Interesting Full Arrest Call

[wrmedic82]

Ok I want to know if this has ever happened to anyone else.

We were sitting underneath a bridge at 820 and Marine Creek in Ft Worth where we normally post. All the sudden a SUV pulls up and the front seat passenger looks like he is having a SZ. I got out and began to do an initial assessment. The patient had agonal respirations, no radial pulses, but had a faint carotid pulse. As my partner approached the vehicle, I went to get our equipment. As soon as I got into the back I hear my partner yell "get a backboard he is in full arrest. So I grabbed the backboard and assisted my partner in getting the patient out of the vehicle. As soon as he was on the backboard, I began CPR. We had a Trainee on the truck, so I had him BVM the patient as I'm pumping chest. We then got the pads on him, to find the patient in coarse Vfib. We delivered 1 shock to the patient which converted the patient into Sinus Tach. My partner then tried for a line, which was unsuccessful. Then he went for the tube. As soon as he was about to intubate, the patient comes to and says "what the hell is going on?" We get him loaded up inside the ambulance. My partner makes a second attempt at a line, then pushes .5 of lidocaine and we transported code 3 to the hospital. The entire time we were transporting, the patient was slightly confused as to what was going on, but answering questions appropriately. Patient was dropped off at the hospital AOx4 and unremarkable. Only thing I wish we did is get a 12-lead, we only did 3-lead don't ask me why, that was my partner's call. I personally would have. As we left I got to shake the man's hand that only a few minutes prior I was pumping on his chest.

Has anyone else seen this happen? Thoughts?

Take Care

Will

Edited July 5, 2009 by wrmedic82

[Ridryder 911]

On a lucky day, it called field resuscitation. Better enjoy it, it does not happen often.

R/r 911

[AnthonyM83]

Had a similar rapid return of pulse and consciousness with extreme confusion and some violence after defibrillation (from Torsades). Had projectile vomiting, possibly from the bagging. After finally calming him down, did a 12-lead, which revealed an AMI. Found out he had been doing coke.

[chbare]

Have had it occur twice in my career. Both times were in the hospital. First, was a patient in his 50's who was having a MI. Developed pulseless ventricular tachycardia and we successfully defibrillated him on the first attempt. He regained ROSC and consciousness immediately and eventually went home after a trip to the cath lab.

The other was a female in her 80's having an MI. She was otherwise healthy and in her 80's. She was well within the fibrinolytic window and I had given the first dose of Retavase. During the wait for the second dose, she said that she wanted to go through with filling out DNR. We had the paperwork ready and she wanted to sign; however, our doctor convinced her to take a little time to think about it and ask any questions. She went into Ventricular Fibrillation and we successfully converted her with one defibrillation attempt. She regained immediate consciousness and ROSC as well. Ended up flying her out; however, she did well from what I remember.

Neither patient had any memories of the event.

Take care,

chbare.

[Richard B the EMT]

Over the years from 1973, when I started, I possibly had a few ROSC, but I cannot say, due to not being able to have followed up on them, if any walked out of the hospital.

[medic82942003]

I had this happen a few times, unfortunately we end up dumping the drug box on their chest, I

worked in Detroit, they have closed so many hospitals-people go to the closed er's alot. lots of

GSW's and OD's.

be safe cheers.

[WelshMedic]

Will,

First of all, congratulations on the save! You've already had some great answers to your question, but I thought I'd also weigh in with an answer.

I suspect that you were witnessing the pre-arrest phase, something which we don't tend too see that much as EMS providers. The weak carotid pulse does seem to suggest a form of (barely perfusing) ventricular tachycardia. The epileptiform seizure activity is a short pre-cursor to unresponsiveness as the brain is starved of oxygen. It's actually a pretty scary sight: I have seen it a few times myself, you just know you're in for some fast action..

A witnessed arrest is, of course, the best type to have. You were right on top of it and that's why the pt. became responsive again. His hypoxic episode was short and sweet, leading to a quicker recovery. My one abiding memory is of the 44 yr ols that arrested in my truck who was given a succesful pre-cordial thump. He was awake again in a matter of seconds and said: "Man, why did you have to go and hit me like that?".

Good call!!

WM

[Jeepluv77]

I, personally, didn't witness this but one of the students in my class did. He brought in the rhythm strip, which was awesome to read. He had a 45 year old male complaining of chest pain. Before they could get him packaged, he went into pulseless torsades. The medic on board gave amiodarone(we still don't know why, instead of mag sulfate) and shocked. The guy converted to sinus rhythm. They again started trying to load him, and he went back into torsades. More ami and another shock he converted to sinus rhythm again. They went through this routine for over an hour total between on scene and transport. He said every time the guy would convert he was A&Ox4, speaking, and only complaining of chest pain that was worse each time he woke up(gee, ya think?). I would be interested to see what happened with this guy at the hospital.

[Just Plain Ruff]

I've had several arrest saves

First one was about 3 months ago, chest pain short of breath on the streetcorner near the local watering hole. On arrival found a patient in tremendous respiratory distress. We put her on the cot and into the ambulance and bam, she coded. CPR for a little bit, tubed and monitor showed profound bradycardia. Ventillated for a short time and pulse rate came back to the 80's, called a bird and patient was flown from the ER and discharged from the receiving hospital with no residual issues.

2nd patient a long time ago was a woman with chest pain in an upstairs room. 12 lead unremarkable. Walked her downstairs to the cot, moved to ambulance, watched patient go from sinus rhythm to slow rate with multiple PVC's and then R on T and v-fib. Called partner to come back and help, shocked x 2 with return of good pulses. Tubed and transported. Flew from ER to cardiac center and she was home in 3 days.

Several others but can't truly remember all the details.

[AnthonyM83]

Got another save last night, though she didn't regain consciousness like in our previous examples. I believe it was respiratory related and the intubation/oxygenation is what really brought pulses back. Was doing a lot better when we left ER.... I never get to find out ultimate outcome, though (discharge and such).