Asystole WITH a pulse

[paramedicmike]

I thought of a VAD, too. But if this patient had one It would certainly be plainly obvious when looking at the patient with tubes sticking out of his chest. That would've been a crucial piece of the story and not omitted from the scenario presented to the students.

There was no mention of CPR in the OP... just that the patient was worked. So it's conceivable that no CPR was done... which would be appropriate if there was a VAD in place. Most VADs I've seen, however, have not produced a pulse. I know producing a pulse with a VAD is a possibility. But my experience with them hasn't demonstrated one.

I'm still a little skeptical that this was a real call, though.

[FireMedic65]

There was a gentleman in my old coverage area that has this problem. It is a real thing. I can't remember the name of the device, but what croaked explained was the same explanation we were given. The guy actually came to the station to with a bunch of info on it. A week or so later, we had to go see this guy for a cardiac arrest. He had a medical ID bracelet, necklace and family members telling you about the device. Also, the scar on his chest made us more aware of some sort of cardiac surgery. Although he did no present the same way as the OPs scenario, most likely would have presented similarly. We got on scene and he was semi-fowler saying he felt better. The monitor was sinus with escape beats.

If the OPs scenario was a real one... shame on everyone that treated this poor fellow. Why everyone would do CPR on a person that has a pulse and BP... is beyond me

[paramedicmike]

Why everyone would do CPR on a person that has a pulse and BP... is beyond me

While I'm not ruling out a poor description of what "work the patient" means, there is no mention of CPR being performed. The VADs on which patients are sent home usually have a hand pump or crank to keep blood moving if, for whatever reason, the electrical power to the VAD became inoperative. Conceivably, since it wasn't specifically mentioned, "working the patient" could simply mean someone operated the manual back up for the device while other resuscitative measures were enacted.

Although, I do agree with your premise. If this guy really had a pulse and a pressure and they really were doing CPR somebody screwed up big time.

ETA: The Heartmate II is the device we're seeing locally. Just in case anyone is interested in reading up on it.

Edited June 10, 2010 by paramedicmike

[FireMedic65]

While I'm not ruling out a poor description of what "work the patient" means, there is no mention of CPR being performed. The VADs on which patients are sent home usually have a hand pump or crank to keep blood moving if, for whatever reason, the electrical power to the VAD became inoperative. Conceivably, since it wasn't specifically mentioned, "working the patient" could simply mean someone operated the manual back up for the device while other resuscitative measures were enacted.

Although, I do agree with your premise. If this guy really had a pulse and a pressure and they really were doing CPR somebody screwed up big time.

ETA: The Heartmate II is the device we're seeing locally. Just in case anyone is interested in reading up on it.

The OP stated that the hospital "continued to work him" and each time they stopped, they would go to pronounce him. Unless I read that wrong and everyone else who replied all assumed the same thing... they were doing CPR... I am sorry if i misread

[paramedicmike]

The OP stated that the hospital "continued to work him" and each time they stopped, they would go to pronounce him. Unless I read that wrong and everyone else who replied all assumed the same thing... they were doing CPR... I am sorry if i misread

Exactly. Given how poorly this was presented to the students in the OP's class it wouldn't surprise me if it was simply stated that the patient was "worked" so that everyone would assume CPR was done when, in fact, it wasn't.

I guess we'll have to wait for BoCat to come back and let us know what the solution is to this case.

[FireMedic65]

Exactly. Given how poorly this was presented to the students in the OP's class it wouldn't surprise me if it was simply stated that the patient was "worked" so that everyone would assume CPR was done when, in fact, it wasn't.

I guess we'll have to wait for BoCat to come back and let us know what the solution is to this case.

You're right. The scenario doesn't make much sense to me at all either. I am sure there are some idiots out there that would do CPR on a patient with pulses/BP and trust the monitor... but I would surprised that a gaggle of people would do the same. Something about the scenario at hand does not make sense. Croakers explanation would make sense to a point, but not completely with how this patient was presented.

I would like to hear more.. and the outcome of the patient. What happened to them to why they are like this.. was it out of know where, some sort of accident, heart attack, choking? I am not fully understanding how all of these could explain one outcome. I would assume something else happened on top of some sort of VAD device.

[Lone Star]

I am confused by all of this!

From what I understand, Asystole means 'absence of electrical activity' which means that the cardiac muscle is at complete standstill. This results in no pulse or B/P.

If the patient DID have a pulse, then I'd be looking in the direction of some sort of mechanical device that is either pumping the blood through the body, or causing the heart to beat (pacemaker)

Either way, wouldn't some sort of device like a pacemaker cause some sort of 'electrical activity' to show on the monitor?

Could there be a short in at least one wire of the harness for the monitor that would cause it to read asystolic?

Even though there were several monitors, are they using the same harness? I know that there are some 'universal' ones on the market...

Can someone let me know if I'm at least in the right ballpark here? For all I know at the moment, I'm just typing to hear 'keyboard sounds'......

[MedicAsh]

I agree with Loner. Its all really confusing. If they did have this device, wouldn't it show some sort of something? I mean look at pacemakers, most times you see them, so first wouldnt you see the pumping device? If the patient was asystolic, that means there is no electrical impulses, so thus there is nothing making the heart contract.

I also have to agree that they were treating the monitor. From day one of my medic classes they have drilled into us not to treat the monitor.

Are they sure that it was a true asystole? Was it confirmed in 3 leads? It all sounds strange to me. If some one is asystolic and cyanotic from the nipple line up, then somethign is obviously wrong. Are they sure they felt a pulse. I know sometimes there have been times i get shaky or accidently bump the patient and it may feel like a pulse but it is not. Could it maybe have been something like that?

[NRPinNEPA]

I have heard that a nearby service has an individual living in their coverage area that has some sort of external device that pumps their heart while showing absolutely no electrical activity on a monitor. If I'm correct, as soon as this person moved into the coverage area or got this device implanted or whatever, the service held a ConEd course specifically on this device. A paramedic at our service stated that he cared for her while he was a student and, just for giggles, put the monitor on and sure enough... the asystole alarm immediately went off and a flat line marched across the screen. Meanwhile, the patient was alert and oriented.

You never know what kind of crazy stuff you're gonna run into.

[paramedicmike]

If this was, in fact, a VAD it is entirely possible for the person to be awake, alert, oriented and able to converse with you while having absolutely no cardiac electrical activity. The patients with whom I've dealt have either been asystolic or VF on the monitor yet they were able to communicate with me... decidedly not dead. The VAD is designed to take over pumping (or seriously assist the heart in pumping) blood throughout the body. Left Ventricular Assist Device (LVAD) patients can be sent home with the device. Bi-VAD (left and right VAD) are generally hospital bound.

It sounds completely counter-intuitive. But with this device it is possible to have an asystolic patient presenting quite alive.

There's a lot of info out there about it. Take a look and see what you find.