That extra 60 seconds.

YYCmedic

YYCmedic

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Recently responded to a call where bystanders state a 50 y/o was playing hockey and had a seizure on the ice, pt came to and skated to the bench under their own power at which point EMS was contacted, due to our dispatch system (the card model that some fo you may know...) the call came in as a (12A) low risk response (no flashy lights) for a postictal seizure pt.... so we got stuck at ALOT of red lights on the way.

Upon arrival, the pt had collapsed on the bench in all of their hockey gear. They were a/o x4 with 0 complaints. Skin is ashen grey/pale and extremely diaphoretic, weak radial pulses, Bp 90/50, sitting the pt up causes them to go unconscious and 12-lead shows Massive Inferior Lateral Posterior MI with reciprocal changes. Enroute to hospital all pulses were lost heart monitor shows rate has sropped down to 30bpm and a Bp was unobtainable... BUT... the pt was still awake and talking to us, with 0/10 CP!!!! 1500cc's were pressure infused iv, adenosine was administered and 12-lead was transmitted to the recieving hospital (very short transport times) he subsequently died in the cath lab about 3 minutes after arrival. Would anyone else be wondering if that few extra minutes spent waiting at red lights would have made a difference for this person? If the dispatch had only thought to ask if this pt was diaphoretic it would have bumped up our response to lights/siren.... maybe its time to review our dispatch model but who am I to know... I just work here!!!
 
There's really no way to know and I wouldn't stress about it too much. If the man upstairs wants him, he'll get him. Its quite possible that yo ugetting there 60 seconds faster would have just meant that he died 4 minutes into the cath lab rather than 3.
 
WuLabsWuTecH said:
There's really no way to know and I wouldn't stress about it too much. If the man upstairs wants him, he'll get him. Its quite possible that yo ugetting there 60 seconds faster would have just meant that he died 4 minutes into the cath lab rather than 3.
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Amen.

Sometime, no matter what we do, if the big guy upstairs wants him to "come home" than no matter what treatment we do, it just simply wont work. Some things are just simply out of our control. Try not to stress out about it too much, it was just one of those things that happens in life.

Take care.
 
TJ_EMT said:
Would anyone else be wondering if that few extra minutes spent waiting at red lights would have made a difference for this person?
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nope, for two reasons.

one, its highly unlikely that that minimal amount of time(realistically what are we talking here, 3 minutes?) would have done him any good. sometimes, its just somebodies time(and i mean that in a completely non secular way). from what you described, that guy was throwing the big one. its not very common that you save those guy. sure, little warning mi's and even pretty decent sized ones will live to walk out the front door but when its the big one, about your only chance s if you drop actually in a fully staffed cath lab.

two, you cant save everybody. you can try, but you will fail. this time, maybe it was your response time(which i doubt). or maybe it was this guy ignoring his problem for 20 years(much more likely). next time it could be faulty equipment or not enough manpower or whatever. the point im trying to make is that when your clock runs out, its game over.
 
I'm going to echo what others have said. Minutes wouldn't have mattered here. It is up to your dispatch to have you respond in an appropriate manner to each call. Having dated a dispatcher at a major dispatch center and heard some stories...it is a job I would never want. I'm fortunate/cursed I guess that dispatch does not dictate our response coming out of the chute. They provide dispatch info and we decide for ourselves code 1 vs code 3. Does lead itself to abuse...sometimes but for the most part it works well.

(I'd have chosed a code 3 response with what you gave me).

Sounds like your dispatch follows MPDS which works well for the most part....this is an example of where if failed. Dispatch failed to ask the appropriate questions to prioritize your response (ashen grey skin, etc).



Chris
 
Like others said I doubt that time would have changed the outcome. As far as dispatch asking extra questions yes we could staff ever dispatch center with doctors that could ask all the questions and give you a diagnosis when they finally get around to dispatching you but that's obviously impractical and asking that many questions still takes time. Dispatchers usually either go through their flip cards or have a list of questions on their computer that they have to get answered and then the computer tells them what level to dispatch the call. They ask the same questions for every call and some of them are slightly subjective causing high priority response for no reason but sometimes it works out the other way for an asymptomatic patient. I know two of the triggers in our area are breathing difficulty and spurting blood. I don't know if it's how they ask the question or what but every patient out there has breathing difficulty and of the three high priority spurting blood calls I've been on two of them were cured with a bandaid.

