I've been questioning and second guessing myself over a call that my partner and I ran earlier this week. The questions are at the very end if anyone cares to respond but does not wish to read the back story. Thanks in advance!
We were called for an unresponsive patient, breathing status unknown, so we went in expecting to work a full code. As we are walking to the patient we are questioning the person who met us at the door and we discern that from the time that the patient was found until EMS was called five to ten minutes elapsed. From the time of our dispatch until we reached the patient was 12 minutes. With at least 12 minutes, and more that likely 17-22 minutes without CPR we were not very hopeful, but still prepared to work the code depending what we found.
We entered the room where the patient was and found them laying on left lateral on the bathroom floor. Face was visible and was a shade of blue/purple/grey that neither my partner or I have ever seen before. Vomitus is EVERYWHERE and we do not palpate any pulses. Lifting the patients left sleve and pant leg reveal what my partner and I both called lividity and her right side was notable pale. Based on these findings as well as the time line that the patient had gone without CPR our protocols allow us not to work the code but to confirm our findings with an ECG, finding asystole.
We placed the defib pads on the patient (we only have a lead two capable monitor and no 'daisies', just the defib pads) and hit the print button. After eight seconds tore off a strip and it was a flat as I have ever seen. I handed the strip to my partner, still printing so that we had a copy for the coroner (as per our protocol). At eight seconds I ripped off the strip and noticed that the lead half second or so was not so flat. We hit print again but before we had a chance to look back to the strip our monitor stated "shock advised". My partner and I both looked at each other confirming that we had both heard that, and we jumped into action. We delivered one shock and began CPR, BVM ventilations and inserted a King tube before analyzing again. We never did get another shock advised and when we reviewed the strips at the hospital just before the shock advised we confirmed V. Fib on the rhythm strip followed by a defib spike and asystole continuously after that. Needless to say as soon as we arrived at the hospital the physicial on call called time of death (yes our protocols make us transport a code in progress), but a few questions have been lingering for my partner and I since the call.
Has anyone else ever gotten a workable rhythm from a patient who by all other assessments was dead?
Was what we saw as lividity something else? And what would it have been?
Does it make sense from a medical perspective (regardless of protocols) to have attempted to work this code?
Any other insight into this situation would be appreciated. I am sure I will never come across this situation ever again but am still anxious to learn whatever I can for future reference.
We were called for an unresponsive patient, breathing status unknown, so we went in expecting to work a full code. As we are walking to the patient we are questioning the person who met us at the door and we discern that from the time that the patient was found until EMS was called five to ten minutes elapsed. From the time of our dispatch until we reached the patient was 12 minutes. With at least 12 minutes, and more that likely 17-22 minutes without CPR we were not very hopeful, but still prepared to work the code depending what we found.
We entered the room where the patient was and found them laying on left lateral on the bathroom floor. Face was visible and was a shade of blue/purple/grey that neither my partner or I have ever seen before. Vomitus is EVERYWHERE and we do not palpate any pulses. Lifting the patients left sleve and pant leg reveal what my partner and I both called lividity and her right side was notable pale. Based on these findings as well as the time line that the patient had gone without CPR our protocols allow us not to work the code but to confirm our findings with an ECG, finding asystole.
We placed the defib pads on the patient (we only have a lead two capable monitor and no 'daisies', just the defib pads) and hit the print button. After eight seconds tore off a strip and it was a flat as I have ever seen. I handed the strip to my partner, still printing so that we had a copy for the coroner (as per our protocol). At eight seconds I ripped off the strip and noticed that the lead half second or so was not so flat. We hit print again but before we had a chance to look back to the strip our monitor stated "shock advised". My partner and I both looked at each other confirming that we had both heard that, and we jumped into action. We delivered one shock and began CPR, BVM ventilations and inserted a King tube before analyzing again. We never did get another shock advised and when we reviewed the strips at the hospital just before the shock advised we confirmed V. Fib on the rhythm strip followed by a defib spike and asystole continuously after that. Needless to say as soon as we arrived at the hospital the physicial on call called time of death (yes our protocols make us transport a code in progress), but a few questions have been lingering for my partner and I since the call.
Has anyone else ever gotten a workable rhythm from a patient who by all other assessments was dead?
Was what we saw as lividity something else? And what would it have been?
Does it make sense from a medical perspective (regardless of protocols) to have attempted to work this code?
Any other insight into this situation would be appreciated. I am sure I will never come across this situation ever again but am still anxious to learn whatever I can for future reference.