Jump to content

  • Log in with Facebook Log in with Twitter Log In with Google      Sign In   
  • Create Account
Current Chat Room Users
0 users are in Main Room:



Did you know it is free to become a member?  Just click "Create Account" on the top right of this page.


Photo
- - - - -

Cardiac Arrest/Combative Patient


  • Please log in to reply
18 replies to this topic

Poll: Signs of Life Prior to ROSC (9 member(s) have cast votes)

Have you ever worked a cardiac arrest with obvious neurological signs of life prior to ROSC?

  1. Yes (6 votes [66.67%])

    Percentage of vote: 66.67%

  2. No (3 votes [33.33%])

    Percentage of vote: 33.33%

  3. I don't believe you! (0 votes [0.00%])

    Percentage of vote: 0.00%

Vote Guests cannot vote

#1 rock_shoes

rock_shoes

    Alta. EMT-P/BC ACP

  • Elite Members
  • 1,045 posts
  • Gender:Male
  • Location:British Columbia
  • Interests:Paramedicine, Climbing (rock,ice,alpine), Mountain Biking, Photography, Music
  • Occupation:Alta. EMT-P/BC ACP
Reputation: 88
Good



Posted 23 January 2013 - 11:20 PM

This is a patient I recently dealt with while working targeted ALS. It was a highly unusual situation and I think it's well worth throwing out for the EMTCity local to play with. Let's start with how you would manage this patient and go from there. I'll chime in with what I actually did and the outcome later on.

 

Initial dispatch info:

 

85 y/o female patient, Chest Pain with SOB.

 

Initial Contact:

 

BLS (PCP crew so think EMT-I) arrived first to patient with declining LOC, Bradycardia, SOB, Pale, diaphoretic. Patient arrested in BLS presence with CPR, PPV, AED applied immediately (one non-shockable rhythm analyzed prior to our arrival).

 

We arrived to BLS crew working the arrest 4 minutes into the resuscitation. The patient patient was found to be in an asystole with absent pulses. The kicker (pun intended) is that the patient was also combative with good CPR (kicking, pulling at the BVM, I'm talking a 2-2-5 total of 9 GCS).

 

That's all I'm giving up for now.

 

GO!


  • 0

#2 Arctickat

Arctickat
  • EMT City Sponsor
  • 1,891 posts
  • Gender:Male
  • Location:Kelvington, Sask
  • Interests:SCUBA, Flying
  • Occupation:Paramedork
Reputation: 382
Excellent

Posted 24 January 2013 - 01:55 PM

Transported a guy once who could actually give me feedback if I needed to improve my CPR.  If I stopped he'd GCS 3, but if I was doing good compressions he'd remain alert and oriented.  This was years before ALS was available and we didn't even have a monitor.  When we got to the hospital they got the monitor on and discovered a Sinus brady of 10 - 20.  Transported him for a pacemaker insertion and he lived for many more years.  That was the best CPR learning experience EVER!!!  I learned exactly what worked best, how hard, fast, and deep was ideal, and he only complained about us beating on his chest once...and it was more of a "Man, this is uncomfortable but better than the alternative" complaint.


  • 0

#3 scubanurse

scubanurse
  • Elite Members
  • 1,774 posts
  • Gender:Female
  • Interests:(OIIIIO)
  • Occupation:RN-BSN
Reputation: 198
Excellent

Posted 24 January 2013 - 02:05 PM

not really sure what you're wanting as far as a scenario...this guy would get the same ACLS treatment and rapid transport regardless of combative behavior during good compression cycles.  

 

I'm not even sure I would do anything to prevent her from becoming combative because at least you know she's getting blood to her brain and vital organs.


  • 0

#4 chbare

chbare
  • Elite Members
  • 3,198 posts
  • Gender:Male
  • Location:United States
  • Occupation:Anti-provencial thinkingtologist
Reputation: 446
Excellent

Posted 24 January 2013 - 02:50 PM

It's important to realise that something known as pseudo PEA can exist where you may still have ventricular contraction and limited systolic pressures with foreword blood flow in an apparently "dead" patient. True PEA mandates complete electrical-mechanical dissociation. Unfortunately, differentiating between the two typically requires the ability to perform cardiac sonography.
  • 0

#5 Arctickat

Arctickat
  • EMT City Sponsor
  • 1,891 posts
  • Gender:Male
  • Location:Kelvington, Sask
  • Interests:SCUBA, Flying
  • Occupation:Paramedork
Reputation: 382
Excellent

Posted 24 January 2013 - 03:08 PM

That's was my conclusion too Chris.  Basically, the pump was working, but so poorly that we couldn't palpate a pulse and that on it's own the brain wasn't being perfused.  However, with the compressions the job was getting done.  I just wish I could have had a way to determine what the exact mechanism was.  Was it the CPR alone? Were our compressions causing the heart to actually beat more effectively and faster?  Without the monitor we'll never know.


  • 0




0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users