# I Can't Collect On him - He's Dead!!!



## MedicPrincess (Aug 21, 2005)

Last night in our ER, EMS brought in a 20 y/o male who had been released from our hospital a couple days ago.  He had been found in cardiac arrest on his bathroom floor by a couple friend who were coming by to see how he was feeling.  So one friend starts CPR, the other calls 911.  Medics get there, start working him.  Its about a 20 minutes from the call to arrival in our ER.  Our staff works him for about another 20 minutes.  DR checks with the dopplar - nothing - so he calls it.

I do my usual registration for a DOA - write "Pt unable to sign" on all the consents and insurnace stuff, print the cover sheet and file it.  I take the family to our quiet room where the "Stripper" Doctor is preparing to meet with them.  Time to go, so I clock out, go home...usual nighttime stuff.

This morning his chart is back on my desk with a note on it to collect the inpatient co-pay and get the forms signed.  I laugh a little and call the girl who audits charts and ask her how in the hell I can collect a co-pay and have consents signed by a dead guy.  

Well...turns out....After the Dr met with the family they began letting the family go in to say their last good byes.  Two by two they went in - apparantly there were about 20 of them by the time I left.  Finally, after everyone goes in, Mom goes in and decides to sit with her boy.  About 15 minutes after she is in there she runs out, grabs Stripper Doctor and says her son in breathing.  Stripper Doctor tries to calm her down, but Mom insists.  So Stripper Doctor goes in the room.  And promptly walks out and says to get her some help in there and page respiratory STAT!    

Dead guy is now in our CCU - not yet awake, but breathing on his own.

How in heck does that happen??? He was dead for AT LEAST an hour and half...probably longer....and now he breaths on his own???  

I don't  think I am going to ask his mama for any money today though....Maybe upon discharge I will....


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## Chimpie (Aug 21, 2005)

:blink:


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## Wingnut (Aug 21, 2005)




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## vtemti (Aug 21, 2005)

:huh:


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## CodeSurfer (Aug 21, 2005)

:unsure:


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## MedicPrincess (Aug 21, 2005)

When we change a patient from an ER patient to an Inpatient we have to list the admitting diagnosis as given to us by the physician...

I just looked at his...it is

Cardiac Arrest with Asystole


Now TELL ME...Isn't someone who is in cardiac arrest technically dead?  And doesnt asystole sort of mean "flat line on the monitor" - like the heart is not beating....

So are they saying we have a guy upstairs who is in cardiac arrest, BUT BREATHING on his own and showing flat line on the monitor????

I am SOOOOOOOOOOOOO CONFUSED!!!!!!!!! :unsure:  :blink:  :unsure:  :blink:  :unsure:  :blink:


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## ffemt8978 (Aug 21, 2005)

:unsure:


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## Wingnut (Aug 21, 2005)

In Emt class they told us when we see asystole, to basically forget getting the person back. (Do the drill of course but don't expect results).

Again I


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## Cap'nPanic (Aug 22, 2005)

JEEZUS!!!!  :blink:  :blink:  :blink: 

Im like you, Im getting very confused, I may be only a basic but dammit I know my cardiac!

Cardica arrest = dead

Asystole = flatlined and bored to DEATH!

Cap'nPanic


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## MedicPrincess (Aug 22, 2005)

I did great in the Cardiac Emergency section as well.  The nurses around here are pretty damn awesome, I have the utmost respect for "Stripper" Doctor (despite referring to her as a stripper)....

They are all pulling the CYA of the year on this one.  He should be dead.  His mom should be burying him today.

This makes me wonder though....He is a frequent admit for DKA...I asked a nurse what his blood sugar this time was...it was 687!!!  

Now we know why he coded!

Now I wonder if he will become compliant...if he ever wakes up.


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## Cap'nPanic (Aug 22, 2005)

I doubt it, most diabetics I know "play" with their BGL's. They dont realize the damage they are doing to themselves. Often they do it for solely attention alone.

