# ROSC question for medics.



## emt seeking first job (Jul 22, 2010)

I just got through an emtb class.

I was told by instructors, during breaks, they never saw someone defibrillated by medics and become response in the field.

Has anyone here, any medics, ever worked a patient, with drugs, airway, and defib, and have them b-4 the hospital ROSC and become repsonsive?

My instructors , some even went so far as to say it would NEVER happen, that one could get a pulse, etc, but they are never responsive.

My common sense tells me ANYTHING can happen, so it probably happened once or twice. I am just interested in hearing first hand stories.

Anyone ever get up, say thank you, and walk away RMA ?


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## Shishkabob (Jul 22, 2010)

Already was answered in your original post "question regarding CPR/ saves ALS or BLS"


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## emt seeking first job (Jul 22, 2010)

Yes and no.

Many of the answers just came from a context of CPR with no defrib.

I am re-asking the question on saves only by ALS, with meds and defib.

Please pardon me if my post offends you.


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## abckidsmom (Jul 22, 2010)

Yes.  We had a witnessed vfib arrest, defibrillated 3 times, CPR for a couple of minutes, 1st round of meds, defibrillated a 4th time for ROSC.  The patient regained consciousness before the helicoptor arrived.


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## socalmedic (Jul 22, 2010)

in four years i have only had one ROSC, she remained unresponsive, 12lead showed massive inferior infarct. she re-arrested at the hospital (stemi center) and was determined to be dead due to massive infarct. and that was my only near.


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## wyoskibum (Jul 22, 2010)

*Yes, I have.....*



emt seeking first job said:


> Has anyone here, any medics, ever worked a patient, with drugs, airway, and defib, and have them b-4 the hospital ROSC and become repsonsive?
> 
> My instructors , some even went so far as to say it would NEVER happen, that one could get a pulse, etc, but they are never responsive.
> 
> Anyone ever get up, say thank you, and walk away RMA ?



I had one patient who had a SCA at a hotel breakfast bar.  An ED doc who witnessed the arrest started CPR.  We had a 3 min response time and the pt was in V-Fib on our arrival.  We ended up shocking 7 times.  Each time a pulsed returned and the  patient went back to V-fib.  After we were able to get an IV and push EPI, pt converted on last shock and stayed in a Sinus Rhythm.  I wasn't able to place an ETT as the patient started to come around.  Patient was conscious upon arrival to ED.

I had another patient who we responded for Chest Pain.  We worked her up for AMI: 12-lead, IV, ASA, NTG.  As we were rolling gurney to ambulance, patient coded.  Patient was in V-Fib, we shocked once and had ROSC.  Pt started coming around and tried to bite my EMT.  After the rig was put back together and paperwork done, pt was able to sign billing form.

That being said, I doubt that anyone would code, be resuscitated and then walk away with a RMA.  They would still need to be transported to hospital.


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## Aidey (Jul 22, 2010)

I have never had one, no. All of my ROSC Pts have died in the long run. I've been called for arrests a couple of times and upon arrival found that the pt is alive and conscious. In all of those cases all indications were that the patient was never dead and CPR was initiated mistakenly. 

I have heard of one case, which a co-worker had 4-5 months ago. It was a young female athlete later found to have long QT. I don't know how many shocks or meds she  was given, but she did regain consciousness on scene.


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## 82-Alpha599 (Jul 22, 2010)

rare but certainly possible. 

like you said anything can happen.

especially in EMS
youll see


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## Veneficus (Jul 22, 2010)

yes,

worked a code that started with bystander CPR, when we arrived, continued CPR, intubated, shocked twice, gave epi and bi carb, converted to sinus tach and opened her eyes, had to give her versed to keep her from yanking the tube out on the way to the hospital.

weirdest one I saw was a guy who coded and during cpr he would open his eyes and look around, try to talk, and then code again when cpr stopped. After about an hour efforts were terminated.


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## Smash (Jul 23, 2010)

Veneficus said:


> weirdest one I saw was a guy who coded and during cpr he would open his eyes and look around, try to talk, and then code again when cpr stopped. After about an hour efforts were terminated.



Had a couple of those, very freaky.  Actually ended up giving one of the versed during the code he was becoming so agitated.  Until we stopped doing CPR.  Very, very disturbing.  He died.  A couple others like that survived though.


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## LondonMedic (Jul 23, 2010)

Veneficus said:


> weirdest one I saw was a guy who coded and during cpr he would open his eyes and look around, try to talk, and then code again when cpr stopped. After about an hour efforts were terminated.


:wacko: Never seen anything quite like that.

I have seen people regain signs of circulation - their skin pinks up a bit, their eyes twitch, etc. - with LUCAS.


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## MrBrown (Jul 23, 2010)

Not personally but one of my mates had a guy in VT who went unconscious, zapped him once, bit of CPR and he was up and talking.


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## Aidey (Jul 23, 2010)

Veneficus said:


> weirdest one I saw was a guy who coded and during cpr he would open his eyes and look around, try to talk, and then code again when cpr stopped. After about an hour efforts were terminated.



