ER

[namaste1967]

Don't know if any of you watched ER last night, but I've got a question about it..........during the episode they we're doing cpr on a pt and apparently they were doing it well enough to get enough O2 to the brain and the pt became and remained A & O while they were still doing cpr.......they tried "everything", but could not get the heart to beat on it's own and eventually they stopped after family arrived to let the pt die. Is this actually possible to do in cpr? I've never heard of such a thing and was wondering how true to life that cpr scene was.

 

[Chimpie]

Yeah, I saw that episdoe last night as well and was wondering the same thing. I hope someone posts an answer in the next two hours cause I have a CPR class to teach and I just know this question is going to come up. :lol:

IMO I'd say no but who knows.

 

[Jon]

Dang... I missed it.

Are you saying the patient was CAOx4 and engaging in conversation???

I don't think that is possible. I'm not sure of the specifics, but "good" CPR will only get a small fraction of the bloodflow necessary to keep the brain alive, and what the brain really survives on is the oxygen still in the body.

I’m going to see if I can find the figures online this morning for you, Chimp.

Jon

 

[Jon]

Firehouse.com / EMSresponder.com Fourms have an intresting pair of discussions going on this, talking that it is "possible."

No heart beat but pt. awake due to compressions? ER TV

Awake and performing CPR!

(Normally I wouldn't post a link to another fourm, but given Chimp's time constraints...)

 

[emtI]

I wondered about that too. I have heard of it, but never actually seen it. He wasn't talking, as he was intubated, but he was moving his arms.

I was also wondering if anyone has seen that zipper thing that the doc put on that massive leg laceration. I've never seen anything like that before.

Just wondered how it works and if anyone else has used or experienced it.

 

[namaste1967]

Originally posted by emtI@Nov 18 2005, 09:24 AM

I was also wondering if anyone has seen that zipper thing that the doc put on that massive leg laceration. I've never seen anything like that before.

Just wondered how it works and if anyone else has used or experienced it.

I second that.............that's a new one to me too.

 

[squid]

I saw that thread on the other forum and was going to mention it, but you beat me to it!

Hmm.... do you think they got to see the episode in advance??

 

[Jon]

Originally posted by squid@Nov 18 2005, 02:07 PM
I saw that thread on the other forum and was going to mention it, but you beat me to it!

Hmm.... do you think they got to see the episode in advance??

no... the one was started as a "weird call" thread

 

[CaptainPanic]

Ive heard stories of people doing compressions and the pt will look up at them or will attempt to move their hands. Ive also heard the same things happening during shocks.

I think Rid commented on it at one time, though I cant be sure. Perhaps Mr. Ryder can give us an explanation with many years experience and 100+ hrs work weeks he's bound to see some of the unexplainable. :blink:

-CP

 

[ffemt8978]

Here is an e-mail I got from ASHI about it:

Charles – all;

Studies have demonstrated that the public maintains unrealistic expectations of the potential for successful recovery following CPR (as high as 50%). This has been attributed to misrepresentation of CPR outcomes on television (Jones 2000). However, this CPR representation in the ER episode is not a misrepresentation. In fact, when the new CPR/ECC science and guidelines (due very soon) are put in practice, we may see a lot more of this type of thing – at least hopefully. Here is an excerpt from “Cardiocerebral Resuscitation, The New Cardiopulmonary Resuscitation by Gordon A. Ewy, MD(Circulation 2005) . Stay tuned for a new focus on the quality and duration of external chest compressions -and hopefully more cardiac arrest survivors without brain damage.



“Why is it that every time I press on his chest he opens his eyes, and every time I stop to breathe for him he goes back to sleep?”



The opening quote above is from a woman who had been given 9-1-1 dispatch telephone instructions in cardiopulmonary resuscitation. It is more than a decade old, but when I listened to this recording, I could not help but marvel at the importance of the observation made by this distraught woman trying to resuscitate her husband while awaiting the arrival of the paramedics. She correctly observed what our and others’ research had found: that during cardiac arrest, maintenance of cerebral perfusion is critical to neurological function. During the hemodynamic phase, the most important determinant of cerebral perfusion is the arterial pressure generated during external chest compressions. This perfusion pressure is lost when one stops chest compressions for rescue breathing. The same can be said for maintaining viability of the fibrillating heart. The fibrillating ventricle can be maintained for long periods of time if there is adequate coronary or myocardial perfusion pressure produced and the coronary arteries are open. If early defibrillation is not available, a major determinant of survival from ventricular fibrillation cardiac arrest is the production of adequate coronary perfusion pressure.”

Ralph M. Shenefelt
Executive Program Director
American Safety & Health Institute
4148 Louis Avenue
Holiday, FL 34691 USA
Phone 800-246-5101
Fax 727-943-7460

-R

On Thu, 17 Nov 2005 23:04:46 -0500, Charles Brogan wrote
> Did anyone see ER tonight (11/17/05)? Is it possible to be doing
> CPR and the patient become awake and if you stop CPR the patient
> looses consciousness?
>
> The story was the pt went into cardiac arrest, went into Pulseless
> VT and was shocked at 200 joules and converted into ST (I think),
> a little while later he went back into Pulseless VT, shocked
> several times with no change, drugs were administered, and pt
> began to move, CPR was stopped and pt went unconsciousness, CPR
> was started again and pt became responsive again. Dr Pratt said
> it was because the brain was receiving adequate oxygen from the
> CPR and ET. Could this really happen? It kind of makes sense.
>
> Respectfully,

 

[TTLWHKR]

They were doing an awful lot of resuscitating for a Mass Casualty.. I TiVo'd it.


