First time CPR

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jwilbz03

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Hello,

So, I am a EMT student about to be completed with the course, however last night I was doing one of my ER clinical rotations when something occured. A 40 yr old came in for bumping his head. Ran him through the CT and nothing showed on the scan. He had no complaints and was in the ER going on three hours. Then he started to having respiratory problems and boom he went into serious brachycardia and unresponsive. I went in and began chest compressions, while they began to bag him with the bvm. Anyways, it went on for awhile and he got itubuated, push meds, etc, but they ended up calling it. It didn't hit me at the time but when I drove home it hit me and that's is all i've been thinking about. Has this happened to you guys/ladies your first time on losing a patient that was tagged "green"?
 
Your first Cardiac Arrest is alway hard. Hopefully you will always think about 'bad' runs: Just don't do it to the point of blaming yourself for what happened; but think about what happened, looking back as a learning experience for yourself and others.
In this case; use it to teach others that not every patient is going to stay 'green', and even though it happened in an ED, and was a Witnessed Arrest; and everything was done fast and properly, people will still die. And no matter what is done, we can't change that.

You did what you could, you started CPR as soon as possible; the nurses and doctors did what they were trained, and what they have learned with experience. He still died, it happens: even in this type of setting, less than 10% of people survive cardiac arrest.

Like I said it isn't your fault, you did the right things; If you still have problems talk to your instructor, or one of the doctors or nurses at the ED, they can put you in touch with someone to talk to for help.
 
Just remember real life isn't like TV. You don't save most people doing CPR. Especially in the pre-hospital setting, you'll lose way more then you save.

Like john said, it's good that you "feel" the loss, but don't let it get to you, or it will bother you down the road, especially after having more calls like this.
 
Yes, OP.

Dispatch was elderly man with a cold, wide can't drive. Got there, loaded, VS in rig...told driver to step on it. The man had CHF, rales, rhoncii, falling BP, and was obtunded on arrival at ER; coded as we were passing him off, so we helped by doing compressions while the ER crew (three people back then) intubated, started an IV, bagged. Afer twenty minutes, the doc looked around and said "Anyone have any ideas?". Called it.

Like Magic Max says, sometimes dead is dead.
 
Once your adrenaline rush in dealing with a Cardiac Arrest wears off, the scene will weigh on your mind for a time.
It's not very nice losing any patient, especially when you are there with all the tools at hand (difib, drugs,personel) from the onset.
I think of a patient in Cardiac Arrest, as Russian Roulet. You never quite know which ones will make it and which ones won't.
Sometimes you will have a save, most times you won't, as Cardiac Arrest statistic's all show.

What can you take away from all this?

1. You have now experienced your first Cardiac Arrest and subsequent death. The guessing as to how you will handle it, is over.
You can move forward, knowing that you dealt with it ok, as many of us have.

2. The first patient you do manage to help save (the one that walks out of hospital at the end of it all)...will be worth all of the minuses, ten fold.

Good luck for the future!

Cheers Enjoynz
 
Color coded traige systems.

another notch on the useless idea belt.


Always remember, any patient can get better, stay the same, or get worse.

It doesn't get more stable than dead.

But it sounds like you did the best you could. Nothing gets you over the last code better than the next one.

Did they really push drugs on him? Which ones do you know?
 
My paramedic preceptor pushed epinephrine and atropine every three to five minutes while the doctory intubated. I switched with a nurse from compressions to bvm untill he was intubated then continued compressions. Continous compressions get very tiring. The doc checked for blood in the abdomen and nothing showed. So, the medical examiner in conducting an autopsy for the cause
 
His heart wasn't broke...

...his head was and odds are, that's what stopped his heart.

Even if you were a brain surgeon you would have ended up starting with compressions anyway. It's a priority thing.

This was a team effort in which you adequately played your part; if the guy would have had a chance, you were there to help him get it.

