Weird patient responses

[bbbrammer]

I'm sure anyone who has been in the field for awhile has a "Did that just happen" story that was something that shouldn't have, couldn't have, or statistically was just unusual. Thought some people here would like to submit.

I'll start:

I had a 56yoM with SVT that was symptomatic, but relatively stable. So we decided on Adenosine instead of cardioversion especially since the pt was conscience and we don't carry versed. So we loaded him up with 6mg Adenosine and waited. Nothing happened so we drew up 12mg and were fixing to push it when the pt when "whoa" and we saw conversion on the monitor. According to the time stamp it was 43sec after the 6mg was pushed. So much for the 6sec half-life.

I also had a pt who was a non-witnesses arrest (68yoM w/ cardiac hx) and found him in asystole. The wife found him within five minutes of the arrest and CPR was started w/in 3min of the 911 call, so I decided to give it a go. 34min later, after 2 rounds of Epi and 1 of Atropine with asystole the whole way, we actually got a pulse back. Now without trying to read to much of the "quality of life" stuff into this, the point is that alot of services have a cease-effort protocol after 30 min of asystole and he came back at 34min. That is statistically unusual.

Does anyone else have a "well that was different" story that they want to tell about?

[AnthonyM83]

On my first student ride-along, the medic gave our pt atropine...his heart beat immediately went DOWN. He ended up having to pace him.

And that other guy's story about patient coming back after they ended resuscitation efforts was pretty good.

[bbbrammer]

The other guy's story gave me the idea for the thread, but I didn't want to start up that discussion again. (Hint for future posters.)

[Asysin2leads]

99 y/o woman, called for unconscious in bed, approximately 20 minutes prior to our arrival. Asystole on the monitor, unfortunately DNR could not be found, so we worked her. After standard round of epi and atropine, no response, asystolic the entire time, for about another 20 minutes. While on the phone with telemetry for a pronouncement, notice something that looks very much like NSR on the monitor, with a strong pulse, patient weakly raises her hand. Its a good thing I didn't have a hammer and a wooden stake at that point. She later died again for good at the hospital after the DNR had been located, and I felt like a very very bad man.

[bassnmedic]

On my first student ride-along, the medic gave our pt atropine...his heart beat immediately went DOWN. He ended up having to pace him.

And that other guy's story about patient coming back after they ended resuscitation efforts was pretty good.

That is unusual, however not unheard of, Atropine sometimes when given in low doses will cause reflex bradycardia.

[medic001918]

That is unusual, however not unheard of, Atropine sometimes when given in low doses will cause reflex bradycardia.

Thanks. You beat me to it. I was going to post the same thing. Especially when atropine is given slowly, it increases the risk for the rebound bradycardia.

Shane

NREMT-P