mobey Posted December 15, 2007 Posted December 15, 2007 Called for 56 y/o male apneic. On arrival Pt found supine on kitchen floor, cyanotic, sliding left arm up and down from head to hip. Eyes open in "death stare", completly apneic, weak carotid @ 46. (you are a canadian BLS crew similar to EMT-I in states I think) Family stated his left arm started shaking as he was walking scross the room then his whole body got involved, and he just collapsed. Your responce time was 6 min, no interventions prior to your arrival. PMHx...3x CABG 6 mos ago, Liver Cancer, Asthma. Your partner puts in OPA and begins ventilation, you attempt IV but fail first attempt. You throw on the monitor and it shows Sinus @ 46 with huge ST elevation. no 12 lead your BLS remember. As you prepare to load onto your longboard you lose the pulse. You start compressions and look over to the monitor to see exactly the same rhythm as before. In the ambulance you throw in a King airway and continue CPR. Only 3 blocks to hospital. Pt has been down now for 18 mins with CPR. On arrival at hospital doc throws 2 rounds of EPI in him with no responce, Rhythm still PEA @ 46 with PVC's every 6 sec or so. Pt has been down now around 25 min and the Doc decides to call it. As you assist nurse to prepare the body for viewing the Doc tells the family. You deflate the cuff on the King and notice his chest moving...NO FREAKING WAY. Yup a pulse. You throw the monitor back on and your PEA now has capture!! So the question is... do you work him?
unknown Posted December 15, 2007 Posted December 15, 2007 How could you not? You have a pulse and spontainouse breathing......
mobey Posted December 15, 2007 Author Posted December 15, 2007 How could you not? You have a pulse and spontainouse breathing...... No spontaneous resps, pulse only
unknown Posted December 15, 2007 Posted December 15, 2007 As you assist nurse to prepare the body for viewing the Doc tells the family. You deflate the cuff on the King and notice his chest moving...NO FREAKING WAY. Yup a pulse. You throw the monitor back on and your PEA now has capture!! So the question is... do you work him? Here where it stated chest moving assumed this ment breathing......
mobey Posted December 15, 2007 Author Posted December 15, 2007 My mistake he was extremely skinny, I meant you could see his a pulsating mass in his chest. He was not moving air.
unknown Posted December 15, 2007 Posted December 15, 2007 My mistake he was extremely skinny, I meant you could see his a pulsating mass in his chest. He was not moving air. Thank you for the clarificaton.
Just Plain Ruff Posted December 16, 2007 Posted December 16, 2007 well it's not really PEA now is it. I'd be working my butt off to resus him. don't have much of a choice now.
MedicMal Posted December 16, 2007 Posted December 16, 2007 Definitely you would resuscitate. What would be your reasoning for not resuscitating?
courageheartx Posted December 16, 2007 Posted December 16, 2007 It's probably in the patients best interest you use your valuble BLS skills and work this patient.....or sh it just might hit the fan in the long run.....You will never be penilized for working a patient whom you are unsure of working.....
mobey Posted December 16, 2007 Author Posted December 16, 2007 Let me add a twist to the question. The Doc turns to you and says "It's your call do you want to work him?" Ya in rural they ask that kinda stuff! Reminder: 28 minutes down, Pt apneic for 8 min prior to your responce, Pt has layed in hospital bed for approx 2-3 min with no pulse and no compressions prior to return of pulse.
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