What would you do in this code?

You couldn't feel a pulse so you continued to code the pt until you did. I'm not seeing what you would have done differently. You were treating the pt since you had no pulse and continued the code. Did you think you should have stopped coding them because of the art line reading? I guess I'm confused as to what you think was done wrong.

This sounds like PEA or pulseless electrical activity. Although there is some electrical activity, there is still insufficient cardiac output to produce a pulse and the patient is still in cardiac arrest. CPR would still be administered under this circumstance. Great question. Hope that helps.

I guess some of us just wondered if the patient indeed had a pulse after the third round, maybe just not bounding enough to feel, or the person checking the pulse just was frantic and missed it. How do you get a pulsatile waveform without a pulse? In hindsight, it makes sense that it could have been faint and CO would have been present but insufficient (and probably not sustained) had we stopped. Thanks RN543 :)

Yup, you don't feel a pulse, you do CPR. When you question if you should be doing CPR, you should be doing it.

If you had a pressure in the 200's like the A-line said, you would have easily felt a pulse. It was appropriate to continue until you were able to feel a pulse.

Now as to why the A-line said you had a pressure and waveform, no idea.

If you had a pressure in the 200's like the A-line said, you would have easily felt a pulse.

I'm not an expert on A lines, but that was what I was thinking too. Either way, if you cannot definitely palpate a pulse, keep going with the code.

I might suggest having a second person checking for a pulse (but not for too long while CPR is on hold) if you think the one person checking for a pulse is frantic and missed it.

Once during a code when we weren't sure about a pulse, we got the ultrasound machine and the MD visualized the heart, which wasn't moving.

Something I wonder is that the patient could have been extremely peripherally vasoconstricted thus the A-line might actually have been seeing a SBP of 200+ and showing a waveform, but since the pulse wasn't palpable, clearly there wasn't sufficient flow. What was the A-line measured DBP?

In any event, I think it was absolutely appropriate to continue working the code until a pulse was palpable. In any event, the fact that the patient passed very quickly after the family withdrew life support simply tells me that this one was very, very sick.

Best indicator for ROSC is etco2 monitoring according to AHA.

If the pulse is not strong enough to palpate then it's not strong enough to oxygenate. Continuing CPR was absolutely the right thing to do.