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Ab s t r ac t This case report highlights the importance of good quality cardiopulmonary resuscitation (CPR). The common injuries that can happen post-CPR. Significance of selecting the correct imaging modality for diagnosing rib fractures and limitations of routine chest X-ray (CXR). Undisplaced rib fractures are more common in post-CPR injuries than seen in thoracic trauma. A high index of suspicion and good clinical examination is the key to patient management. Keywords: Cardiopulmonary resuscitation, Chest X-ray, Computed tomography, Rib fracture, Ultrasonography. Indian Journal of Critical Care Case Report (2022): 10.5005/jp-journals-11006-0006

Ca s e De s c r i p t i o n A 38-year-old male, known case of hypertension since 8 years, chronic kidney disease (CKD) on regular dialysis thrice a week for 7 years, was recently admitted with a history of mild COVID infection in April 2020. He was apparently alright, and presented with gradually progressive dyspnea on exertion of 2 days duration to the emergency department. On evaluation he was unresponsive, and had an absent central pulse. He had a cardiac arrest secondary to hyperkalemia. CPR was initiated. Correction of hyperkalemia was done. Return of spontaneous circulation was achieved after five cycles of CPR. The patient was intubated and shifted to the intensive care unit for further management. Hemodialysis was initiated. After 6 hours, his sensorium was assessed. He was conscious and obeying commands. He had hypertension for which nitroglycerin infusion was started. He had left-sided chest pain which was increasing with the inspiration. CXR was checked for any rib fracture, which didn’t reveal any obvious abnormality (Fig. 1). A 2D echo was done, which showed dilated chambers with global hypokinesia. Electrocardiogram and cardiac markers didn’t reveal any ongoing ischemia. The cause of chest pain was attributed to chest compressions.