I've heard of that also, it happened at the hospital I did my internship at (not while I was there, a few years before I think.)


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## WolfmanHarris (Jul 23, 2010)

LondonMedic said:


> :wacko: Never seen anything quite like that.
> 
> I have seen people regain signs of circulation - their skin pinks up a bit, their eyes twitch, etc. - with LUCAS.



I can't wait until our LUCAS 2's hit the trucks. Just had my in-service CME on them last month. What an exciting piece of kit.

I've never seen it. But I'm a VERY white cloud. My last VSA was two months ago. They were obviously dead. Before that it was four months ago. They didn't make it.

While the individual stories are interesting and fun, be careful not to get too caught up in anecdotal evidence. Your instructor's have, and that's been the cause of this discussion. Arguing from experience is a logical fallacy and one of the one's we easily fall back upon.

That being said, they had a fun ROSC at the hospital when I was there on clinical. Guy in Emerg codes, CPR started right away by the MD. Guy gets a ROSC nearly immediately. Doc got a little too hung up on AHA standards and insisted on finishing two minutes of CPR. Despite the eyes starting to open and the grunting.


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## MasterIntubator (Jul 23, 2010)

Yes, yes and yes.  Since 2005, I personally have had 12 ROSC codes with stable vitals.  5 went home, the rest stayed in ICU for who knows how long, as follow up becomes diffcult due to pt privacy and stuff.  
2 of those "went homes" became awake in the medic unit... disoriented and mad as hell. One of them had a down time of 4.5 minutes ( CAD notes/MDT times ) and was worked on for 20 minutes - 7 defibs, numerous rounds of meds, and onlu BVM without airway adjuct ( did not need it... good compliance, and good experienced person on airway ).  That one talked to me before I finished my paperwork, and I had some in depth conversations with him of what he remembered, experienced, etc etc.
These were documented, and are on file as well as been registered with the "ROSC I survived a code" study.... I can't think of the exact name right now... but had something to do with ILCOR and a developed database of ROSC folks. 
Numerous co-workers have done the same, and have the citations and "expert" witnesses as well. 

What I have come up with, that makes the difference, based on all of our local studies... is that Non-traumatic, non-medically complicated full codes should have the best chance of ROSC in the field, when the medics'...... let me say this again.... when the medics' and thier crews have thier shiznit together, train together, approach methodically and calm with the sense of urgency and accuracy in thier treatments... stuff like this will happen often, compared to other units.  Sad.... but true.  
It does, and has been proven on my unit, as well as others in my area.

Key # 1:  Fast, uniterupted CPR.  We do about 120 compressions a minute. ( 2 a second )
#2 : Do all treatments with compressions.  Defib should only take a second to deliver and get back on that chest. You charge during compressions, quick look at the screen before pressing the button.  No time to go ... "ummm... that looks like.... ".  Just know it.

#3: Calm down and breathe
#4: Slow those BVMs down, and work with EtCO2 waveform. Titrate BVMs to that.
#5: Don't give too many drugs... all at once.  Give them a chance to circulate and work.
#6: Calm down and breathe
#7: So far, I still have not seen any further improvement with the ITD, as the walking-talking ROSC cases did not have one on, many of the rest did.  Again... subjective data, maybe different factors. 
#8: Calm down and breathe

Sooooooo, for an instructor to give such a blanket statement without the raisens to back it up, should probably broaden thier knowledge base and keep up to date with the latest out there.
SO yes, it will one day happen to you, and when it does.... it feels great and is what makes 20 some year veterans keep doing this. ( there is more that keeps it going... but you know what Im sayin)

Keep it pumping!


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## rescue99 (Jul 23, 2010)

emt seeking first job said:


> I just got through an emtb class.
> 
> I was told by instructors, during breaks, they never saw someone defibrillated by medics and become response in the field.
> 
> ...





Sure! A few times but frankly, this is rare event. Not only have they become responsive but they were sitting up talking at the ER.No one ever "walked away." One gentleman was hit 17 times and was tubed yet still tried to get up and leave. I'm guessing his LOC may have been nearly as fried as his chest hairs at the time. 5 weeks later, he resumed his job as a business owner.


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## itzfrank (Jul 31, 2010)

Only 1 time. She was back to work a few weeks later. 7 minutes of CPR, vfib, 1x defib, no drugs. She was awake at our arrival at ER. Only person I've ever seen be back to responsive after ROSC.


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## JeffDHMC (Aug 1, 2010)

Had an 80+ F wake up and try to refuse after de-fib years ago. I don't recall seeing it any other time.


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## Akulahawk (Aug 1, 2010)

I've seen a couple pre-hospital ROSC. Both had a short downtime, and got back to a perfusing rhythm. Neither regained consciousness in the field. The first was sparked x2, no drugs. The second one was in agonal resps when I found him, went into cardiac arrest from there, before I could start ventilating him. A couple minutes of good CPR and ventilation and he did have ROSC, still required the BVM. He was tubed, D/C from hospital about 3 weeks later, to SNF, with brain damage, didn't get good details about the extent or whether that was the cause of his arrest. I learned about his case outcome, mostly in-passing from another crew.


