11 back from flat line....

Just what it said. In about 30 years, you’ll figure it out.
 
I am the King of the Impossible!
 
All these "ROSC" patients we recieve into the ED either get pronounced soon, or are lifeless up in ICU until they pass. Like it was mentioned above. ROSC on grandma or grandpa is a horrible outcome and just a waiste of time. Hard reality.
 
wtferick said:
All these "ROSC" patients we recieve into the ED either get pronounced soon, or are lifeless up in ICU until they pass. Like it was mentioned above. ROSC on grandma or grandpa is a horrible outcome and just a waiste of time. Hard reality.
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So, if you get called to grandma's house, you'd prefer she have a DNR? (Not attacking you by any means, collecting opinions)
 
wtferick said:
All these "ROSC" patients we recieve into the ED either get pronounced soon, or are lifeless up in ICU until they pass. Like it was mentioned above. ROSC on grandma or grandpa is a horrible outcome and just a waiste of time. Hard reality.
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Maybe we just tone the salt back a little bit and remember that there are many patients that EMS can and do resuscitate and thanks to the work of the ED, ICU, and rest of the system, some of these patients do actually walk out of the hospital. I don't run my arrests with the assumption that they all end up dead.
 
Tigger said:
Maybe we just tone the salt back a little bit
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Awww, but I don’t wanna...

All jokes aside, a number of years ago I ran an arrest with a very promising intern. It was an older gentleman who’s wife I’m convinced wasn’t completely aware of the gravity of the situation thanks in part to the FD coddling their words of “comfort” with her.

I’d asked both the FD and the patient’s wife several times about a DNR, but unfortunately his poor wife appeared so overwhelmed I don’t know that she had time to grasp the calls momentum, or the choices required to be made on her behalf at that moment.

The call went well and the patient was bucking on the ETT by the time we offloaded with an adequate SPO2 and other signs of promising perfusion.

In the end, the family decided to discontinue efforts once more of them had gathered around his side for the vigil.

When I later found this out, my admitted self-gratifying feelings alongside the pride I felt in my interns performance turned more melancholic.

So, it does happen- both the good and bad feels. And yes, patients of all ages can survive a cardiac arrest with a good neurological recovery.

And I’m also going to bet most of the “salts” on this forum have brought at least 11 back from “flatline”...(inserts gag here).

As far as their outcomes, we’ll never know most of them. Glory hounds aren’t just in the firehouses, they’re just typically more abundant there.
 
wtferick said:
All these "ROSC" patients we recieve into the ED either get pronounced soon, or are lifeless up in ICU until they pass. Like it was mentioned above. ROSC on grandma or grandpa is a horrible outcome and just a waiste of time. Hard reality.
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I've had many field arrests who end up walking out of the hospital.

In fact we very recently had a case where the patient left with no neurological deficits at all. The patient lived because when fire arrived they immediately started high quality CPR and used their AED to defibrilate him, the paramedic ambulance service intubated him and provided amazing respiratory support and transported him, the ED in less than an hour stabilized his ventilatory managment and corrected his acute electrolyte abnormality which likely precipitated the arrest before then admiting the the unit, and the ICU cooled him and recovered him. Without every peice of that puzzle the patient would likely not be alive let alone without deficits.

I can recall many cases with similar outcomes because every part of the system worked together from precips to older adults. I've also had countless codes that either got called or the patient ended up having a subsequently poor outcome, and these are statistically in the majority but that doesn't discount those who we've saved.
 
Peak said:
The patient lived because when fire arrived they immediately started high quality CPR and used their AED to defibrilate him, the paramedic ambulance service intubated him and provided amazing respiratory support and transported him, the ED in less than an hour stabilized his ventilatory managment and corrected his acute electrolyte abnormality which likely precipitated the arrest before then admiting the the unit, and the ICU cooled him and recovered him.
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I don’t care how long any provider has been doing this, the calls that flow like this would make anyone of us feel good inside.

It’s also an excellent example of the team concept. Even if most of the players never receive credit for their role, it’s a feeling that’s kept many people (including myself) around long enough to call it a career.
 
Peak said:
...... and corrected his acute electrolyte abnormality which likely precipitated the arrest before then admiting the the unit, and the ICU cooled him and recovered him. Without every peice of that puzzle the patient would likely not be alive let alone without deficits...
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So, this certainly speaks to the reality that not all arrests are the same. A vasculopath with CAD arresting either directly or indirectly 2/2 those problems is not the same guy as the one with frogged up electrolytes because of whatever reason. I'm not sure that whatever 'neuro deficits' occur, don't occur in the ICU after successful resus because of cardiac function and attendant perfusion that has progressively declined in the period after admission to the hospital.
 
wtferick said:
All these "ROSC" patients we recieve into the ED either get pronounced soon, or are lifeless up in ICU until they pass. Like it was mentioned above. ROSC on grandma or grandpa is a horrible outcome and just a waiste of time. Hard reality.
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That's a pretty big generalization to make. My first solo arrest as a medic was a 91 year old male. He was awake and looking around before we had him on the stretcher since he had CPR by fire immediately. I've had other instances of people 60+ leaving the hospital with no neuro deficits.

I admittedly am quick to pull the trigger to cease resus on unwitnessed arrests with a laundry list of issues, but just because it's someone older doesn't mean good outcomes almost never happen. Hell, my grandma is 75, still works full time, takes my sister's to school a lot, and constantly insists on making sure I'm well fed. She isn't taking tons of meds or in poor health like what we see a lot. There are still plenty of people in the 60+ category that are good people to get ROSC on, but it's the people that don't take care of themselves we see most often.
 
StCEMT said:
That's a pretty big generalization to make. My first solo arrest as a medic was a 91 year old male. He was awake and looking around before we had him on the stretcher since he had CPR by fire immediately. I've had other instances of people 60+ leaving the hospital with no neuro deficits.

I admittedly am quick to pull the trigger to cease resus on unwitnessed arrests with a laundry list of issues, but just because it's someone older doesn't mean good outcomes almost never happen. Hell, my grandma is 75, still works full time, takes my sister's to school a lot, and constantly insists on making sure I'm well fed. She isn't taking tons of meds or in poor health like what we see a lot. There are still plenty of people in the 60+ category that are good people to get ROSC on, but it's the people that don't take care of themselves we see most often.
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First Full Arrest was a 17 year old at the High School. Called at the ED. Recently had a 19 year old brought in by friends, with the patient being called at the ED as well. We all have a different point of view on this subject matter.
 
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