You can shock that

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Yesterday we had an arrest at a local nursing home. It was witnessed and she got CPR pretty much immediately. BLS gave a shock before we got there too. We arrived and I got the tube (woot!) while my partner started the IV and checked out her rhythm. It was like her heart couldn't decide what to do. First it was asystole, then v-fib, then v-tach, then IVR, then asystole. It didn't stay in any one rhythm long enough to get very far down an algorhythm. We ended up giving her epi and atropine, and on the way to the hospital we shocked her.
In the hospital it was very strange because the doc, first spent way too much time convincing himself that the tube was in. a. there is no reason to believe it wasn't. b. if we had been bagging the stomach for 20 minutes, I like to think we would have noticed by then.
Then he gave orders for D50, calcium, and bicarb, some more epi, and then left. From there basically a nurse and I ran the arrest with the doctor coming in every few minutes to check in.
The patient kept going into shockable rhythms so we shocked her probably five more times. All we did from there was relieve people doing CPR, gave more meds, and I kept saying 'You can shock that." I wondered how long this could go on, and figured that eventually we would shock her into the most stable rhythm of all: asystole. But then, suddenly, the nurse thought she found a pulse. It was funny as we all stopped and there was a hand on every available artery. We got a doppler and indeed had a pulse!
I left the room feeling excited even though I knew it was all futile. It was still cool to get a return of spontaneous circulation, a clinical save. The patient was admitted, and about three hours later a code blue was called to her room. I guess we can take comfort that maybe we gave her family a chance to say goodbye.

Comments

Anonymous said…
I did my third arrest ever today, and we got her back! Admitedly 5 shocks later and full drug protocol (not by me, mind, I'm still in training at the moment) but still..


...it feels great :-)

(It sucks that the chest x ray showed left sided masses, turned out to be undiagnosed end stage lung CA)

Nice save:)
11 April, 2008
Anonymous said…
Convincing doctors that the tube is in is never easy. They view it as I high liability issue and I have even had a doc decide that unless he intubated he was pulling it and intubating himself. With the advent of out of hospital capnography proving tube placement has gotten much easier. If the tube is in the esophagus there is no lasting waveform. Period, no questions.
13 April, 2008
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