anyone ever seen this in a full arrest?

Biffs25 · Feb 27, 2005

Treat the patient, not the monitor...Was there a pulse?

If not, then i would assume the proper procedures were followed. If all that was being treated was the monitor, then shame on all practitioners involved.

To answer your question however, I have seen a conversion from asystole to NSR with one dose of epi and one dose of atropine together, but the rythm didn't last.

I have personally never seen an asystolic patient "biting down", but have had a hard time opening the mouth for intubation.

As far as a sentinel event, trust your instincts, talk to fellow co-workers. but remember the monitor doesn't always tell the truth.

jwk · Feb 27, 2005

1.) Adult Patient with multiple complications go from complete asystole to a perfect sinus tachycardia with one dose of epi 1:10,000 IV push?
2.) Patient biting down when attempting to bag them but the patient being in asystole?
3.) As someone who has been involved in several hundred codes who has never seen the above, would you say a sentinel event/negligence occurred if the above happened, yet you witnessed that the patient was not properly hooked up to BOTH cardiac monitors in the trauma room?

1) No

2) Yes - you can actually have a conscious patient if you're doing great CPR. It's really wierd if your patient is staring at you while you've pumping on their chest.

3) Yes, that would be a big booboo. I've seen an awake patient defibrillated when an EKG lead popped off - the nurse saw the flat-line (we defibbed asystole routinely 25 years ago), called a code, and shocked him as we were running in the room. The patient was NOT happy!

Always look at your patient, whether in the ER, ICU, or OR.

Pete495 · Feb 28, 2005

I have seen a patient go from asystole to SR, maybe not necessarily sinus tachy, but sinus rhythm after one dose of Epi.

If the patient was biting down, he obviously was not in asystole, or he could have been having a vagal episode, thus he probably had a pulse (hopefully). In any case, he should have had the EKG leads on him. Personally, I don't think I would call it a sentinel event. The patient wasn't harmed, and you may have actually benefited the patient from doing what you were doing, even if it was dumb luck. Typically, if the patient benefits from dumb luck, it won't really be considered a sentinel event. Yes, he went tachy a little bit, but did he suffer any consequences as a result of the action? If so, then maybe a sentinel event is in order. But to examine this episode with a fine tooth comb seems kind of sensless, esp. when there are much bigger fish to fry. I could get into the whole politics of examining such events, but I don't want to bother right now.

jwk · Feb 28, 2005

I have seen a patient go from asystole to SR, maybe not necessarily sinus tachy, but sinus rhythm after one dose of Epi.
If the patient was biting down, he obviously was not in asystole, or he could have been having a vagal episode, thus he probably had a pulse (hopefully). In any case, he should have had the EKG leads on him. Personally, I don't think I would call it a sentinel event. The patient wasn't harmed, and you may have actually benefited the patient from doing what you were doing, even if it was dumb luck. Typically, if the patient benefits from dumb luck, it won't really be considered a sentinel event. Yes, he went tachy a little bit, but did he suffer any consequences as a result of the action? If so, then maybe a sentinel event is in order. But to examine this episode with a fine tooth comb seems kind of sensless, esp. when there are much bigger fish to fry. I could get into the whole politics of examining such events, but I don't want to bother right now.

If in fact the EKG wasn't hooked up, and you were treating the patient for asystole, I think it IS a sentinel event, because you had the potential for creating a life-threatening problem. You can't treat this as no harm/no foul. What if this happens again? What if your dose of epi had shot the patient's BP through the roof and ruptured his previously unknown cerebral aneurysm?

Why would you NOT want to look into this event? What politics are there to be played with a potentially life-threatening complication or error?

Pete495 · Feb 28, 2005

I agree with you that some would consider it a sentinel event. I just don't think most facilities would take the time to investigate unless there was a bad outcome. As for whether I would investigate this event, it's enough for me to say a mistake was made, and deal with the individuals involved (I'm obviously not an administrative guru). If we examined every potential life threatening problem, health care workers would be quitting and pulling their hairs out.

