Full Arrest Narrative

[Dominion]

Ok I know this is kinda dead horse territory but I wanted to get some other opinions and not just those who I work with. I've had my first couple full arrests as a paramedic rider and while both were not only my first as a paramedic but were my firsts...period (both were ROSC and are in ICU still). Anyways I've written two different narratives, trying two different styles (these are for class). Could I get some advice on writing a narrative for cardiac arrests?

My two went like this (details changed to protect HIPAA). Additionally this is JUST the narrative, I also included medical history, medications, age, non-hipaa violating demographics, etc that we got on scene in another section of the document. I very rarely repeat their history in the narrative unless it is SPECIFIC to the run as I've already written that info on another page of the run form.

Cardiac Arrest 1:
Pt found supine, CPR in progress via FD. FD on scene states a neighbor heard a loud bang from suspected fall of the pt and initiated 911 response. Suspected downtime approx 25-30 minutes. Unk history, Unk Meds, Unk Allergies, ID on scene recovered by PD. FD reports AED attached no shock advised, CPR in progress for 10 minutes c minimal interruption. Defib pads attached to monitor, CPR halted. Pulseless, asystole. CPR resumed, intubation attempted c success by paramedic (7.0), IO access obtained, Epi 1:10000 1mg via IO, pt immobilized c minimal interruption. Rhythm and pulse reassessed. ROSC, pulse verified x2 carotid, sinus tach on EKG. Moved to ambulance -> C-3 <Hospital>. Enroute: ventilation's & O2 maintained, ETCO2 @ 46, EKG shows possible ST elevation in leads II, III, & AVF, 12-lead not obtained due to transport time and available resources. EKG trend to sinus brady, pulseless after reassessment. PEA (Sinus Brady). CPR resumed, Epi 1:10000 1mg, Atropine 1mg. Rhythm reassessed, pulseless, PEA sinus tach, CPR resumed, 3rd Epi given. Arrived to <hospital>, prior to transfer from stretcher to bed reassessed c ROSC. Pt moved, report given, care transferred to ER staff.


Cardiac Arrest 2:
Pt found supine in floor, CPR in progress by FD. Pt was found by husband approx 10 minutes prior to arrival unresponsive, not breathing. Husband pulled pt into floor and began CPR until arrival of FD. FD ventilating PT, AED attached, no shock advised. CPR ceased, EKG reads sinus brady PEA. CPR resumed. IO initiated R tibia, 1L Saline WO, Epi 1:10000 1mg & Atropine 1mg given on scene prior to transport. -> c-3 <hospital>. Enroute: Intubated 6.5 ETT, + ETCO2, +Breath Sounds x4, - Epigastric sounds, + Visualization. Ventilated 12/min BVM. Persists sinus brady PEA, epi 1:10000 1mg & Atropine 1mg given. Approx 5 minutes from hospital rhythm check reveals PEA @ 80, epi 1:10000 1mg given. On arrival to hospital pulses faint carotid, heart sounds extremely faint. Report given to <hospital> MD, care transferred to ER staff.

[Linuss]

Totally depends on your protocols / schools wants, but:

Where was the IO started?
EDIT: I see you have it in your second report but not the first.



And did you reassess ET placement after each movement?

[Dominion]

Originally Posted by Linuss

Totally depends on your protocols / schools wants, but:

Where was the IO started?

The second narrative states R tibia, the first narrative does not. These are direct copy pastes with just identifying info removed/changed so I did miss that. My school wants nothing less than absolutely perfect, I have yet to get my QA back on these two reports as we're a bit behind on that front. I know that they will be dissected I was just looking for other opinions on format, should I focus less on play by play and more on generalization. The first arrest was more of a up and down type scenario with several rhythm changes, pulses coming and going, etc while the second was more straight forward. We got there, she was PEA, she stayed PEA (although rate came up) until arrival when she regained faint pulses.

Edit War!: Tube was reassessed, but I didn't write it so it didn't happen. Another thing I missed.

[piranah]

you do not have to write that you checked LS after every movement it is implied that correct practice was performed....you do however put LS in when describing the secondary/third assesment....

