A woman in her fifties with recurrent, metastatic renal cell carcinoma, previously treated with a radical nephrectomy and transurethral resection of a bladder tumor, was admitted to the hospital for management of chemotherapy-induced weakness and malaise. The patient was anemic and required RBC transfusion. Worsening hematuria was attributed to a recurrent bladder mass.
On hospital day 3, a rapid response code was activated for sudden unresponsiveness. Upon arrival of the response team, the patient was noted to be pale, diaphoretic, and in acute hypoxic respiratory failure. The patient’s BP was 90/40 mm Hg, and heart rate was alternating between tachycardia and bradycardia. Oxygen saturation on 4 L nasal cannula was 80% to 85%. Response to verbal and noxious stimuli was absent. The patient’s breathing was rapid and labored, and the lungs were clear to auscultation. ECG demonstrated right-sided ST elevations and complete heart block. The patient was promptly intubated and transcutaneous pacing was initiated.