IE - One diabetic M I know had a fight with his girlfriend one night, he decided to OD on a bunch of snickers candy bars, ended up in the ER and was in a coma. Of course his then-girlfriend became extremely worried and came to the ER to "forgive" him and all of that good emotional BS. After the 3rd-4th time this occured she realized his BGLs always went out of whack after they had a fight when she threatened to bring the relationship to an end. The last time that happened she wanted me to go with her so I did, well she unloaded on him! She pretty much told him to quit the drama and grow up or was really going to end up dead or Schiavo-esque. Hell I was even brought in and I chimed in as well, telling him all the problems he could have in the future if he kept this nonesense up. She broke up with him in ER and we promptly left. Now he's calling her a cold-hearted worthless B****. Oddly he just recently got busted for weed and meth and ended up in a cell. Maybe that had something to do with it?   

-Cap'nPanic


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## Wingnut (Aug 22, 2005)

> _Originally posted by Cap'nPanic_@Aug 22 2005, 12:55 PM
> * Oddly he just recently got busted for weed and meth and ended up in a cell. Maybe that had something to do with it?
> 
> *


 Those types aren't the sharpest cards in the deck. I'm really not suprised.


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## Jon (Aug 23, 2005)

> _Originally posted by Wingnut+Aug 22 2005, 03:26 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (Wingnut @ Aug 22 2005, 03:26 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-Cap'nPanic_@Aug 22 2005, 12:55 PM
> * Oddly he just recently got busted for weed and meth and ended up in a cell. Maybe that had something to do with it?
> 
> *


Those types aren't the sharpest cards in the deck. I'm really not suprised.   [/b][/quote]
 i was thinking the same thing.


as for the code, if the doc used all reasonable availible means to determine death, then she should be fine.... if she used a doppler, or even better, an ultrasound, to listen for blood flow, after verifying asystole in 3 leads x12 seconds.... that is more than AHA says you must do...

as for breathing later... someitmes when you move a dead body, they gasp or far... it is the stomach gasses and equalizing of pressures.....

as for bing in ICU..... guy is probalby a total vegtable.... after an hour or 2 of down-time, you've got to be.... he will either have life support turned off or get some nasty hospital infection (MRSA / VRE) within the next 2 or 3 weeks, and die, or will live for years and become the next schivo....


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## Wingnut (Aug 23, 2005)

> _Originally posted by MedicStudentJon_@Aug 23 2005, 07:27 AM
> *
> as for bing in ICU..... guy is probalby a total vegtable.... after an hour or 2 of down-time, you've got to be.... he will either have life support turned off or get some nasty hospital infection (MRSA / VRE) within the next 2 or 3 weeks, and die, or will live for years and become the next schivo.... *


 Good point Jon, as for me I'd rather have died with the asystole than end up like that.

If I remember correctly? we have a 2 minute reserve of ATP then parts of our brain go night-night for good.


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## Jon (Aug 23, 2005)

> _Originally posted by Wingnut+Aug 23 2005, 12:24 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (Wingnut @ Aug 23 2005, 12:24 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-MedicStudentJon_@Aug 23 2005, 07:27 AM
> *
> as for bing in ICU..... guy is probalby a total vegtable.... after an hour or 2 of down-time, you've got to be.... he will either have life support turned off or get some nasty hospital infection (MRSA / VRE) within the next 2 or 3 weeks, and die, or will live for years and become the next schivo.... *


Good point Jon, as for me I'd rather have died with the asystole than end up like that.

If I remember correctly? we have a 2 minute reserve of ATP then parts of our brain go night-night for good. [/b][/quote]
 close..... and this is WHY the "autopulse" folks say it is the greatest thing since sliced bread.... B)   

CPR keeps the blood going through the heart, but only gives 1% or so of the normal flow to the brain..... 

Zoll says Autopulse restores 90% or better of the brain's bloodflow..... this means that you have more time to get the heart going again.

The only AED / Defib "Save" I've seen, where the guy was perfectly normal and not impaired afterwards.... the medic, on the bike, with the AED, almost WITTNESSED the arrest... he was looking in that direction and didn't see the guy go down. but saw the "Uh Oh" squad show up.....  

arrest to defib time was almost definatly under 2 minutes.

Jon


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## Cap'nPanic (Aug 23, 2005)

Statistically for every minute your down your chances for survival decrease by 10 percent.

You have less than half of one percent chance of a full recovery from a cardiac arrest.

Your brain does have oxygen stores, but very very very little. This is also the reason why every once a zillion codes that you do in your career that while doing compressions the person might look up at you or might move, people have also been known to be fully conscious during shocks, but then become unconscious when not shocking. 

But as for being in asystole and conscious, I dont buy into that BS.

