- CPR > 20 min is of no use
- No pupillary reaction means they are dead - do not resuscitate
- pH < 7.0, too bad - they are not gonna come back
0900AM: I was signing off after the night shift, when they wheeled in this man,
- IV access
- 200J X 8 Shocks
- 13 amps Epinephrine
- Amiodarone 300mg then 150mg
- Lidocaine 100mg
- 2gm Magnesium
- + Dopamine was started during the compressions
- Intra arrest ECHO
Cardiology was already paged during the compressions on the basis of the ECHO that demonstrated RWMA. Cardio registrar was with us during the later half of the resus, witnessing everything with a fair amount of skepticism.
|Post Resus ABG|
So, This guy who was almost "brought dead", walked out of the hospital after about 14 days, neurologically intact.
This leaves us with a few questions:
Key Message: Traditionally prolonged CPR is recommended for LA toxicity, Intra arrest lysed PE, Hypothermia aka special situations. But individualise this timeline with every patient. 20 minutes is not a deadline for everyone. Use age and co morbidities before you make the decision to stop.
|ABG next morning|
And numbers on the blood gas cannot dictate the prognosis and your decision to stop/continue the resuscitation should never be based on them.
This is only possible when all the team members are completely aware of the resus plan. For instance, If you are planning a resuscitative thoracotomy, better make sure that your Cardiothoracic team of surgeons is okay with that and they must be on the same page with ED in terms of indications of doing this procedure because surgeons often refuse to take up a patient if they were never in favour of doing this procedure at the first place, and things get ugly from there.
- 20 minutes - does not fit all.
- Don't be fooled by those numbers on the blood and non reacting pupils are not good enough.
- Have pre existing protocols, don't not fight with the logistics when you are stressed.