medicv83 Posted October 9, 2008 Posted October 9, 2008 http://www.foxnews.com/story/0,2933,433830,00.html Take a look at this story printed by Fox news on their website. Entails a woman being seen at the ER in a hospital in DE and being pronounced dead, and subsequently the morgue attendant noticed breathing. Im lost at this story, just figured Id share. Says per the "medical charts" she was seen for CP and ultimately had an MI, then arrested and they gave her "multiple meds" and "synchronized shocks".
Richard B the EMT Posted October 9, 2008 Posted October 9, 2008 I was party to similar. In, perhaps 1986, I was detailed out of my usual assignment (a call-taker in EMD) and was working an NYC EMS ambulance out of Elmhurst Hospital base. My partner and I, and a Paramedic ambulance crew, were dispatched to an "ARREST" call, to find a 70 something male down on the floor of a small living room. My partner and I started CPR, and were then joined by the Paramedic team, who put the patient on the EKG, started lines, and followed all appropriate ALS protocols for field treatment of an Arrest. It seemed they poured half the drug box down the IVs. Unrelated to the actual treatment, my partner started to slide his legs under the couch to position himself a bit better, and a large dog, not seen by us, started growling at him. On my side, I laughed a bit at the situation, but then felt the need to position myself a bit more comfortably, and another dog, also unseen, started growling at me. Somebody in the household called the dogs away, and put them into another room. So much for the 10 second scene safety survey! After about a half hour, the Paramedics, seeing asystole on the EKG, following protocol to terminate rescusitive measures, contacted the OLMC for permission (One of the few times the NYC EMS is required to do a "Mother/Father, May I"), and permission was granted. We started disconnecting the tubes, the BVM, and cleaning up the mess we had generated. Last to come off the patient were the EKG cables. That's when we noticed there was a heart rate being registered by the EKG machine. Wouldn't you say that a heart rate of 6 is just a bit Bradycardic? We re-started CPR, reconnected everything, and the Paramedics re-established the LL contact with OLMC, opening with identifying themselves by radio designation, and calling themselves the "Miracle Workers". The Paramedics then dumped the other half of the drug box into the guy, a late arriving supervisor brought the stretcher over, we "packaged", loaded, and flew to Elmhurst, CPR the entire time. My partner and I brought another patient into Elmhurst about an hour and a half later. The ER, we saw, had our previous CPR patient on a ventilator, but his heart was apparently doing fairly good on it's own. I have no clue, unfortunately, if he survived, and if he did, if it was a decent "Quality of Life" save.
BEorP Posted October 9, 2008 Posted October 9, 2008 It really isn't that uncommon compared to what most people would imagine.
fiznat Posted October 9, 2008 Posted October 9, 2008 That's when we noticed there was a heart rate being registered by the EKG machine. Wouldn't you say that a heart rate of 6 is just a bit Bradycardic? You never mentioned if this patient actually regained a pulse and blood pressure. A few bumps on the ECG at a rate of 6 sounds like an agonal rhythm or PEA. ...Neither of which are "saves" by any measure. ACLS says to treat them just like asystole, which they essentially are. I'm not trying to take away from your story, just wanting more info. We've all heard of stories like this in the news before. I guess it happens. I am surprised that the news got such a thorough look at the medical records, though. It sounds like someone who doesn't know medicine wrote this article anyways, so I wouldn't be surprised if something was lost in the translation.
Dustdevil Posted October 9, 2008 Posted October 9, 2008 v83, I don't understand the point of your thread. I don't see anything wrong with the article. I don't find any inaccurate statements or assumptions in it. The "synchronised" part was a direct quote from the record. What -- as a paramedic -- do you think you "know" that you find problematic with the article?
mrmeaner Posted October 9, 2008 Posted October 9, 2008 The shocks may not have been synchronized with a heart rhythm, but with the administration of CPR and medications. There are far greater evils in the media.
medicv83 Posted October 9, 2008 Author Posted October 9, 2008 I think Dust, that I must be confused I guess on the application of synchronized vs unsynchronized shocks and when to use them. Either medically they performed or attempted to perform synchronized shocks on an arrested patient, in which I cant imagine they would have, which then makes the records errored, or it makes the author of the article lazy and incompetent on reporting an accurate scenario of the patient care given. I like to think the latter in this case, as Im sure there were attempts of unsynchronized shocks delivered to this patient. Im curious though, as to the way in which they present statistics on ROSC. Your condescension is disgusting Dust by the way.
paramedicmike Posted October 9, 2008 Posted October 9, 2008 I don't see a problem with the article either. The reference to synchronized shocks are directly referenced as being part of the medical record. What is incomplete is the information on the medical record itself. Perhaps, during the working of the code, they did synchronize the shocks. Who are you to argue otherwise? You weren't there. You don't know. As to the topic of discussion regarding people reading who know better, what is it, exactly, that you know better? Perhaps you don't really know as much as you thought? -be safe
Dustdevil Posted October 10, 2008 Posted October 10, 2008 I think Dust, that I must be confused I guess on the application of synchronized vs unsynchronized shocks and when to use them. Either medically they performed or attempted to perform synchronized shocks on an arrested patient, in which I cant imagine they would have, which then makes the records errored, or it makes the author of the article lazy and incompetent on reporting an accurate scenario of the patient care given. Or neither. The article itself clearly states the following... Judith Johnson, 61, of Georgetown, Del., was actually having a heart attack when she arrived at the hospital in May 2007. Less than 45 minutes after she arrived, she went into cardiac arrest. So she did not arrive in cardiac arrest, meaning there was forty-five minutes of medical management before she arrested, during which time the need for synchronised cardioversion is probable. Did you miss that part, in your haste to trash someone, or do you, as you admit, not clearly understand the purpose and indication for synchronised vs. unsynchronised cardioversion? Your condescension is disgusting Dust by the way. As a former professional journalist/reporter, I would say the same about you. Hypocrisy much? And minus five for posting in the wrong forum.
ERDoc Posted October 10, 2008 Posted October 10, 2008 I would agree with the others that question the posting of this article. I am not sure of your concern, however. If you are concerned with the pt being pronounced and then being found alive in the mourge, yup, I agree that is scary, but it does happen. As for the synchronized shocks, it's is impossible to judge from what little medical information is presented. Be careful to judge when you don't have all of the evidence.
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