Code Patient Question

firemedic0227

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Tones go off for a Code 99 Patient (CPR In Progress). I was on the engine and we are not ALS equipped. We get to the location and run into the building where the patient is found. The Patient is awake but not orientated. We see a nurse kneeling next to the patient trying to obtain a BP. She states that when she found the patient he was laying on the ground and had no pulse and not breathing. She stated she did one round of CPR and did 2 breaths at that time the patient came to and pushed her off his chest. She said his blood pressure was 140/100ish. We attached a pulse ox probe on the patient while we were waiting for the ALS Ambulance to arrive O2 sats were 96 on 3L NC. His heart rate was 137 and regular.

From my experience this just doesn't seem right. Is it normal for a Code Patient to come around after one round of CPR to a heart rate of 137 and a normal(ish) BP? Is it possible that the patient vagaled down so much that his heart rate became so low that she wasn't able to feel a pulse and to where it looks like the patient isn't breathing?
 
Possible? Yes. Likely? No.
 
Is it normal for a Code Patient to come around after one round of CPR to a heart rate of 137 and a normal(ish) BP?

No. Normal would be for the dead to stay dead.

Is it possible that the patient vagaled down so much that his heart rate became so low that she wasn't able to feel a pulse and to where it looks like the patient isn't breathing?

Yes.



My money is on either a narcotic OD (hey, no breathing!) or seizure (hey, tachycardia and not alert!) and the 'nurse' freaked out seeing someone unconscious on the floor and in their rush couldn't detect a palpable pulse.
 
No. Normal would be for the dead to stay dead.



Yes.



My money is on either a narcotic OD (hey, no breathing!) or seizure (hey, tachycardia and not alert!) and the 'nurse' freaked out seeing someone unconscious on the floor and in their rush couldn't detect a palpable pulse.

Better money would be on a syncopal episode.
 
He pushed the nurse off? You know what they say; stop CPR after the second ouch, or if the Pt begins to fight your compressions, whichever occurs first. ;)
 
He probably was never in arrest, BUT you know what???

I'd be so impressed that our local SNF staff started CPR, that I'd be too elated to even care that he had a pulse the entire time.
 
It just didn't seem like a true Cardiac Arrest type situation. My first intuition was that this patient is doing damn good for just coming out of Cardiac Arrest. Every Cardiac Arrest patient that I have ever encountered has also thrown up A LOT also this patient didn't. I would have liked to see the 12 Lead or even the 3 lead to see what it showed, but unfortunately it was with another 911 agency that we automatically mutual aid for that facility so I wasn't able to see it.
 
We had a guy who would go into arrest then come out spontaneously. I don't know what his diagnosis was, but we took him in, they put an EKG on him, he said "Oh-oh, here I go..." and passed out, scope flatlined for a few seclonds, then what looked like a tangle of PVCs, thn he was back, groggy then back but weak.
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How about Munchausen by Proxy (Hero Syndrome)?

Or syncope, then staffer unable to get vitals becaue she was in too big a hurry? ANd iof iot was syncolp, what happened....TIA, coronary spasm, polypharmcy/overdose, vasovagal?
 
Or syncope, then staffer unable to get vitals becaue she was in too big a hurry? ANd iof iot was syncolp, what happened....TIA, coronary spasm, polypharmcy/overdose, vasovagal?[/QUOTE]

And vlop gurggle mrshcnurgle foop!
Sorry, keyboard got away from me again.
 
He probably was never in arrest, BUT you know what???

I'd be so impressed that our local SNF staff started CPR, that I'd be too elated to even care that he had a pulse the entire time.

This ^^^
 
We had a guy who would go into arrest then come out spontaneously. I don't know what his diagnosis was, but we took him in, they put an EKG on him, he said "Oh-oh, here I go..." and passed out, scope flatlined for a few seclonds, then what looked like a tangle of PVCs, thn he was back, groggy then back but weak.

I just had a patient recently at the hospital I work at who was a no code. He had a few episodes where his eyes would roll back in his head, hed stop breathing, and would have no palpable pulse. This would go on for over half a minute before hed start breathing, a pulse would return and hed eventually return to normal(for him).

Apparently this happened once when he was on telemetry and if I remember right they said it showed asystole for a while.
 
I just had a patient recently at the hospital I work at who was a no code. He had a few episodes where his eyes would roll back in his head, hed stop breathing, and would have no palpable pulse. This would go on for over half a minute before hed start breathing, a pulse would return and hed eventually return to normal(for him).

Apparently this happened once when he was on telemetry and if I remember right they said it showed asystole for a while.

Sick sinus syndrome perhaps.
 
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