In any case however, the patient should be treated like a VIP. As you said, the patient could have had an unknown cerebral aneurysm. If the patient warrents further testing after the dose of epinephrine, than it should be given without hesitation. Because we don't know all the facts of the case, it is difficult to say what complications the patient would or could develop. However, I just feel that rehashing it in the Board Room gives the administrative junkies something to feel good about, while belittling the actions of people that they have nothing to do with on a daily basis, and have a difficult time relating to anyway. And typically their half *** action plans for making it better never get implemented, so basically the whole thing is a forifice half the time. I only say this because I've been involved in one, and have heard of a couple of others. Just my experience with a sentinel event.

EmeraldNYL, BSN, RN · Mar 2, 2005

1) Yes, but like someone else said, the rhythm didn't last.

2) No, but I've seen something similar. We were once coding a fairly young patient for over a half hour and we pumped him so full of epi and atropine that his arms were moving even though he had no pulse!! I guess it was because of all of the sympathetic stimulation??? Because he was definitely asystolic! It was the freakiest thing I have ever seen.

resqyou35 · Nov 24, 2009

While working as a Paramedic, we had a foreign body obstruction call that was "corrected" prior to us getting there. The staff at the Assisted Living center where no help and literaly getting in the way. We moved him to the Rescue and started treating him while our Engine crew got his paperwork. He was moving good air with no SOB. He suddenly went to a profound bradycardia then to aystole with no pulse...wires were connected to EKG. While wating for paperwork we called the recieving facility since he was a DNR, but with no paperwork given by staff yet. He came back to a S. Brady with no meds besides AMBU bagging him with 100% O2 and brief CPR. In Florida he is only a DNR if the original papers are with the PT. Must have had a strong vagal response. We did get the DNR paper just in time to see his HR return. We were awarded a "Field Save" by the department for a Do-not-resucitate!!

ellakate · Nov 25, 2009

When I was a new graduate, my patient Cora flat lined. Since she was in her late 80's, the code team received orders to not resuscitate. My good friend, Cindy was a tall, blonde West Texas lady, also a GN. We worked to provide final care to Cora. We left the monitor leads on and began to reposition her in the bed. The doctor pronounced her dead. We were so new that we didn't even think to take the leads off.

Cindy and I turned Cora and cleaned her, then heard a beep. We looked at the monitor screen and the patient had resumed a sinus bradycardia. Both of us were new grads and we had never seen this before. Cora drew a deep breath and opened her eyes, looking at Cindy. She said, "Hello, Big Blondie, are you my nurse today?"

Cindy burst into tears of joy. Cora lived another 6 weeks and was able to return home.

detroitdano · Nov 27, 2009

When I was a new graduate, my patient Cora flat lined. Since she was in her late 80's, the code team received orders to not resuscitate. My good friend, Cindy was a tall, blonde West Texas lady, also a GN. We worked to provide final care to Cora. We left the monitor leads on and began to reposition her in the bed. The doctor pronounced her dead. We were so new that we didn't even think to take the leads off.
Cindy and I turned Cora and cleaned her, then heard a beep. We looked at the monitor screen and the patient had resumed a sinus bradycardia. Both of us were new grads and we had never seen this before. Cora drew a deep breath and opened her eyes, looking at Cindy. She said, "Hello, Big Blondie, are you my nurse today?"
Cindy burst into tears of joy. Cora lived another 6 weeks and was able to return home.

Sounds like:

1) A freaking miracle

or

2) Two leads weren't checked, and/or the doc didn't listen for heart sounds.

cgriffin12 · Dec 11, 2009

saw it happen twice about a month ago with the same pt, he went asystole twice, three days apart, and recovered to sinus tach both times after 1 push of epi and being ventilated with ambu bag. It turned out that he had subclinical aspiration and that was the root of his problems. Anyways, you cant call this a sentinel event and "blow the whistle" on someone if you don't know for sure he wasn't asystole. Furthermore if you were present and didnt check for a pulse or ensure someone else did before giving the epi then you are to blame also.