Your job isn't about success or failure; it's about doing the best you can with the skills, tools and experience you have. Everything else is about learning to be more effective. That's where the focus goes.
 
jwilbz03 said:
My paramedic preceptor pushed epinephrine and atropine every three to five minutes while the doctory intubated. I switched with a nurse from compressions to bvm untill he was intubated then continued compressions. Continous compressions get very tiring. The doc checked for blood in the abdomen and nothing showed. So, the medical examiner in conducting an autopsy for the cause
Click to expand...

came in with a head injury and devolped 2/3 of the cushings triad, id still bet on the head despite them finding nothing with the scan
 
Findings change over time.

There are also some head bleeds that are extremely difficult to detect prior to ventricular shift.

During neurosurgery we were presented with several that looked apparently normal that were all some type of acute bleed.

It wasn't until later scans that the only obvious sign was midline shift, which is definately bad news.

Not to split hairs, but if I were tasked with helping somebody who had a head bleed and their heart stops, I think I would go right for whatever tool was handy to penetrate the skull, because CPR doesn't do anything for herniation, but relieving pressure does.

From an epidural, I'd even be willing to bet an IO needle would work.
 
So understanding the your correct Veneficus, I wonder how my medical director would react to me taking an EZIO drill to my next arrest from head trauma :D:D.
 
usalsfyre said:
So understanding the your correct Veneficus, I wonder how my medical director would react to me taking an EZIO drill to my next arrest from head trauma :D:D.
Click to expand...

It is probably better if you call and ask how she might feel about that first.
 
So, the medical examiner in conducting an autopsy for the cause
Click to expand...

This is why I would follow up with them to find out for certain. Ask your medical director to pull the records for you as you're interested in learning from the case. Most of the time, the records are pretty cheap (says the guy with 1500+ autopsy reports sitting in a file cabinet in his office as a result of his research activities).
 
Let's play HOUSE...

Fell, and hit head becuase of cardiac issues causing hypoperfusion to the brain and related organs.
 
mycrofft said:
Fell, and hit head becuase of cardiac issues causing hypoperfusion to the brain and related organs.
Click to expand...

I tried to respond to what was presented rather than stipulate on a cause.

The information presented was very scant, but I was very curious as to why the resuscitation attempt revolved around an arrest for unknown reasons algorythm.

Obviously we are not privy to the very many findings that could make this approach a good idea or not.

Having said that I am aware that there are many providers and facilities that follow resuscitation algorythms to the letter for better or worse. While I do not agree with that approach, by the numbers it should save the greatest amount of people.
 
CPR could make herniation worse, pushing in more blood (if it's being done right).

I was just thinking about the relative frequency of cardiac syncope versus CVA or CV insult syncope.

Now I'm thinking about undetected CVA and CV insult syncopes.

Doesn't herniation cause apnea before cardiac standstill?Ah, he said respiratory problems then bradycardia. OK. Wonder if brady was by EKG, or BP ausc, or by palp?). If so, how long before? And what kind of arrythmia presents, or does one, or would it be whatever part of the heart is least-perfused presenting first? (What about occiputal trauma directly insuilting the grey matter?). A whole 'nother deep side of the pool.

Well, I'M not searching his house.:unsure:
 
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jwilbz03 said:
A 40 yr old came in for bumping his head. Ran him through the CT and nothing showed on the scan. He had no complaints and was in the ER going on three hours. Then he started to having respiratory problems and boom he went into serious brachycardia and unresponsive."
Click to expand...

Sounds like it fits right in to the head injury, respiratory, bradycardia, epidural bleed timeline, sequele from this.

Like I said, not enough info to make reasonable decsions though.

Speculating for a moment that it was a bleed in the head, relieving the pressure is not part of the cardiac arrest algorythm and the lack of reversible cause evident. Goes back to my thinking though, if you don't have a handy neurosurgeon, what is the harm in making a hole in his skull? You'll make him "more" dead or possibly save him with some deficit?

Estimate the depth, put the needle in. Hook it up to suction if need be.

I can see where the argument is that CPR would make this matter worse, but really, without some type of cranial vault pressure reduction, it is just a question of "more" dead in my opinion.

One thing that always vexed me.

In residency, EM physicians are taught to crack a chest, even though they cannot close it. But they are never taught an emergent craniotomy?

Seems sort of lacking doesn't it?
 
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