Conerns about a code I worked this morning

[KMAC]

Im an EMT-B in new jersey. At 430 this morning we got tapped out for a code. Life support (MICU with at least 1 MICRN and usually the paramedic tour chief) arrived about a minute before we did. When we were walking in they were just putting the moniter and pads on the pt. she was completely Asystolic (sp...im tired), she had an internal pacemaker..it shocked her a few times with absolutly no effect. We shocked her 3 times (dont remmember the power settings off hand) and still complete asystoly (yeah..i know..sp). Medics pushed some drugs after finally getting a line in at an ankle site (the POS bone gun didnt work and of the 3 times it was tried). and it took some time for the medic to tube her, both tried a few times, eventually it worked. anyway, the husband thought she was down for about 20-30 min. prior to calling, our responce time was 11 minutes. my question is, why did the medics feel the need to work her for 40 minutes on scene when she was completely flatline for 30 minutes and had no color change on the CO detector? am i missing something? or were we working her just for show? (i wasnt really able to talk to the medics afterwards, they got another job as soon as we dropped her off)

[chbare]

The first question I have to ask is why did they defibrillate asystole? Perhaps there is more to the story than you think? I wonder if the initial rhythm was shockable and perhaps she deteriorated into asystole as the code progressed. As far as working a code for 40 minutes, I cannot comment because I do not know you guidelines or the wishes of your medical director regarding cardiac arrest patients.

Take care,

chbare.

[whit72]

Im not sure I get your drift but around here we don't shock asystole.

[KMAC]

thats the only rhythm i saw...i took a quick look when i got in the room, maybe she was a really weak V-fib or somethin..i dunno...it was early, i was tired, maybe i missed somethin, im gonna hunt down the TC tomorrow and talk to him about it. ive worked a whole hell of codes but this one was just a bit different than all the others

[whit72]

We don't work anyone for show. Are medical director wants them worked unless obvious signs are present. Sometimes it sucks, you do what you have to do. Some might be viable most are not.

If she was truly pulseless for forty minutes I am guessing she was probably asystolic, but who knows. Nothing surprises me anymore.

[KMAC]

TY for the input all. Like i said im gonna hunt down the TC tomorrow and talk to him about it

[Dustdevil]

im gonna hunt down the TC tomorrow and talk to him about it.

Tank Commander? :?

Minus 5 for unapproved abbreviations.

To address your primary question, the answer is that you really don't know how long she has been in arrest. Just because somebody has been unresponsive for 20 to 40 minutes does not mean they have been pulseless for that amount of time. And we can't really rely on lay person reports to make that determination. That's why we have objective guidelines for establishing who is and is not a candidate for resuscitation. Subjective doesn't cut it. Unless your patient meets those objective criteria (rigor mortis, dependent lividity, decomposition, decapitation, etc...), they get the benefit of the doubt. Unfortunately, your post doesn't give us any objective data to judge by, so we don't know what the nurse/medic were basing their judgement upon. They may have been right. They may not have.

To reiterate the most important point here....

DO NOT base your resuscitation decisions on subjective reports of "down time." They are irrelevant in a medical sense.

Now, to address the treatment given, uhhh... yeah... we don't shock asystole. I have to admit to giving it a shot in the dark after I have tried everything else for the last fifteen minutes without success. But I sure don't delay my ABCs and pharmacological therapeutics for it. Are you sure you know the difference between asystole and v-fib? Because if you are correct, and the MICNs and paramedics in that system don't know the difference, I would RUN from that community in fear of my family's health and welfare.

As for the spelling thing, you did fine with "asystolic." You did, however, misspell the much easier "moniter" though.

[CBEMT]

why did the medics feel the need to work her for 40 minutes on scene when she was completely flatline for 30 minutes and had no color change on the CO detector?

I hope you don't mean the CO2 detector that is used to verify ET tube placement! :shock:

How many times did they try? I feel pretty confident that they have protocols governing this. Ours it two attempts and you're offscene, with a recommendation to just BLS the airway to begin with.

As far as the "POS bone gun," I've never used one myself but I'm told it's pretty hard to screw up. Yet in this situation it was attempted 3 times without success?

I'm starting to think that the B team was working that night...

[chbare]

Remember, in the setting of poor perfusion (Cardiac Arrest) and severe ventilation/perfusion mismatch (massive PE) , you may in fact have very low or unobtainable exhaled C02 values. In addition, it sounds like they were not using capnography, just a simple color changing device. I have had mixed results with these devices.

I will not condemn the crews airway management strategies until we have an actual number of attempts at ETI.

I have known a few BIG's to fail as well. A highly experienced medic that I worked with tried twice with different devices without success during a bad code. His technique was correct. Sometimes these mechanical devices fail.

I am not sticking up for the team in question. However, I think we need more information about their actions prior to passing judgment or commenting on the way they handled this situation.

Take care,

chbare.

[Dustdevil]

KMAC said CO detector, not CO[sub:4202366a02]2[/sub:4202366a02] detector.

I guess it's a scene safety thing? :?