Some notes on cardiac arrest

When I work in the field as a paramedic, there are many strange things that I come across. Strange things in relation to a cardiac arrest situation are no different. Here are a few things I've noted that are funny (though not in the circumstance) that made me take a step back when I got there:

Here's the picture: dispatched out to a 70 year old man in a nursing home..."cardiac arrest". We get there and the patient is, indeed, in cardiac arrest. He is on the bed (which has little cushioning...but it not a firm surface in the least bit) and the staff are doing "chest compressions". Instead of really doing chest compressions, all they are doing is pushing the guy into the bed and letting him bounce back up. No compression of the chest is occurring -- just a lot of bouncing.

This is useless. You can bounce the patient to high-heaven...but unless you compress their chest to squish (really technical terms here) their heart between the sternum and spinal column, you are not going to get a pulse back. Sorry. Compress the chest and there's a chance.


Imagine that same picture: 70 year old man in a nursing home..."cardiac arrest". The patient is not in cardiac arrest but merely has a pulse that is difficult to find (but it's there if you know where to look, trust me). The staff are doing chest compressions on this guy and he is none-too-pleased with them but they won't stop. "Hey! Stop!" coming from my patient's mouth is generally enough to get me to stop pushing on their chest. Just saying...

A new picture: dispatched to some doctor's office, urgent care or something of that matter for a "cardiac arrest". Staff on scene have the crash cart and are doing CPR. One is performing mediocre compressions (I try not to fault them -- they haven't done their homework and research -- then again, maybe that is their fault) that barely show up on the monitor the patient is connected to (at least they are on a hard surface -- plus 1 point for them). One person is performing ventilations. These are being done in a 30:2 cycle (not what's best for the patient...but what was taught for a long time). And then you have this one staff member desperately trying to get IV access on this patient. Important? Yes. But don't monkey around with trying to get an IV instead of paying attention to the monitor to deliver the appropriate defibrillation for the patient at the right time (on top of that, not doing continuous and good quality chest compressions).

In that situation, I get the exacerbated staff member who says "I'm trying to get a line for you guys but I just can't seem to get it!" Guess what! I have something even better and quicker: an IO drill. Find my landmark, give me 10 seconds and it's in and ready to flow with medications.

Last picture I'm going to share: dispatch to a nursing home (this happened recently, actually): 80 year old female in cardiac arrest. Staff on scene have their crash cart, are performing chest compressions and attempting to get IV access. The crew of the first ambulance walks up in there and realizes the patient is a "Code-7"...DRT...dead. Patient has been dead for a while. And here's the staff: working this patient as a full-code and not even paying attention to the signs of death.

Here are my take-away points:

1. Place patient on firm surface. Less work for you. Better potential outcome for the patient.
2. When doing chest compressions, compress the chest! Make it show up on that monitor over there. We want to see those chest compressions on there.
3. Also, chest compressions should be interrupted for 2 things...and 2 things only: defibrillation and to check a rhythm. (This does not mean to stand there and look at it for 10 seconds or 2 minutes trying to determine the rhythm before resuming compressions. Get a peek and keep going. When defibrillating, keep doing compressions until it is time to shock. You, the compressor, should be the last thing to clear the patient prior to defibrillation and you should be the first thing to touch the patient after defibrillation.)
4. Yes, an IV is important -- but don't work on that to sacrifice other necessary things...things that can make the immediate difference (example: compressions and defibrillation).
5. If you see obvious signs of death (example: lividity, rigor mortis, ice cold to the touch), don't work the patient as a code. They're dead and they aren't coming back at that point.

Now, in all of this, I don't mean to say that we do everything perfectly when we run a code. Far from it. We are far from perfect. But, there are some big things that can be done to help increase the patient's chances of survival which, in the end, is everyone's ultimate goal, yes? If someone's heart has stopped beating, we want to see them have life come back into them and they be able to walk out of the hospital alive and well.

Hope that helps and that is has at least piqued your interest to do some looking into about this kind of thing.