Cardiac Arrest: A Story Told With EKGs

[Dustdevil]

**Now I know some of you are going to mention this, so I'd like to talk about it. It appears from the 12 lead that the patient is in a 3rd degree AV block. I did not see this at all during the call. To be honest, I gave it pretty much a cursory look considering all else that was going on- noticing the inferior MI and moving on. The lidocane drip happily dripped away the whole time. What do you guys think of that?

Okay, I didn't want to poop your party, but now that you've had a couple of days to bask in the afterglow, it's time to get down to business.

What did your cursory look tell you this rhythm was? What was your working rhythm interpretation at the time you decided to give lidocaine? By "cursory look," do you mean you gave the rhythm itself a cursory look, or that you gave the machine's printed interpretation a cursory look? I mean, if you actually looked at the rhythm itself well enough to determine infarct, then you couldn't possibly have missed the block. The first rhythm out of fib was clearly a block, so it did not suddenly develop at the time of the 12 lead.

I'm thinking you got real lucky on this one. Your cursory look, reliance on a machine interpretation, and getting locked into the v-fib cookbook tunnel vision could have resulted in fatal consequences for your patient. But all's well that ends well.

And plus 10 for fessing up before somebody called you on it, so all in all, you break even. :wink:

[fiznat]

I figured someone would really call me on this sooner or later.

To be completely honest, I screwed it up. I didnt look at the 12 lead for rhythm at all, I just examined for infarct and injury and moved on. That was (obviously) a mistake. In something of a defense, though, I didnt simply go by the machine's interpretation: I never do that. I couldnt have, in this case anyways, since even the LP12 calls the rhythm "undetermined."

I was working under the loose impression that the rhythm was junctional, as the rhythm does appear to be for at least a significant portion of the time. A critical mistake I made was to remain loosly interested in the rhythm itself, not looking specifically for blocks (even when giving lidocane), and chalking up a lot of irregularity to simply "an irritable post-arrest heart." Looking back, though, the rhythm does seem to change several times, with varying degrees of AV dissociation throughout our transport. The 12 lead was done almost last, though, so I think it is probably fair to say that the heart did finally settle into a consistent 3rd degree block. I should have cut off the lidocane at that point.

When I get home tonight (I'm at work till 1730 today), I'll try and post up a few of the actual 3 leads so that we can get a better idea of how the rhythm changed throughout the call.

I guess there isnt much more that I can say. It was a mistake, and I agree a potentially bad one at that. I'm lucky that things ended up so well. Next time I will NOT miss something like this.

[OVeractiveBrain]

Im just happy all our touting about ROSC hyporthermia is actually paying off! Did Turbiak mention anything about in the ER? Or is it just an ICU protocol now? Im trying to get Midstate to do it, maybe even Yale, but I think its hot that anywhere is actually taking the step! I heard youre officially cleared now?

Overactive

[Crankyemt]

Is Lignocaine really still your first line drug of choice??? Do you have cordarone/amiodarone at your disposal or on your protocol

[FormerEMSLT297]

Thats just great to have one that "Walks away"..... enjoy it while you can,,, I know I havent had all that many that walk out with no neuro deficits ...

Congrats,,

[AZCEP]

Is Lignocaine really still your first line drug of choice??? Do you have cordarone/amiodarone at your disposal or on your protocol

Amiodarone wouldn't have been any better a choice than the Lidocaine. Following the defibrillation, the patient was in an AVB/bradycardia. Using any of the antidysrhythmics COULD have caused even more conduction system dysfunction.

[zzyzx]

A true save on your first full arrest?! That's awesome. Congrats!