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AnnieOaklyRN, BSN, RN, EMT-P 23,982 Views

Joined Oct 24, '06. AnnieOaklyRN is a RN, Paramedic. She has 'Previously ER RN, 17 years in EMS (yes, I still love it) , IV RN 8 months!' year(s) of experience and specializes in 'IV RN, (911) Paramedic'. Posts: 2,046 (33% Liked) Likes: 2,333

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  • Sep 9

    1) if you are not a DNR and have no signs of prolonged death (lividity, rigor mortis, significant trauma and presenting in traumatic cardiac arrest etc) we are obligated to start resuscitation, no matter your age or quality of life.

    2) I have only had two patients survive to discharge with an intact brain after pre-hospital cardiac arrest in my 19 years in EMS. One was 22 and the other was in his 60s, both had wives, girlfriends, kids, parents, siblings, and maybe even grandkids to return too, and the potential for decades more to spend with those loved ones, making the other 498 that didn't survive worth taking the chance on.

    3) Consider the 80% practice, so that 20% will live as we become more proficient.

    4) Do you play the lottery? you should because there is a small chance you may win, there is a bigger chance you may loose, but you still play because even a small chance of becoming rich is worth the risk and effort. Consider cardiac arrest resuscitation as playing the lottery, except the prize is far better in that someone may win a second chance at life and a family wins more time with their loved one. The gamble is that sometimes you loose, but you cannot predict that.

    5) We cannot truly predict who will live and who will die, or how long they may hang on, or whether their brain will be intact, thus we cannot pick and choose who we resuscitate (the exception is rule #1) .

    6) As a healthcare provider you may secretly wish you don't get that 80 or 90 year old back because you know the chance of them ever coming off a vent and walking out the hospital is just about zero, and the only thing that is gained is a body that is traumatized, more suffering if you get them back even if it's brief, and a family who gets their grief prolonged, and lets not forget the financial burden, but you do it because you have too (see #1).


    7) You will loose more than you save, but those two people I spoke of in #2 are real. The 22 year old went into cardiac arrest while at work after drinking numerous energy drinks throughout the morning, which put him in V-Fib arrest. We shocked him 3-4 times, gave him epi, Amiodarone, intubated him, and 30 minutes of CPR all on the side of the road, before putting him in the ambulance after ROSC was obtained. In our ambulance he was unresponsive with posturing so I really didn't think he would walk out of the hospital, but after several days of induced hypothermia he woke up neurologically intact. He now has a normal life and is healthy, and with the exception of his implantable defibrillator he is like any other 24 year old ( this was two years ago). I have never met him, but I knew his name of course so I "checked" on him on FB and I see the value our work and cannot imagine not attempting to resuscitate in appropriate cases, as I see him going to a baseball game with his GF or spending the day with his family.

    To answer your question, you are running for the 100% of cardiac arrests that occur on your watch, since you cannot predict who will be part of the 8% of cardiac arrest patients who do survive to discharge and go home will be.

    Annie

  • Sep 1

    Hi,

    Ventricular fibrillation: is when multiple cardiac pacemaker cells in the ventricles are firing simultaneously in a disorganized manner, thus there is no organized contraction of the ventricles, which in turn leads to ineffective contraction of the ventricle, and lack of adequate circulation to the body. V-fib is ALWAYS pulseless (unless the person has a ventricular assist device, then they may present alert or with decreased mental status), the person is dead, although initially they may have seizure activity followed by a period of agonal breathing. They need unsyncronized defibrillation.

    Ventricular tachycardia is when ONE cardiac pacemaker cell in the ventricles is firing rapidly allowing rapid repeated depolarization of the ventricles. This is and organized rhythm and some patients will retain adequate circulation, while others will present in cardiac arrest. In those with a pulse, as someone else mentioned, the treatment can range from IV Amiodarone or Lidocaine to synchronized cardioversion, it all depends on the person's level of consciousness and secondly their BP. I have had multiple patient's in v-tach that have been pulseless, one that was completely awake with a really good BP, and another one who was semi awake and a BP that was tanking. So the treatment varies as you can see. Obviously if they are pulseless its straight forward defibrillation. Just remember these patients can also present with brief initial seizure activity followed by agonal breathing.

