MonkeyArrow
Forum Asst. Chief
- 828
- 261
- 63
ALS crew plus ALS fire engine dispatched to SNF for a 76 year old man presenting with lethargy. The pt. is paraplegic (that's all you know for know...) but is otherwise healthy with a normal mental baseline. ALS crew arrives to find the man in sinus bradycardia with inadequate peripheral (or central) perfusion. The crew took a BGL which was at 30 mg/dl. The crew pushed D50 and initiated TCP, which was effective showing good capture on the monitor. 12 lead was never obtained as the pt. deteriorated before one could be obtained.
Crew loaded to transfer with nearest hospital 10 minutes out. While loading, pt. deteriorated into asystole when TCP was d/c and ACLS protocols were started. Compressions were started, no drugs given in route. Crew opted to bypass ETI during transport and placed a King successfully. Pt. was managed successfully with the king until arrival to the hospital. Good vascular access with 2 18g PIV bilaterally in the arms.
At the hospital, a round of ACLS meds were given and the rhythm converted into PEA. RT successfully converted the King to a ET tube on the first attempt. Hung a bag of D10. I don't have an updated BGL to give you. Soon after, pt. converted into NSR with pulse of 109 and a BP of 100/56. Patient was still being ventilated and a norepi drip was started. Patient maintained this status for 4 minuted before crashing again.
VFib on the monitor. Compressions started. ER Doc opted to shock at 200J. Push epi. Shock. Call the code.
Obviously, this ultimately played out in the ED. However, had this same scenario played out in the field (minus the norepi drip), would you have called it or would you have continued resuscitative efforts?
Personally, I would have continued resuciation and would have transported since the patient has converted out of asystole once into a normal rhythm and the cause, to the best of my knowledge, is reversible (hypoglycemia). The docs said that he was probably deteriorating throughout the night and was dying during the night. But for a person who has converted out of a terminal rhythm once, I would have aggressively carried on until someone else called it (read as EDP). If I continued, what is the chance that he would have a meaningful recovery with neurological condition intact to discharge? Not very good. Is it my call to try to decipher his odds and what may have happened throughout the night? I don't think so.
Crew loaded to transfer with nearest hospital 10 minutes out. While loading, pt. deteriorated into asystole when TCP was d/c and ACLS protocols were started. Compressions were started, no drugs given in route. Crew opted to bypass ETI during transport and placed a King successfully. Pt. was managed successfully with the king until arrival to the hospital. Good vascular access with 2 18g PIV bilaterally in the arms.
At the hospital, a round of ACLS meds were given and the rhythm converted into PEA. RT successfully converted the King to a ET tube on the first attempt. Hung a bag of D10. I don't have an updated BGL to give you. Soon after, pt. converted into NSR with pulse of 109 and a BP of 100/56. Patient was still being ventilated and a norepi drip was started. Patient maintained this status for 4 minuted before crashing again.
VFib on the monitor. Compressions started. ER Doc opted to shock at 200J. Push epi. Shock. Call the code.
Obviously, this ultimately played out in the ED. However, had this same scenario played out in the field (minus the norepi drip), would you have called it or would you have continued resuscitative efforts?
Personally, I would have continued resuciation and would have transported since the patient has converted out of asystole once into a normal rhythm and the cause, to the best of my knowledge, is reversible (hypoglycemia). The docs said that he was probably deteriorating throughout the night and was dying during the night. But for a person who has converted out of a terminal rhythm once, I would have aggressively carried on until someone else called it (read as EDP). If I continued, what is the chance that he would have a meaningful recovery with neurological condition intact to discharge? Not very good. Is it my call to try to decipher his odds and what may have happened throughout the night? I don't think so.