Dispatch is not a perfect system but it in general is fairly practical looking at it from all aspects. Don't beat yourself up over it.
 
wait...what?

TJ_EMT said:
Upon arrival, the pt had collapsed on the bench in all of their hockey gear. They were a/o x4 with 0 complaints. Skin is ashen grey/pale and extremely diaphoretic, weak radial pulses, Bp 90/50, sitting the pt up causes them to go unconscious and 12-lead shows Massive Inferior Lateral Posterior MI with reciprocal changes. Enroute to hospital all pulses were lost heart monitor shows rate has sropped down to 30bpm and a Bp was unobtainable... BUT... the pt was still awake and talking to us, with 0/10 CP!!!! 1500cc's were pressure infused iv, adenosine was administered and 12-lead was transmitted to the recieving hospital (very short transport times) he subsequently died in the cath lab about 3 minutes after arrival. Would anyone else be wondering if that few extra minutes spent waiting at red lights would have made a difference for this person? If the dispatch had only thought to ask if this pt was diaphoretic it would have bumped up our response to lights/siren.... maybe its time to review our dispatch model but who am I to know... I just work here!!!
Click to expand...

Last time I checked adenosine is indicated for reentrant pathway SVT's, not for a profound bradycardia, and when a patient loses a pulse and BP in the presence of electrical activity on the monitor they are in PEA. Chest compressions are indicated.

I call bull:censored::censored::censored::censored: on this. It sounds like the story that floats around on some EMS boards about the asystolic cardiac arrest where the patient opens their eyes and looks at the EMT's when they are doing chest compressions.
 
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Some you can catch and some they will go on their own...

* One can have every piece of equipment, and every other bell and whistle, but when it is the patient's time to leave this earth, medicine, and all who work in this profession, can't stop death, in some ways it can only be prolonged.......-_-
 
TJ_EMT said:
Recently responded to a call where bystanders state a 50 y/o was playing hockey and had a seizure on the ice, pt came to and skated to the bench under their own power at which point EMS was contacted, due to our dispatch system (the card model that some fo you may know...) the call came in as a (12A) low risk response (no flashy lights) for a postictal seizure pt.... so we got stuck at ALOT of red lights on the way.

Upon arrival, the pt had collapsed on the bench in all of their hockey gear. They were a/o x4 with 0 complaints. Skin is ashen grey/pale and extremely diaphoretic, weak radial pulses, Bp 90/50, sitting the pt up causes them to go unconscious and 12-lead shows Massive Inferior Lateral Posterior MI with reciprocal changes. Enroute to hospital all pulses were lost heart monitor shows rate has sropped down to 30bpm and a Bp was unobtainable... BUT... the pt was still awake and talking to us, with 0/10 CP!!!! 1500cc's were pressure infused iv, adenosine was administered and 12-lead was transmitted to the recieving hospital (very short transport times) he subsequently died in the cath lab about 3 minutes after arrival. Would anyone else be wondering if that few extra minutes spent waiting at red lights would have made a difference for this person? If the dispatch had only thought to ask if this pt was diaphoretic it would have bumped up our response to lights/siren.... maybe its time to review our dispatch model but who am I to know... I just work here!!!
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??????????????

If that was the treatment, you probably did not do the patient any favors by getting to the scene. Although that could be a matter of opinion since prolonging the inevitable is difficult also.

Look up the probability of survival for an MI that massive. Once you understand a little more about medicine, you realize what your capabilities are and what those of nature or a higher God than EMT(P) are.
 
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Seconds count in the OR and ER. Usually, minutes count in the field

I can't address whether this is a great example of treatment in the field, and I can confirm that monitoring instruments can tell you the pt is clinically dead when he/she is still talking to you (check your leads?). I can say is that when the old MI does the tic tac toe across your myocardium, nothing will help you after a couple minutes but a transplant.

I hate it when the dispatch includes layperson dx's like "seizure", "stroke", or "drunk".
 
I am glad someone else caught that treatment????? Are you sure they didn't push Atropine?