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## emt seeking first job (Aug 1, 2010)

itzfrank said:


> Only 1 time. She was back to work a few weeks later. 7 minutes of CPR, vfib, 1x defib, no drugs. She was awake at our arrival at ER. Only person I've ever seen be back to responsive after ROSC.




Did she speak?

What did she say?


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## emt seeking first job (Aug 1, 2010)

JeffDHMC said:


> Had an 80+ F wake up and try to refuse after de-fib years ago. I don't recall seeing it any other time.




Interesting.

What did she perceive as just happening to her?


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## task (Aug 1, 2010)

Pt went into arrest in a restaurant, luckily for him a coworker EMT started CPR immediately. On scene we shocked him a couple of time, first round of meds ( 1 epi, 90 of lidocaine) ROSC he bit at my blade as i was trying to intubate. before we got in the truck i had him on a NRB. started a lidocaine drip. He was CAO during transport, C/C of CP then started our chest pain protocol, ASA and NTG before we got to the LZ. The PT went back to work at the restaurant 2 weeks later. 

i have had several saves some with purposeful movement, and spontaneous respirations, You don't expect them to wake up and talk to you.


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## the_negro_puppy (Aug 2, 2010)

You can watch someone in real life being de-fibbed by an AED and regain conciousness.

This was done in Sydney, I believe the young man had a pre-existing undiagnosed heart condition that caused him to go into VF while swimming

http://www.youtube.com/watch?v=ICODRFoWZkw

also good if you have never seen agonal resps before


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## Melclin (Aug 2, 2010)

the_negro_puppy said:


> You can watch someone in real life being de-fibbed by an AED and regain conciousness.
> 
> This was done in Sydney, I believe the young man had a pre-existing undiagnosed heart condition that caused him to go into VF while swimming
> 
> ...



I love how ridiculously inaccurate the narrator is.

My favourite is: "A shot of maxolon will help stabilize taka". Now I know why all the arrests I go to die..I'm not treating their nausea. :lol:

Best CPR I ever saw on TV was on Surf Patrol. I tried to find a copy to show my Johnos how deep and violent it looks compared to TV CPR. Never did find one though.


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## MrBrown (Aug 2, 2010)

Melclin said:


> I love how ridiculously inaccurate the narrator is.
> 
> My favourite is: "A shot of maxolon will help stabilize taka". Now I know why all the arrests I go to die..I'm not treating their nausea. :lol:



At least you go to arrests mate, I get lots of "ischaemic changes on 12 lead ECG" but no arrests.  I think .... hang on

"Hello HEMS? Yes, yes, ok ta"
"Brow, its a go mate"
"What is it Oz, an arrest?"
"Afraid not mate, its an RTA, persons trapped, lot of calls saying its serious"
"Aw bloody hell you are the curse of me"

All set, very good, we're off ....


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## Melclin (Aug 2, 2010)

MrBrown said:


> At least you go to arrests mate, I get lots of "ischaemic changes on 12 lead ECG" but no arrests.  I think .... hang on



Just let them bake for a while.


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## i5adam8 (Aug 2, 2010)

Here is an interesteing video


http://www.youtube.com/watch?v=rv-uWXo4xzU


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## dmiracco (Aug 2, 2010)

Absolutely, apparently your Instructors havent seen it before but that doesnt mean it cant happen so they are wrong. I have had this happen a handful of times.


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## zmedic (Aug 2, 2010)

the_negro_puppy said:


> You can watch someone in real life being de-fibbed by an AED and regain conciousness.
> 
> This was done in Sydney, I believe the young man had a pre-existing undiagnosed heart condition that caused him to go into VF while swimming
> 
> ...



That's a great video, I've been showing it to my classes for the last few years as a great example of a code save. 

They do have to speed up their chest compressions though.


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## the_negro_puppy (Aug 2, 2010)

zmedic said:


> That's a great video, I've been showing it to my classes for the last few years as a great example of a code save.
> 
> They do have to speed up their chest compressions though.



Indeed, I believe this episode was shot before they changed. Here in Aus we do 30:2 @ 100bpm for adults.

I had an arrest the other day where our medical director (Senior Emergency Doctor) came out. At one stage he jumped on compressions and was really pumping the guy- at around 120bpm


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## YoungestSV (Aug 3, 2010)

What about this:
http://www.youtube.com/watch?v=rv-uWXo4xzU&feature=PlayList&p=77748C04F5C656DC&playnext=1&index=13


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## MrBrown (Aug 3, 2010)

the_negro_puppy said:


> Indeed, I believe this episode was shot before they changed. Here in Aus we do 30:2 @ 100bpm for adults.
> 
> I had an arrest the other day where our medical director (Senior Emergency Doctor) came out. At one stage he jumped on compressions and was really pumping the guy- at around 120bpm



Dr R came out for an arrrest? Man, he must had nothing better to do 

I was given some advice not to "overcompress" the patient as apparently this does not allow sufficent itme for ventricular filling and will cause low cardiac output.


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## MasterIntubator (Aug 3, 2010)

120 works miracles.....


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