30yo female code on a BLS transport w/ possible seizure activity.

SoCal911

SoCal911

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Hey guys, I chose to put this in the ALS section hoping I could get a little more insight from the guys who've completed their medic training. Yesterday I had a 29yo patient on a routine transport to receive a head scan following what they felt was a syncopal episode at home, test came back normal so the doc wanted a head scan to rule anything else out.

Back story, previous Hx of depression only. NKDA on no Meds and no Meds were given.

So following the scan were enroute back to the sending facility (the scan used no contrast invade you were wondering) when my patient who was talking to me and I had just completed vs on (p88 r12-14 bp130/82) stopped talking and twitched/jolted ONE time (looked very similar to a defib shock) she went completely limp, eyes rolled back, little to no pupil response, non-responsive to verbal or painful, pulse less and apneic... At this point I've alerted my partner and he's pulled to the shoulder and hopped in back. Now, having a very hard time believing my 29yo pt just dropped in full arrest, I grabbed my ears and checked for heart sounds - nothing. So grabbed the defib from outside the unit and started to slap the pads on, while my partner verified no pulse and proceeded to give (2) very sharp compressions.

Here's the interesting part... Just after the second compression the patient jolts and begins to breath and slowly becomes alert (not oriented in the least) - vs were taken immediately and were nearly identical to the vs taken 5 minutes prior, slowly she becomes further oriented but only to person and place (the back of an ambulance) and she still has no idea what's up.

I'm suspecting that those compressions had something similar to a precordial thump effect, being her down time was about a minute if that.

What the hell happened? Any ideas?
 
There is no way to tell if the change was spontaneous or the result of therapy.(compressions)
 
Or whether the patient simply experienced a syncopal episode.
 
SoCal911 said:
she went completely limp, eyes rolled back, little to no pupil response, non-responsive to verbal or painful, pulse less and apneic...

I grabbed my ears and checked for heart sounds - nothing.

while my partner verified no pulse
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usalsfyre said:
Or whether the patient simply experienced a syncopal episode.
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It sounds like a did a decent assessment. Why would you say that?
 
I've just seen a couple of cases of panicked BLS providers starting compressions inappropriately lately.
 
Ok, stupid question. Why was the patient being transported in an ambulance? Was there no scanner available at the sending facility?
 
Young adult with syncope and now what looks like aborted cardiac arrest.... certainly arrhythmia/cardiac until proven otherwise in my mind. What'd EKG look like?
 
Sounds oddly similiar to an 18 year old full arrest i had that had a witnessed seizure on a bicycle while riding. Turns out to have been his 3rd "seizure".

In reality it turns out the kid had an undiagnosed Prolonged QT syndrome causing lethal changes and the physicians suspect that the falls from the past 2 cardiac episodes were essentially precordial thumps enough to bring him out of the lethal rhythms.

This may be what you had seen also. Would be a great call for you to do some follow up on
 
Aidey said:
Ok, stupid question. Why was the patient being transported in an ambulance? Was there no scanner available at the sending facility?
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No scanner available at the sending facility, she was admitted for a witnessed episode of what the family described as a syncopal. No history of previous syncopal. I did a very thorough assessment to verify, no pulse (at either radial or carotid - just to be sure I didn't miss one) no reps, none to extremely sluggish pupil response, and no heart sounds when checked (I had a hard time believing a 29 yo just coded, so I threw on my ears and it was silent) this was verified by my partner (I wanted to be 100% sure I wasn't seeing things). Now for some clarification, my partner has 3 years experience in a heavy heavy 911 system and I myself have about 7 months in different 911 systems and where we work weve both run full arrests as a bls unit PTA of an ALS squad. I've seen arrests and the whole bit - I can assure you that this was not a case of BLS provider panic or a syncopal. This was as sure as my mother lives today - a full arrest.
 
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SoCal911 said:
No scanner available at the sending facility, she was admitted for a witnessed episode of what the family described as a syncopal. No history of previous syncopal. I did a very thorough assessment to verify, no pulse (at either radial or carotid - just to be sure I didn't miss one) no reps, none to extremely sluggish pupil response, and no heart sounds when checked (I had a hard time believing a 29 yo just coded, so I threw on my ears and it was silent) this was verified by my partner (I wanted to be 100% sure I wasn't seeing things). Now for some clarification, my partner has 3 years experience in a heavy heavy 911 system and I myself have about 7 months in different 911 systems and where we work weve both run full arrests as a bls unit PTA of an ALS squad. I've seen arrests and the whole bit - I can assure you that this was not a case of BLS provider panic or a syncopal. This was as sure as my mother lives today - a full arrest.
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Just a hunch but if shes being scanned for "what the family described as a syncopal episode" then id imagine theres a good chance that its the same thing as you witnessed.

Who is to say she doesn't have an extremely irritable heart regardless of age (some people are that unlucky) and is not getting a few minutes worth of pulseless v-tach or something similar that corrects itself. Technically it is a cardiac arrest but at the same time to an uniformed family who just thinks she fainted, its a syncope.

Had you gotten the AED on before it corrected itself we would have had an entirely different viewpoint. (not implying you were slow or anything)
 
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Several questions

How was this disposed of? Did you call ALS? Divert to the closest ER?

Why is the AED kept putside the unit?
 
Now Fire took off before I could get a look at the 12-lead but I did hear that they did endup bypassing several hospitals to get her to a speciality center - not by pt request. Fire also called and gave us an adahboy
 
firecoins said:
Several questions

How was this disposed of? Did you call ALS? Divert to the closest ER?

Why is the AED kept putside the unit?
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ALS was activated and the pt was transported by als. And.. we kept the first in bag and AED in the compartment outside, we're first on scene quite often, its more accessible to grab and go on a call, additionally we'd have to pull over to use the AED in the back of the unit anyways, so we felt the benefits of having it in that compartment outweighed the negatives.

I've walked in on plenty of arrests, but never had one in the rig.
 
NYMedic828 said:
Just a hunch but if shes being scanned for "what the family described as a syncopal episode" then id imagine theres a good chance that its the same thing as you witnessed.

Who is to say she doesn't have an extremely irritable heart regardless of age (some people are that unlucky) and is not getting a few minutes worth of pulseless v-tach or something similar that corrects itself. Technically it is a cardiac arrest but at the same time to an uniformed family who just thinks she fainted, its a syncope.

Had you gotten the AED on before it corrected itself we would have had an entirely different viewpoint. (not implying you were slow or anything)
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Agreed, the way it happened didn't allow for that unfortunately.
 
FLdoc2011 said:
Young adult with syncope and now what looks like aborted cardiac arrest.... certainly arrhythmia/cardiac until proven otherwise in my mind. What'd EKG look like?
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Strangely enough I saw two people in the last few weeks sent to neuro from cardio admitted for syncope, both had negative scans, and both ended up with cardiac etiology dx after negative scanning.
 
One, awesome original post and sounds like a really good assessment. I don't remember reading why this was a BLS transport and not an ALS? I'm not sure how the transports go where you are from. But would've thought that to be an ALS transport before the arrest.
 
CCNRMedic1982 said:
One, awesome original post and sounds like a really good assessment. I don't remember reading why this was a BLS transport and not an ALS? I'm not sure how the transports go where you are from. But would've thought that to be an ALS transport before the arrest.
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Well thanks :) She was deemed stable enough for BLS by the referring MD. Honestly I'm not sure what test were performed. All I got was "blood work and labs were normal" from the RN prior to transport.
 
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