-CapnPanic

The one, the only, filled with useless info....  B)


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## rescuejew (Aug 23, 2005)

I had one like that, well similar...33 yo female, coke OD found down by her kids (ugghhh, dont even get me started...)  who started CPR.  Systole for 45 MINUTES!!!  4 rounds of drugs, intubated, sternal IO, nada.  

2 more rounds of drugs en route...arrive at ED and pt is worked for another 0 minutes with nothing.  Doc Austin leaves to inform the family that their kid is dead.  All resuscitative measures have been stopped by this point.  WHen Doc comes back, someone had forgotten to d/c the monitor and the pt had a pulse of 120 with a BP of 90 systolic.  I personally just think she was living off EPI and Dopamine but...(intone twilight music here...) one never knows...


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## Jon (Aug 24, 2005)

> _Originally posted by rescuejew_@Aug 23 2005, 04:08 PM
> * I personally just think she was living off EPI and Dopamine but...(intone twilight music here...) one never knows... *


 to quote my instructor.... "If you give enough Epi to a rock, it will have a pulse"

Jon


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## rescuejew (Aug 28, 2005)

small variation Jon:  we got, if you give enough EPi to a steck it will crawl across the table...


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## Jon (Aug 29, 2005)

whenever I hear these stories I remeber Monty Python and the Holy Grail.... "I'm Not Dead Yet"


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## rescuejew (Aug 29, 2005)

"tis only a flesh wound...get back here and FIGHT!!!"  LOL


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## Jon (Aug 29, 2005)

I'm getting better....


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## emtbass (Sep 14, 2005)

Im so stubborn, I will probably be someone who "dies" for a few hours, and then "comes back".  This all just seems to weird to me.  Your dead... You just dont come back ny yourself.  You dont have a nice new life pack 12 implanted in your heart to get you back 2 hours later.  What is you were already in the mourge or something, you came back, but then suffocated cause you in a metal case... now that would suck.  you could have made it.. but not now.... sorry bout ya bad luck!!!

If I ever code..... wait I have.... nevertheless.... If I ever code again.. once they get me back (cause they will    )... im gonna pop up and say "gottcha ya".  And then complain that my ribs are broke.. and get all pissed off.


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## HotNoldEMTchick (Sep 14, 2005)

All I can say is holy


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## DFDEMS (Sep 15, 2005)

> *How in heck does that happen??? He was dead for AT LEAST an hour and half...probably longer....and now he breaths on his own???*



Ancient Chinese secret. 

1 eye of newt, bat wings and a couple of frog legs. Mix it all up, do a little happy dance. The odds are about the same I would imagine after 1 1/2 hours.  1 in a billion or so. Just image the look of "I told you so" you could give everyone if it worked.. 






> * and this is WHY the "autopulse" folks say it is the greatest thing since sliced bread*



We use the "thumper" that is the same in principal I guess. They work like a champ. They compress and ventilate for you (5:1).


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## Ridryder911 (Sep 19, 2005)

Chances are that he really was not in "true aystole" and someone pulled the plug too soon. I have seen this happen more than once.  The DKA ( although that glucose was not that high.. (usually I see them > 1000 -2000 (diluted)mg/dl before arrest) he probably was extremely acidotic and then the epi kicked in later.. causing the catecholmine rush... they were right "cardiac arrest-aytole".. what they did not document early terminaiton of cardiac arrest resucitation procedure. 

Hate that when the patient responds after the family been told they were dead.... that is why he is still in ICU... and probably the billing charges will be wrote off, to prevent a law suit.

Be safe,
Ridryder 911


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## Ridryder911 (Sep 19, 2005)

sorry it posted twice ?


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## MedicPrincess (Sep 19, 2005)

> _Originally posted by emtbass_@Sep 14 2005, 02:45 AM
> * What is you were already in the mourge or something, you came back, but then suffocated cause you in a metal case... now that would suck.  you could have made it.. but not now.... sorry bout ya bad luck!!!
> 
> *


 Sorry I missed this before...

That image is just do dang funny.....


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## ffemt8978 (Sep 19, 2005)

I keep thinking about that NC medic that got suspended for pronouncing a guy dead on the scene of an accident only to have him "live" as he got to the morgue.

Think the state will pull the doc's license here for the same reason, now that the precedent has been set?  Probably not.


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