Did the medic who fell through the floor die?

 

[emtI]

Originally posted by TTLWHKR@Nov 19 2005, 04:07 AM
They were doing an awful lot of resuscitating for a Mass Casualty.. I TiVo'd it.

That was one of my thoughts too. I can't believe they tied up two doctors to care for that one CPR patient for the whole incident. It was an unusual case, but nonetheless, all those patients, and two dr's working on one guy who was obviously not gonna make it? I mean, he coded in the field, I thought in an MCI that was a black tag.

 

[Chimpie]

It's been a while since I went through Triage training, but I do remember that if you come across someone with no pulse, black tag them.

But what about if while you're treating them you lose the pulse? Do you just stop and move on or do you try and save?

 

[Ridryder911]

I have had several people with low cardiac rate or output so CPR was initated to improve cerebral perfusion.. many would even say "..that hurts"..or try to push your hands away while doing CPR.. freaky; however in the cath lab you can see there is not enough bood pressure or cardiac output to maintain cerebral or coronary perfusion. This was performed until a balloon pump was placed to maintain pressure.

Be safe,
R/R/ 911

 

[TTLWHKR]

Our Triage System:

Initial Assessment - Not the time to administer extensive treatment:

Anyone who is walking, No matter the injury.
Green Tag

Anyone who cannot walk
Yellow Tag

Anyone with multiple fractures, that also has: bleeding, cannot walk, injury to the head, breathing probs, or abd pain (if they can walk, automatically a yellow tag).
Red Tag

Not breathing, no pulse, unresponsive
Open the airway (look/listen/feel), check for a pulse, listen for heart beat if possible...

Once the airway is open, if still not breathing and no pulse..

Black Tag.

You have other patients, and secondary Triage must be done. Working every DOA at an MCI, will lead to other patients dying as well.

 

[Stevo]

wow, now everytime i do cpr on gramps the family will insist that i'm 2nd rate if he doesn't narrate the whole thing?

thanks ER

~S~

 

[Phridae]

Originally posted by Stevo@Nov 19 2005, 09:39 PM
wow, now everytime i do cpr on gramps the family will insist that i'm 2nd rate if he doesn't narrate the whole thing?

thanks ER

~S~

Haha!! I was thinking the same thing!!

I'm finding what happened on ER to be a bad thing to EMS. Now when someones' loved one codes they're going to expect CPR to wake them up, when in all it's likely-hood it wont. Do the people on ER think what they decided to do on their show will influence the uneducated public? I think not. But it does.

and FYI, again, aliens did not kiddnap me. I am alive and well. Just busy and don't have a working computer...blah blah blah.

 

[TTLWHKR]

Originally posted by Phridae+Nov 19 2005, 10:38 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (Phridae @ Nov 19 2005, 10:38 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-Stevo@Nov 19 2005, 09:39 PM
wow, now everytime i do cpr on gramps the family will insist that i'm 2nd rate if he doesn't narrate the whole thing?

thanks ER

~S~

Haha!! I was thinking the same thing!!

I'm finding what happened on ER to be a bad thing to EMS. Now when someones' loved one codes they're going to expect CPR to wake them up, when in all it's likely-hood it wont. Do the people on ER think what they decided to do on their show will influence the uneducated public? I think not. But it does.

and FYI, again, aliens did not kiddnap me. I am alive and well. Just busy and don't have a working computer...blah blah blah. [/b][/quote]
It really does make people live in TV Land... We're all in one big f*cking episode of Pleasantville, omg, there's a cat in the tree... HELP! CAT! CAT! CALL THE FIRE DEPARTMENT!

 

[Stevo]

i say go with it, brush up on the Ventriloquism and make a few timely combacks...

Next of Kin; " Is Gramps gonna make it?"

Gramps: "Not if you keep making that friggin' meatloaf of yours"

extra credit if you can make his lips move with the BVM


~S~

 

[Wingnut]

LOL, you guys crack me up. I think (hope) that most of the general public knows that the drama shows are not accurate. Hell I catch at least a handful of mistakes watching each episode of those shows (my husband won't watch them with me anymore) There was a show on a while back, kind of like a documentary explaining to people that what they see on these shows pretty much never happens in a real ER. Maybe they should air it again.

Something that gets me and it's how I always begin my CPR classes is that people don't realize that CPR isn't necessarily to bring someone back, I tell them that on a rare occasion it will (like drowning) but for the majority its to keep the body going until the dr's can revive the patient, and I'm shocked at how many people are shocked when I explain it to them.

Maybe we should put a show or website together....Truths vs TV lol :lol: