I saw something this week in a code that is truly unique and a bit disturbing. We were doing CPR on a pt that coded and he started moving his arms purposefully. We stopped chest compressions and he was asystole and without a pulse. The ED doc that was running the code stated that he probably had enough cerebral perfusion during CPR to allow him to be responsive. I have seen this one other time (in my 14 years of critical care) but not as pronounced as in this case. Moral of the story, just because the pt is moving doesn't mean that spontaneous circulation has been restored.
I'm new to this forum but I really like it. I'm sure we see unique situations in our small circle of practice that are shared around the world by other clinicians. The left ventricular assist device (LVAD) might be the "device" that "rakcna" was thinking about. My pt was too sick for that; a trip to the cath lab was perhaps a missed opportunity at an earlier time.
Had patient we had been coding for 25 minutes (started with torsades, to Vfib, finally PEA). The patient was pulseless and purple-faced. When the code was called he raised his arms up forcefully and they fell back down. Over about the next minute, pt opened his mouth wide and gulped for air two times. Never saw that in a deceased pt before.
Regarding the thump. It's interesting that your instinct was to thump the patient. I, too, have had the instinct to thump a patient on the chest when they go pulseless and have had to stop myself because it isn't done in my ER. The one time I saw it done was after a code. The MD had pronounced a patient dead and walked out of the room. One of the male nurses said, "Thump her on the chest one good time, what have we got to lose?" So someone did. It didn't work, but for a second we were hopeful. Interesting!
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Pre-cordial thump was once the standard of all witnessed arrests....whether or not they were on a monitor. I have given a pre-cordial thump on a couple of patient and seen it work...he yelled at us every time. He was a post CABG having what we now call...torsades.
Regarding the thump. It's interesting that your instinct was to thump the patient. I, too, have had the instinct to thump a patient on the chest when they go pulseless and have had to stop myself because it isn't done in my ER. The one time I saw it done was after a code. The MD had pronounced a patient dead and walked out of the room. One of the male nurses said, "Thump her on the chest one good time, what have we got to lose?" So someone did. It didn't work, but for a second we were hopeful. Interesting!
If you're not thumping them within the first minute, it's useless.
I shocked a patient out of v fib once. As soon as the shock was delivered she yelled, "owwwwww!!" And popped back into NSR. I think I jumped back 3 feet I was so startled. I asked her "Ms. X do you know what just happened?" "Yeah, I finally fell asleep until you guys woke me up!!!!" Yikes.
I hate to be a nitpicker(even though I'm pretty sure that's not a real word) but defibrillation doesn't "restart a heart that's in true asystole", reversing the cause does. Defibrillation (hopefully) restarts a heart that's in pulseless VT or VF.
That aside I have had one patient who would "come back to life" so to speak during compressions and pull at your hands on his chest, and would immediately go pulseless and unresponsive upon stopping compressions. Truly unsettling! He did not make it.
Gonna pick a little more at that nit...
The GOAL of defibrillation is to get back a viable rhythm, but the act of defibrillation itself does not restart the heart.
Defibrillation overwhelms the heart's electrical system, stunning it, leading to a momentary cease in all electrical activity.
Then, if the myocardium has enough oxygen it will restart itself in an organized rhythm.
I know, details, details, but that's the business we're in.
Blandini7
14 Posts
I'm new to this forum but I really like it. I'm sure we see unique situations in our small circle of practice that are shared around the world by other clinicians. The left ventricular assist device (LVAD) might be the "device" that "rakcna" was thinking about. My pt was too sick for that; a trip to the cath lab was perhaps a missed opportunity at an earlier time.