There is a reason they call that AMI the "widow maker"! It is usually a complete blockage and they don't last to make it to the cath lab. That extra 60 seconds in response time would have meant one thing.

He would have lasted 4 minutes in the cath lab, rather then 3!
 
I'm thinking the adenosine probably did him in..... Do you mean atropine?
 
emtbill said:
I call bull:censored::censored::censored::censored: on this. It sounds like the story that floats around on some EMS boards about the asystolic cardiac arrest where the patient opens their eyes and looks at the EMT's when they are doing chest compressions.
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Why do you think this is bull? I have personally watched a patient in VF open her eyes with chest compressions, no Urban Legend there. I remember her well, after we converted her on our second defibrillation she awoke and stated she coudn't go to the hospital because she needed to go to work! Was having an MI, went straight to the cath lab and discharged home 4 days later.
 
As I scrolled down this thread I was wondering if anyone would catch "adenosine". Hopefully they meant "atropine". Normally no palpable pulse would mean CPR. However if a pt is able to carry a conversation then they have a pulse and a rate of 30 and symtomatic I think pacing would be more appropriate.

An extra 2 - 3 minutes probably would not have made a difference, but we'll never know. When your numbers up, it's up.
 
emtbill said:
wait...what?



Last time I checked adenosine is indicated for reentrant pathway SVT's, not for a profound bradycardia, and when a patient loses a pulse and BP in the presence of electrical activity on the monitor they are in PEA. Chest compressions are indicated.

I call bull:censored::censored::censored::censored: on this. It sounds like the story that floats around on some EMS boards about the asystolic cardiac arrest where the patient opens their eyes and looks at the EMT's when they are doing chest compressions.
Click to expand...

I actually agree...
 
TJ- we def need confirmation on care rendered. It seems as though pacing would have been the best choice.... Was this done?
 
We had a guy who would talk until clical asystole hit...

Long history of witnessed V-tach to V-fib to pulselessness (still fibbing), would call us, we would get to ER, he would say "Here I go", and away he went. Did this enough timnes to be a local legend.
However, I recall reading how guillotined heads would open and roll their eyes and move their jaws from agonal cranial nerve activity.
 
boingo said:
Why do you think this is bull? I have personally watched a patient in VF open her eyes with chest compressions, no Urban Legend there. I remember her well, after we converted her on our second defibrillation she awoke and stated she coudn't go to the hospital because she needed to go to work! Was having an MI, went straight to the cath lab and discharged home 4 days later.
Click to expand...

The call information just sounds sketchy at best. Like others have been saying, you treat the patient and not the monitor, but I find it hard to believe that a patient who has no palpable pulse or blood pressure, and who is suffering from a STEMI that later killed him is going to be completely asymptomatic. I have personally seen an asymptomatic STEMI patient who's ST segments were taller than the R waves, but she had so much morphine and metoprolol in her that it really didn't surprise me. With no drugs on board, no pulse and no BP this pt isn't going to be "awake and talking with 0/10 CP", and if they are alive, they won't be for long. That is just intuitive. All of that, coupled with the report of adenosine administered, just makes this story very sketchy. Either the OP was exaggerating, or someone who told him the story was mistaken, which isn't too far fetched. Stories are easily skewed as they're told from person to person.
 
I see what your saying, my only comment was directed at a pulseless patient opening their eyes with chest compressions. That I have seen myself.

I also assume he meant atropine and not adenosine for the bradycardic rhythm, simple typo....I hope.
 
SORRY EVERYONE!!... thats slightly embarassing... DEFINATELY MEANT ATROPINE!!! Gave him 1.0 Mg IV, it brought his rate back up to about 56 Bpm for about 2 minutes then dropped back down to around 30... unfortunately pacing wasnt an option due to the fact that we couldnt get our pacing pads to stick at all, you'd wipe him off and he'd be dripping sweat again in seconds.

Again sorry, didnt have time to proof read, I was typing up a storm during what little down time I had on my Saturday night shift during the first blizzard of the year and the retarded drivers in this city.

...NOW! for those of you who are calling BS on this, then you obviousley have never witnessed this... fair enough. IT HAPPENED!! haha, didnt think it was possible myself! He was pulseless and completely asymptomatic (0/10 CP) but still awake and talking to us... crazy thing to see.
 
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