# Who Needs An AED? CPR FTW!



## 20XII (Dec 17, 2012)

So today in my EMT-B class our instructor showed us this crazy video. We have a couple local casinos and this larger gentleman about 6'2" 320 lbs just coded right in front of the tables. Of course, being a casino, there were tons of cameras. So you see this guy just faceplant and about 30 seconds later one of the EMR's on sight ran over, checked for a pulse (obviously no pulse), and started doing CPR and somehow without using an AED this guy just came back. I will try to get a copy of the video next time I am in class to post on here. It was pretty miraculous.


----------



## VFlutter (Dec 17, 2012)

My guess is the guy had a syncopal episode due to a self terminating tachyarrhythmia or a sinus pause and was only pulse-less for a few seconds. Realistically the CPR probably didn't do anything but wake him up


----------



## JPINFV (Dec 17, 2012)

Chase said:


> My guess is the guy had a syncopal episode due to self terminating tachyarrhythmia or a sinus pause and was only pulse-less for a few seconds. Realistically the CPR probably didn't do anything but wake him up


----------



## Aidey (Dec 17, 2012)

JPINFV said:


>



I have that shirt, lol.


----------



## STXmedic (Dec 18, 2012)

20XII said:


> So today in my EMT-B class our instructor showed us this crazy video. We have a couple local casinos and this larger gentleman about 6'2" 320 lbs just coded right in front of the tables. Of course, being a casino, there were tons of cameras. So you see this guy just faceplant and about 30 seconds later one of the EMR's on sight ran over, checked for a pulse (obviously no pulse), and started doing CPR and somehow without using an AED this guy just came back. I will try to get a copy of the video next time I am in class to post on here. It was pretty miraculous.



Any chance the EMR just missed the weak, thready, collapsible pulse... :unsure:

I like chase's theory.

And I love that shirt


----------



## DrParasite (Dec 18, 2012)

5 or so years ago, had a unit respond to a cardiac arrest with CPR in progress.  ALS and BLS were requested.  Apparently the cops did one round of CPR, patient got up and walked away.  ambulance never  even made it.

See, apparently CPR does save lives!!


----------



## CGULL (Jan 6, 2013)

Chase said:


> My guess is the guy had a syncopal episode due to a self terminating tachyarrhythmia or a sinus pause and was only pulse-less for a few seconds. Realistically the CPR probably didn't do anything but wake him up



Agreed. Remember if it is a true MI, CPR is just keeping the brain and organs alive until an AED is brought. People can look like they are having an MI when something else could be wrong.

Remember to shake & wake, check for breathing and pulse before you start pounding away on their chest!


----------



## JPINFV (Jan 6, 2013)

CGULL said:


> Agreed. Remember if it is a true MI, CPR is just keeping the brain and organs alive until an AED is brought. People can look like they are having an MI when something else could be wrong.
> 
> Remember to shake & wake, check for breathing and pulse before you start pounding away on their chest!




Myocardial infarction (MI) and cardiac arrest are not equivalent terms.


----------



## RustyShackleford (Jan 6, 2013)

Nor are they in the same ball park


----------



## mycrofft (Jan 6, 2013)

My favorite theory about CPR "saves" is that it is initiated on people who don't need it, or people with a transient cause, daily. 

If they require CPR, they better not be "walking away"!

Actually, If you do't see the subject go down, calling for help (and presumably quickly looking for the AED) comes before ARC CPR (layperson).

Good CPR promptly and correctly done gives a chance, coupled with AED a much better chance, if they are recoverable* in  the   first   place  !*.


----------



## Handsome Robb (Jan 6, 2013)

So we had a instance like this recently. Female in her early 20s collapsed in front of the ALS standby rig 50 yards from the finish line of a half marathon. They found her pulseless with agonal respirations. Started compressions, scooped her up put her on the gurney and moved her to the rig. The medic doing compressions was a hefty dude, 6'7" an easy 260#. It was a dual medic rig, about 15 years experience between the two of them, both confirmed she was pulseless. When they got her in the back and onto the monitor she was in a sinus tach with corresponding pulses. She was answering questions with good vitals in the back of the transport rig. Doc said the medics were idiots. Lab results confirmed elevated cardiac enzymes. 

Only theory anyone could come up with is compressions from the big medic imitated a precordial thump and terminated the dysrhythmia. She had no H/A/M, was admittedly dehydrated, hungover and had taken an adderall that morning. No family hx either.


----------



## mycrofft (Jan 6, 2013)

I think the episode of dysrythmia ended. Her potential for it again is pronounced. Especially if she gets that stupid again.


----------



## Aidey (Jan 6, 2013)

I'm almost positive elevated enzymes are normal after a marathon. After all, elevated enzymes are a sign of muscle damage, which is expected after intense exercise.


----------



## mycrofft (Jan 6, 2013)

Elevated enzymes plus S/S and serial EKG's for comparison (and include a rhythm strip, thank you) are what you need.

Had a guy once who had an ...ok EKG with the automated 12 lead. I ran a 1 minute rhythm strip and in that we saw a wave of PVC's come on, then taper off. Missed by the 12 lead snapshot entirely.

PS: in the casino, try an ammonia  inhaler. Shame to make someone who has died or needed hospitalization settle their tab before they leave, right?


----------



## NomadicMedic (Jan 6, 2013)

Aidey said:


> I'm almost positive elevated enzymes are normal after a marathon. After all, elevated enzymes are a sign of muscle damage, which is expected after intense exercise.



Yep, troponin is elevated after a marathon. 

https://www.mja.com.au/journal/2009...mong-marathon-runners-perth-marathon-troponin


----------



## NomadicMedic (Jan 6, 2013)

mycrofft said:


> in the casino, try an ammonia  inhaler. Shame to make someone who has died or needed hospitalization settle their tab before they leave, right?