[Dominion]

Originally Posted by piranah

you do not have to write that you checked LS after every movement it is implied that correct practice was performed....you do however put LS in when describing the secondary/third assesment....

When you say secondary/third assessment what are you specifically referring to? Do you mean when you are performing additional assessments such as rhythm checks, pulse checks, etc?

Additionally would some of you be willing to type up an example cardiac arrest narrative? Maybe one from memory or just make it up? I'd like to see the other styles of what's out there.

[MrBrown]

You guys seem to write overly complex and wordy entries, or is it just me?

PMHx: Triple bypass ~ 3 yr ago

Hx: Found collapsed on floor by coworkers

O/A: On floor, appeared poorly perfused and responsive to verbal stimuli of crew presence

O/E: Slow, shallow breaths ~ 8/min with fast, weak pulse. Appeared pale, sweaty and agitated. Denies chest pain and no previous history of this ocurring before. ECG > VT at 190.

Rhythm became nonperfusing, patient went unconscious with absent pulse.

Shock x 1 at 360J converted to sinus rhythm and patient regained consciousness.

Enroute: Nil significant change

Vital signs:
PR 190 BP 90/50 RR 8 GCS 13 (3/4/6) BGL 5.8
PR 100 BP 130/80 RR 10 GCS 14 (4/4/6) SPO 99% O2

Treatment:
Oxygen 10L NRB
IV attempt 16g R forearm
IV 16g L AC, 1L NS W/O
Shock x 1 360J (VT>SR)

[Linuss]

Originally Posted by MrBrown

You guys seem to write overly complex and wordy entries, or is it just me?

PMHx: Triple bypass ~ 3 yr ago

Hx: Found collapsed on floor by coworkers

O/A: Unresponsive on floor

O/E: Slow, shallow breaths ~ 8/min with fast, weak pulse. Appeared pale, sweaty and agitated. Denies chest pain and no previous history of this ocurring before. ECG > VT at 190.

Rhythm became nonperfusing, patient went unconscious with absent pulse.

Shock x 1 at 360J converted to sinus rhythm and patient regained consciousness.

Enroute: Nil significant change

Vital signs:
PR 190 BP 90/50 RR 8 GCS 13 (3/4/6) BGL 5.8
PR 100 BP 130/80 RR 10 GCS 14 (4/4/6) SPO 99% O2

Treatment:
Oxygen 10L NRB
IV attempt 16g R forearm
IV 16g L AC, 1L NS W/O
Shock x 1 360J (VT>SR)

That's not a cardiac arrest narrative...

And you're not in an as litigious country as we are.

[Dominion]

Originally Posted by Linuss

That's not a cardiac arrest narrative...

And you're not in an as litigious country as we are.

I'm going to second this one. Here simple mistakes such as extra penstrokes in the margins on your paperwork can be twisted by a lawyer to make you seem careless. Our QA guy is a defense attorney that specializes in medical cases and has represented many EMS cases. This is something that HAS been pointed out to us by him. Making weird marks or maybe a stray mark has been used against him in a case to show the 'carelessness' of the person at trial. Not to say this is a common occurrence, but just the lengths some lawyers will go to in this country to attempt to win their case.

[Melclin]

Don't you have templates to write these things against? Similar PCRs or something? Doesn't someone tell you how to write them?

Whats the purpose of it anyway? If its for school why are they getting you to recite a cardiac arrest algorithm? Wouldn't a reflective piece be a better? Or are you practicing for some requirement of the job. Do you guys write narratives like this after an arrest on the job? Whats wrong with the PCR?

[Linuss]

Originally Posted by Melclin

Don't you have templates to write these things against? Similar PCRs or something? Doesn't someone tell you how to write them?

Whats the purpose of it anyway? If its for school why are they getting you to recite a cardiac arrest algorithm? Wouldn't a reflective piece be a better? Or are you practicing for some requirement of the job. Do you guys write narratives like this after an arrest on the job? Whats wrong with the PCR?

Most PCRs I've seen have a narrative section for a written out 'story' of what happened.