old female with no previous history of thyroid dysfunction or disease. The eventual workup revealed a thyroid-stimulating hormone (TSH) of greater than 100,000 milli-international units per liter (mlU/L) and a thyroxine (free T4) level of less than 0.10 nanograms per deciliter (ng/dl). At the time of presentation, she was found to have a positive COVID-19 test despite being vaccinated. She was started on a levothyroxine injection, which led to eventual symptom resolution. Our aim of this case report is to highlight the possibility of her acute hypothyroidism being triggered by the onset of COVID-19.

Upper extremity deep vein thrombosis (UEDVT) is a rare condition that makes early clinical evaluation and treatment important prior to the formation of deep vein thrombosis (DVT). Typical risk factors include male sex, young age, repetitive arm over abduction and hyperextension, indwelling catheters, cervical first rib, and thoracic outlet syndrome. One common cause of UEDVT is Paget-Schroetter syndrome (PSS). If untreated, pulmonary complications such as venous thromboembolic disease and pulmonary embolism (PE) may develop. We present a case of a 34-year-old Caucasian female who presented to the emergency department with sudden, acute right arm pain after blow-drying her hair, consistent with UEDVT. CT angiography (CTA) demonstrated moderate thromboembolic disease within segmental and subsegmental branches of the left upper, left lower, and right lower lobes. Ultrasonography (US) of the upper extremity showed non-compressibility of the right axillary and basilic vein, a finding consistent with acute DVT. Peripheral angiogram revealed imaging consistent with undiagnosed thoracic outlet syndrome secondary to effort thrombosis. The patient deferred surgical intervention and agreed to begin long-term anticoagulation therapy. PSS requires immediate recognition and treatment to prevent possible long-term neurologic and vascular compromise. Despite the patient lacking the typical population demographics, PSS should be considered given the patient's symptoms and presentation. Recognition of UEDVT despite classic signs and symptoms consistent with known risk factors is imperative upon clinical suspicion. Delay in clinical management may lead to fatal complications. We aim to highlight a case of PSS along with alternative pathways for treatment delivery.