    Remember when it comes to your heart, the fastest wins. In other words whatever cardiac pacemaker cell or cells are "firing" at the fastest rate win, whether it is in your normal electrical conduction system or in another part of the heart. (this is key information to remember when trying to understand arrhythmias)




    Annie

  • Aug 28

    Hi there,

    I am in the same area of the US and I recommend you continue looking for a job and start your RN-BSN. MA is a very tough job market, but you may have some luck with your associates.

    I am not sure where in MA you are, but I HIGHLY recommend Rivier University in Nashua, NH for your BSN, as they offer a flexible schedule and they offer both online and hybrid classes. They are also reasonably priced even though it is a private college and the faculty are wonderful too! You can easily work full time and do your BSN, so I wouldn't worry.

    If you have any questions feel free to respond on her or send a PM. Good luck!


    Annie

  • Aug 23

    Septic shock is when the patient stops compensating and their perfusion decreases (low blood pressure), it has nothing to do with their response to medications given.

    Assuming this is homework, please look up the other information and tell us why you think their BP drops.

    Annie

  • Aug 22

    I would NOT do a nursing diploma program because even with your other degrees you will have a VERY hard time finding a job, especially as a new grad!!

    Hospitals want and ADN at the minimum and most prefer BSN candidates, especially in Boston. If you apply as a diploma grad and your competition has an ADN or BSN , guess who will get the job! Hospitals don't seem to care much if you have non nursing degrees.

    This advise is especially true if you are in Massachusetts, as there are few new grad jobs and LOTS of new grads looking.

    Good luck

    Annie

  • Aug 22

    Septic shock is when the patient stops compensating and their perfusion decreases (low blood pressure), it has nothing to do with their response to medications given.

    Assuming this is homework, please look up the other information and tell us why you think their BP drops.

    Annie

  • Aug 22

    Septic shock is when the patient stops compensating and their perfusion decreases (low blood pressure), it has nothing to do with their response to medications given.

    Assuming this is homework, please look up the other information and tell us why you think their BP drops.

    Annie

  • Aug 17

    As a previous poster eluded too you need to make sure the person is declined by the medical examiner and the family isn't requesting an autopsy BEFORE you remove anything, once the body is declined then remove them per your facilities policy.

    Annie

  • Aug 14

    As a previous poster eluded too you need to make sure the person is declined by the medical examiner and the family isn't requesting an autopsy BEFORE you remove anything, once the body is declined then remove them per your facilities policy.

    Annie

  • Aug 14

    As a previous poster eluded too you need to make sure the person is declined by the medical examiner and the family isn't requesting an autopsy BEFORE you remove anything, once the body is declined then remove them per your facilities policy.

    Annie

  • Aug 14

    As a previous poster eluded too you need to make sure the person is declined by the medical examiner and the family isn't requesting an autopsy BEFORE you remove anything, once the body is declined then remove them per your facilities policy.

    Annie

  • Aug 13

    As a previous poster eluded too you need to make sure the person is declined by the medical examiner and the family isn't requesting an autopsy BEFORE you remove anything, once the body is declined then remove them per your facilities policy.

    Annie

  • Aug 13

    As a previous poster eluded too you need to make sure the person is declined by the medical examiner and the family isn't requesting an autopsy BEFORE you remove anything, once the body is declined then remove them per your facilities policy.

    Annie

  • Aug 12

    As a previous poster eluded too you need to make sure the person is declined by the medical examiner and the family isn't requesting an autopsy BEFORE you remove anything, once the body is declined then remove them per your facilities policy.

    Annie

  • Aug 12

    As a previous poster eluded too you need to make sure the person is declined by the medical examiner and the family isn't requesting an autopsy BEFORE you remove anything, once the body is declined then remove them per your facilities policy.

    Annie


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