Got ROSC last night w/ CPR

[rhan101277]

I just wanted to post this because good outcomes are rare. Had a 45 y/o female come in POV complaining of shortness of breath. She was breathing 6x a minute. She went into cardiac arrest, we started CPR, intubated, NG tube, arterial line. Her initial ABG's were Ph 6.91; PaCO2 52; PaO2 244; HCO3 15. After 2 rounds of epi and atropine we got SVT at 169, eventually it slowed to sinus tach. Also gave 2 sodium bicarbs. She started trying to breath against the tube and kinda chew at it. We put a commercial ET-Tube holder device on. Her pupils went from non reactive to very sluggish reaction. A chest xray was done and her whole right lung was whited out, she was non-compliant with meds, HTN hx and diabetic with initial CBG of 400 something.

Anyhow I am trying to find out how she is doing, just because I like to know. Before she left for helicopter another ABG and Ph now 7.42, PaC02 42, Pa02 85, HC03 17.

It just felt good to see CPR work and drugs work, instead of seeing people who don't recover.

We did about 15 minutes of CPR during all of this, anyhow just wanted to post it.

 

[VentMedic]

It just felt good to see CPR work and drugs work, instead of seeing people who don't recover.

Just remember there is still a long way between ROSC and recovery. Don't be too disappointed if recovery might not be as expected especially with the other noted conditions.

However, I'm glad you got to see ROSC first hand.

 

[rhan101277]

Just remember there is still a long way between ROSC and recovery. Don't be too disappointed if recovery might not be as expected especially with the other noted conditions.

However, I'm glad you got to see ROSC first hand.

Yeah I hope for the best, we were right there. She got CPR immediately without delay. The doctor did note she has never seen anyone survive below 7.19 Ph. Her organs didn't have to deal with that acidity for to long though.

 

[VentMedic]

Yeah I hope for the best, we were right there. She got CPR immediately without delay. The doctor did note she has never seen anyone survive below 7.19 Ph. Her organs didn't have to deal with that acidity for to long though.

7.19? Most of my patients are still alert and watching TV with that pH although they might not be feeling that great. It is not uncommon to even see a 6.8 occasionally especially with DKA. In the ICUs we may also allow permissive acidosis down to 7.22. It all depends on the disease process and the etiology of the acidosis.

I would also suspect she was acidotic when she arrived.

 

[rhan101277]

7.19? Most of my patients are still alert and watching TV with that pH although they might not be feeling that great. It is not uncommon to even see a 6.8 occasionally especially with DKA. In the ICUs we may also allow permissive acidosis down to 7.22. It all depends on the disease process and the etiology of the acidosis.

I would also suspect she was acidotic when she arrived.

Yeah she probably was acidotic when she arrived. Probably not as profound as the 6.91.

 

[Simusid]

Stupid newbie followup question. I'm a basic with only a few dozen runs under my belt and have seen nothing at this level. How is the Ph done in the field? I've never heard any of our medics talk about it.

 

[medicdan]

THe OP was discussing a patient encountered on hospital (presumably ER) clinicals, where the "code" was assisted by hospital staff, including an RT, who I would guess drew the Arterial Blood Gas (ABG).

 

[rhan101277]

She died, We had her alive on the helicopter, guess that is the way you have to think about it.

 

[viccitylifeguard]

Stupid newbie followup question. I'm a basic with only a few dozen runs under my belt and have seen nothing at this level. How is the Ph done in the field? I've never heard any of our medics talk about it.

id also like to know how to do this as we have not been shown how to during my emt course here in alberta also another newbie question what does ROSC stand for ive never heard of it

 

[fma08]

Stupid newbie followup question. I'm a basic with only a few dozen runs under my belt and have seen nothing at this level. How is the Ph done in the field? I've never heard any of our medics talk about it.

You don't do pH in the field unless your ALS rig has one of those i-STAT devices or some other machine. You can probably figure out that they might be in acidosis based on past medical history and a thorough exam.

id also like to know how to do this as we have not been shown how to during my emt course here in alberta also another newbie question what does ROSC stand for ive never heard of it

ROSC is Return of Spontaneous Circulation

 

[viccitylifeguard]

ROSC is Return of Spontaneous Circulation[/QUOTE]
cool thank you for the response now i have a term for what happened to a pt of mine about 10 years ago while lifeguarding . unfortunatly he also didnt make it .

 

[rhan101277]

You don't do ABG's in the field, but as a paramedic you must know how to interpret them. Especially during transfers, you pull the chart and read about the patient. Are they stable enough to transfer? Read all through that information. Just because you are sent to transfer, just don't mindlessly put a patient in the back who clearly needs more definitive care before transport. Doctors do not just mindlessly take people in from one hospital to the other. Its just good to be a patient advocate.

Some doctors (small hospital ones) will fail to understand how it is someone can be hypoxic and have a pulse ox of 100%. This is where knowing this information can come in handy.

 

[Shishkabob]

You don't do ABG's in the field,

Sure, not technically arterial, but the istat is close enough for what we use it for.

 

[nomofica]

id also like to know how to do this as we have not been shown how to during my emt course here in alberta also another newbie question what does ROSC stand for ive never heard of it

Nice to see another Albertan in the forums.

 

[fma08]

You don't do ABG's in the field, but as a paramedic you must know how to interpret them. Especially during transfers, you pull the chart and read about the patient. Are they stable enough to transfer? Read all through that information. Just because you are sent to transfer, just don't mindlessly put a patient in the back who clearly needs more definitive care before transport. Doctors do not just mindlessly take people in from one hospital to the other. Its just good to be a patient advocate.

Some doctors (small hospital ones) will fail to understand how it is someone can be hypoxic and have a pulse ox of 100%. This is where knowing this information can come in handy.

Don't be lumping them all together. I work for a "small hospital" and the doctors I work with are quite intelligent thank you.