I think you'd be hard pressed to find a service that still allows ammonia inhalants.


----------



## Aidey (Jan 6, 2013)

Most of the FDs where I work carry them.


----------



## Handsome Robb (Jan 7, 2013)

Aidey said:


> I'm almost positive elevated enzymes are normal after a marathon. After all, elevated enzymes are a sign of muscle damage, which is expected after intense exercise.



That was my thought as well. 

FWIW, and I know it's not hard evidence, but the MDs decided she had in fact arrested and there was a giant news article about it. 

I wasn't there, but the fact that two very experienced medics, and an experienced Intermediate all agree she was pulseless makes me think she really was in arrest but I'm not the sharpest tool in the shed so take it with a grain of salt.


----------



## mycrofft (Jan 7, 2013)

There ARE a segment of codes who are reversible because the trigger was transient (my repeated litany, electrocution, suffocation, poison). As was noted above, asystole does not equal MI (not _always_; but _usually_, and more usually as the age climbs and the setting is sedentary).

_This seems to be a point we have trouble getting our heads around_, as well as *equating true asystole (flatline) with "pulselessness" *(usually not auscultated, but palpated radially and maybe at the carotid) which can be a range of arrhythmias or subjective failure to sense a pulse. Lack of semantic turgor leaves room for misunderstanding. Misunderstanding can lead to maltreatment.


----------



## med109 (Jan 7, 2013)

We had this recently, paged for general weakness. Once on scene bystanders state patient was outside waiting for EMS, and "she collapsed" so bystander checked for a pulse, didn't find one and began CPR, did CPR for about a minute (thank God she remembered it from girl scouts 30 years ago!) and patient "came back to life". She was so healed that she was smoking a cigarette when EMS arrived (cardiac arrest IS very stressful).

There was a front page article in the paper about the bystander being a hero, and how important CPR is, and "she saved my life" blah blah ad nauseum. Of course the article also included that it took 45 minutes for the ambulance to arrive! Of course the person writting the article never contacted EMS to verify anything. We contacted the newspaper and encouraged her to talk to some Dr's and do some research about people coming back from CPR to a smoking position, AND to contact dispatch in the future for correct times before making an ambulance department look that bad. She did contact the ER Dr (our advisior) and he told her that the patient probably had a sycopal episode with a faint pulse or something similar. Of course the paper never wrote a follow up!


----------



## mycrofft (Jan 7, 2013)

med109 said:


> She did contact the ER Dr (our advisior) and he told her that the patient probably had a sycopal episode with a faint pulse or something similar. Of course the paper never wrote a follow up!



Where's the story in an apology? "If it bleeds, it leads".


Seeing a CPR subject sit up and smoke is as good as seeing a firefighter exit a fire, pull off her/his SCBA mask, and light up.


----------



## medichopeful (Jan 7, 2013)

RustyShackleford said:


> Nor are they in the same ball park



Well, they could be! :huh:


----------



## mycrofft (Jan 7, 2013)

medichopeful said:


> Well, they could be! :huh:



In the USA and outside Pediatrics, they most probably are, but that little wedge of the piechart that says "I can be saved" is worth going for.

Tell you what; if my offspring or wife go down and you (generic you) are there, you have my permission to try your best to save them, 'k? I want 'em BACK.


----------



## medichopeful (Jan 7, 2013)

mycrofft said:


> In the USA and outside Pediatrics, they most probably are, but that little wedge of the piechart that says "I can be saved" is worth going for.
> 
> Tell you what; if my offspring or wife go down and you (generic you) are there, you have my permission to try your best to save them, 'k? I want 'em BACK.



Oh, absolutely go for it!

Mycrofft, I'll do my best for ya!


----------



## Anonymous (Jan 7, 2013)

Had a call where medics got pulses and a perfusable rhythm back with CPR and one round of Epi. No defib. Patient was later called at the hospital. 

From what I am gathering from this thread this is not possible?


----------



## mycrofft (Jan 8, 2013)

It all depends upon what caused the death.

Again,
1. Not finding a palpable pulse in the field does not mean there IS no pulse.
2. No palpable pulse does not mean there is no AUDIBLE pulse.
2. Just because there is no audible nor palpable pulse (even in a quiet room) does not mean there is no shockable rhythm.

There are, a.)  haemodynamic asystole (no pulse), and there is  b.)electrical asystole (flatline, "Kansas Sign"). You can have a without b, but not b without a.

The pt is not survivable, despite CPR/AED and drugs if:
1. The heart is dead (enough necrosis or neuro blockade).
2. The brain is dead (ditto)
3. The cause of either of the above is persistent enough that CPR etc cannot outlast it or there is no countermeasure.
There. Magic Max's definition of "All-Dead!".


----------



## Soldiermedic247 (Oct 16, 2014)

He could of also had a spell of PEA during the syncopial episode


----------



## vcuemt (Oct 17, 2014)

No matter how expansive your protocols, no one recommends trying to being back a patient dead for over a year.


----------



## Gurby (Oct 17, 2014)

Responded to a respiratory distress call earlier this week in hospital.  A million people in the room standing around trying to bag/intubate/etc.  Pt is on a monitor, and suddenly somebody looks up and points out that pt is asystolic.  Leads checked, pulselessness confirmed by like 5 different MD's who were in the room.  ~8 minutes of rib cracking and a few rounds of epi later he was back in a sinus rhythm with corresponding pulses.

I was shocked, but apparently it is possible to bring somebody back with nothing but CPR and maybe some drugs.  I'm sure the fact that CPR was started within probably 20 seconds of him going asystolic made a big difference.  Guy was a trainwreck and probably didn't make it in the end anyways, though.


----------

