Weird Code

  1. Hi everybody

    I had a weird code the other night and was curious if anyone has ever had the same thing happen. Or if anyone else wants to share another weird code story.

    Ambulance calls in with a 30ish male, code blue, meth OD, been down for twenty minutes, asystole the whole time. Pt. comes in and we run the code for another thirty minutes. Monitor still showed asystole after the last epi circulated.

    Our ER doctor comes in and gives the order to stop. Staff confirmed no pulse via monitor and stethoscope for a full minute. ER doctor is ready to call it when the pt. takes a breath. Pt. is intubated and we can see the condensation in the tube. Doctor gives the order to continue the code. After about two minutes of this we stop again. Pt. again breathes on his own. This time, there were four in a minute period, very shallow respirations. There was barely any chest rise, but there was condensation in the tube. He is still pulseless. Pt. stops breathing and is called five minutes later.

    I talked with the ER doctor later on that night, and he thought it was just a string of agonal respirations and nothing more.
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    13 Comments

  3. by   JentheRN05
    Isn't that considered a PEA? Pulseless Electrical activity or something like that? It's been quite a while since I had ACLS and I think this is actually used with a monitor, NM lol
  4. by   EricJRN
    Man, I bet there were a few people who did not sleep so easy that night! What other drugs had been given besides the epi?

    PEA would be when your patient is pulseless despite the monitor showing a rhythm that is usually associated with a pulse. For example, the monitor looks like sinus rhythm, but the patient has no pulse.
  5. by   babynurselsa
    Just based on what you said I would have to agree with the doc. These were probably agonal respirations.

    Eric is correct, PEA is when you see activity on the monitor without an associated pulse. Asystole is what they refer to on teh TV as flatline. NO activity.
  6. by   EDValerieRN
    So he was coded in the field for 20 and in the ED for 30, and never had a tube? I'm just curious as to why he wasn't intubated until the you guys saw a spontaneous breath. Not trying to be a jerk, just curious... that seems weird in itself.
    Did you guys check in two leads? I wonder if he was in v-fib or something and was still managing to breathe... if such a thing happens. More likely agonal.
  7. by   subee
    Quote from EMSChild
    Hi everybody

    I had a weird code the other night and was curious if anyone has ever had the same thing happen. Or if anyone else wants to share another weird code story.

    Ambulance calls in with a 30ish male, code blue, meth OD, been down for twenty minutes, asystole the whole time. Pt. comes in and we run the code for another thirty minutes. Monitor still showed asystole after the last epi circulated.

    Our ER doctor comes in and gives the order to stop. Staff confirmed no pulse via monitor and stethoscope for a full minute. ER doctor is ready to call it when the pt. takes a breath. Pt. is intubated and we can see the condensation in the tube. Doctor gives the order to continue the code. After about two minutes of this we stop again. Pt. again breathes on his own. This time, there were four in a minute period, very shallow respirations. There was barely any chest rise, but there was condensation in the tube. He is still pulseless. Pt. stops breathing and is called five minutes later.

    I talked with the ER doctor later on that night, and he thought it was just a string of agonal respirations and nothing more.

    If the hypoxia is global, the brainstem is the last to go, thus the persistent vegetative state state. This fellow had a little stem function left when he came in, but not enough function to initiate normal breathing pattern.
  8. by   emsrn1970
    Doctor is correct
  9. by   Altra
    Quote from EDValerieRN
    So he was coded in the field for 20 and in the ED for 30, and never had a tube? I'm just curious as to why he wasn't intubated until the you guys saw a spontaneous breath. Not trying to be a jerk, just curious... that seems weird in itself.
    I read the OP to mean that the visible condensation in the tube was used as evidence that he took a breath ... not that he was intubated after the breath.
  10. by   nuangel1
    the dr was correct they were the last agonal breaths.it was not pea.
  11. by   Larry77
    This situation does not seem very strange to me but I have had some "out of the norm" codes when illicit drugs are involved. I agree with the agonal breaths and non-pea responses.
  12. by   JentheRN05
    Just so you all know - I realized I was wrong in the same sentence. I just pushed submit because I was being stupid. It has been a while since I had ACLS but I do remember (obviously) that PEA is seen with a strip and not agonal breaths lol
  13. by   EDValerieRN
    Quote from MLOS
    I read the OP to mean that the visible condensation in the tube was used as evidence that he took a breath ... not that he was intubated after the breath.
    Thanks for the clarification. Now that I read it, I see you're right in the meaning. I was a little worried there for a second!
  14. by   EMSChild
    Pt. was intubated by EMS while on scene. It was the five lead that showed flatline. Sorry, I can't remember what other drugs we pushed. I'm trying to find the chart.

    Yeah, maybe this wasn't the weirdest code 'ever' but it did freak the staff out for the night! Okay, anyone else have a story?

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