Uncommon cause of cardiac arrest in the emergency department

A previously healthy 48-year-old woman presented to a peripheral ED with non-specific signs and symptoms, including vomiting, abdominal cramping, shortness of breath, tachycardia and hypertension. Despite supportive measures the patient rapidly deteriorated, resulting in a cardiac arrest during an interhospital transfer. This required aggressive resuscitation, but without success. The case represents a diagnostic dilemma in the ED regarding the diagnosis and initial management of the patient's presentation.