Another Question/critique

[campsitewilly]

The other day while working, i came across a downed individual, the subject was lying on their side very blue in the face taking gaping snoring respiration, maybe 1-2 times a min, and completely unresponsive, i could not detect a carotid pulse and began cpr and called for ems response, when the ambulance arrived i had a weak but detectable carotid pulse. this turned out to be an opiate overdose and 8mg of narcan got the individual responsive and transported. my question is, what i was seeing in the breathing was that agonal respiration accompanied by a sudden cardiac arrest?

im new to the ems game and have been replaying this in my head making sure i recognized the right signs and performed the correct action, so any critique or support will be well received. thank you

 

[NomadicMedic]

You saw the depressed respirations of an opiate overdose.

Good for you for doing something.

Here's the questions:

Was he really only breathing once or twice per minute?

Was there really no pulse?

Did EMS really give him 8mg (8!!) of narcan?

 

[campsitewilly]

i couldnt find one when i approached and felt, i could have missed when feeling around but i went forward assuming no pulse

and yes 4 doses of 2mg, they used all they had

 

[E tank]

Not unlikely that in that situation the HR could have been in the uber low range, ie, 20, so while there may have been a pulse, unless the checker was anticipating it, it wouldn't be that easy to pickup.

 

[medichopeful]

The other day while working, i came across a downed individual, the subject was lying on their side very blue in the face taking gaping snoring respiration, maybe 1-2 times a min, and completely unresponsive, i could not detect a carotid pulse and began cpr and called for ems response, when the ambulance arrived i had a weak but detectable carotid pulse. this turned out to be an opiate overdose and 8mg of narcan got the individual responsive and transported. my question is, what i was seeing in the breathing was that agonal respiration accompanied by a sudden cardiac arrest?

im new to the ems game and have been replaying this in my head making sure i recognized the right signs and performed the correct action, so any critique or support will be well received. thank you

You made the right call! And very well may have saved this person's life. Nicely done.

In the situation you described, CPR was absolutely the right call. It's impossible to know whether the patient was truly in cardiac arrest, but since you were not able to detect a pulse in a completely unresponsive patient, treating it like a cardiac arrest was the right thing to do. If you're ever in doubt whether you have a pulse or not, assume that you don't.

The only thing I can say is that this wasn't a "sudden" cardiac arrest, because there was a known cause (hypoxia R/T opioid use). An example of a "sudden" cardiac arrest would be someone who is walking down the street and their heart stops.

You recognized the signs, and performed the correct actions. Not everybody would do that, and not everybody would get involved in a situation like this. Give yourself a pat on the back, you earned it.

 

[medichopeful]

i couldnt find one when i approached and felt, i could have missed when feeling around but i went forward assuming no pulse

It can't be stressed enough that this was the right thing to do. If you're not sure if there's a pulse, it's much better to do CPR. It's better to do CPR on someone who did, in fact, have a pulse that wasn't detected than it is to "assume" you had a pulse (even if you weren't sure) and to delay compressions.

 

[CALEMT]

You can have agonal breathing in the full arrest setting. One of the last full arrests I had the dude was in agonal breathing, but then again he was pretty "fresh". Like others the only "critique" is this isn't sudden cardiac arrest, but cardiac arrest stemmed from a narcotic overdose. Oh and damn... 8mg's of narcan.