Asystole WITH a pulse

[thrutheashes]

I agree that the information provided about this call is sketchy, at best. However like someone else in the post said, the wording is misleading.

Just a thought though. Could it be intentionally misleading, because the OP was told they can find information from any source they could find. Thats telling me that the instructor is deliberately holding information to make the students think.

The discussions so far have been very thought provoking, and I look forward to the answer when/if posted.

[BoCat9]

Ok, a little more info. Heart sounds were never heard. Pulse was during CPR and without CPR. No known medical hx. This is coming from the nurse at the hospital that worked on the pt. I really don't know what to think either and everyone has told me its not possible.

Please remember I was not on this case and I am giving you the facts as presented to the class.

Edited June 11, 2010 by BoCat9

[emtannie]

Ok, a little more info. Heart sounds were never heard. Pulse was during CPR and without CPR. No known medical hx. This is coming from the nurse at the hospital that worked on the pt. I really don't know what to think either and everyone has told me its not possible.

Please remember I was not on this case and I am giving you the facts as presented to the class.

BoCat, I don't think anyone is directing their concerns at you - you are just telling us what you were told. Ashes is right - it is generating some interesting discussion though.

If you get a chance to talk to the nurse who worked on this patient again, maybe ask some additional questions to get more clarification:

- if you had a pulse without CPR, why did you do CPR?

- what medications did you give to this patient?

- what was the patient's GCS? Were they a GCS of 3? (I wonder, since previous informaiton had him sitting up between CPR cycles)

- did the patient have any appliances (pacemaker, internal defibrillator, other) to assist with heartbeat? Even though there is no known medical hx, doesn't mean there isn't one.

That's all I can think of off the top of my head for now.

Keep digging!

[BoCat9]

No pacemakers or anything like that. According to my instructor, the guy who actually talked to the nurse, they did an ultrasound and a dopplar. The only places they saw any blood moving was in the brachial and carotid arteries. No heart sounds at all. No chest x-ray was done. They are doing an autopsy though. The guy was unresponsive, he would only sit up for a second or two before he went back down.

Initially I asked if they were checking a pulse with their thumbs, the instructor said "I hope not." Shot it the wind, but possible.

[thrutheashes]

Initially I asked if they were checking a pulse with their thumbs, the instructor said "I hope not." Shot it the wind, but possible.

ROFLMAO. As sad as it is, I suppose you gotta ask! BoCat, please be sure to let us know if you find out anything else.

[DwayneEMTP]

In the end, in any way that my little pea brain can see, it makes no difference if the heart is beating because of electronic support, some device that creates circulation via some mechanical manner, or if he's been infected by some body snatching alien kinda thing that makes the heart beat with mind waves. If this pt had a perfusing pulse then none of the rest of the story makes sense.

An ER staff, even a very, very poor one should be able to determine that something very strange is going on with a pt that has fixed/dilated pupils, no cardiac electrical activity, a pulse, yet still manages to sit up and look around during a resusce attempt, right?

And yet they were unable to find a way to discontinue attempts nor define where the pulse is coming from? If there is a pulse there truly are a very, very finite number of places to look when trying to figure out how that is possible. See what I mean? Worst case someone should have said, at some point during the resusce attempt, "Can someone figure out where that God damned pulse is coming from!!??"

I hope your instructor is top notch, but he's either simply screwing with you guys to get you to think outside of the box, hoping that someone is going to stand up and yell, "Bullshit!" or he's talking out of his ass...

Dwayne

Edited to reformat

Edited June 12, 2010 by DwayneEMTP

[Lone Star]

In the end, in any way that my little pea brain can see, it makes no difference if the heart is beating because of electronic support, some device that creates circulation via some mechanical manner, or if he's been infected by some body snatching alien kinda thing that makes the heart beat with mind waves. If this pt had a perfusing pulse then none of the rest of the story makes sense.

An ER staff, even a very, very poor one should be able to determine that something very strange is going on with a pt that has fixed/dilated pupils, no cardiac electrical activity, a pulse, yet still manages to sit up and look around during a resusce attempt, right?

And yet they were unable to find a way to discontinue attempts nor define where the pulse is coming from? If there is a pulse there truly are a very, very finite number of places to look when trying to figure out how that is possible. See what I mean? Worst case someone should have said, at some point during the resusce attempt, "Can someone figure out where that God damned pulse is coming from!!??"

I hope your instructor is top notch, but he's either simply screwing with you guys to get you to think outside of the box, hoping that someone is going to stand up and yell, "Bullshit!" or he's talking out of his ass...

Dwayne

Edited to reformat

I keep trying to pronounce this sucker 'dead', but I can't seem to stop this pesky 'pulse', and it's screwing up all my plans to get out of here and on the golf course!!

[BushyFromOz]

I call bullshit on the whole thing

My .2 cents

Ok, a case was presented to us in class, actual call that took place sometime last week. We were told we could use any source to find the answer.

Ambulance service brings a mid-50 y.o.m. into the hospital. Found pt unresponsive, put pt on the monitor showing asystole. Crew checked a pulse, found a pulse in the carotid and brachial pulse. Pt cyanotic from nipple line up. HR ranged from 70-200, erratic. Pt had a BP or 110/70-200 systolic. Pupils dilated, nonreactive. Agonal resp, medics tubed the pt. Pt placed on 3 different monitors, leads and pads changed with the monitor. I monitor on the back of the ambulance, 2 monitors in the hospital. Hospital staff continued to work the pt for an hour and a half, each time they stopped to pronounce him, he would sit up, look around and then lay back down. Has anyone ever heard of this happening or have any idea what may have caused this?

/\/\/\/\/\/\/\/\/\

just so i can see what we are talking about..........

Pulsitile asystole is impossible, even with VAD or any other mechanical device has to show some kind of electrical interference on any monitor. Hell, i can get the pulse oximeter to show some pacemaker spikes on the screen if i get the leads in the right sort of tangle.

This pt has signs of life and i do not understand why this pt would recieve CPR (if in fact this occurred)

The monitor shows asystole but the pt has a pulse, big deal, our MRX's tell us the pt is in VT all the time because it cant figure out a paced rhythm with a wide or inverted QRS or a rough road. I can get it to say i'm in VF if i squeeze up like im trying to have a big crap too!

Cyanosis from the nipple line and up, pulse present, erratic. Ill go with an ?? obese person or one with high electrical impedence who has Atrial fib and thrown saddle PE (APO/pulmonary effusion/pericardial tamponade as an ultra long shot) Ill put this down to treating the monitor and not the patient.

Another oprion is good ole chinese whispers has changed the story purple monkey dishwasher.....

Edited June 12, 2010 by BushyFromOz