I attended a cardiac arrest recently with a Graduate Paramedic who commented that our patient’s agonal respirations made it challenging to palpate their carotid pulse (or lack thereof).
This led me to reflect on the difficulty the general public encounter when trying to figure out if a person who suddenly collapses is just ‘having a turn’ or something more sinister is at play – and what a fantastic job our call-takers do sorting this out without being in front of the patient.
(Un)fortunately I’ve witnessed more than one cardiac arrest, and no two have presented identically.
Almost 18 months ago, I linked to this fantastic article on EMS 12-Lead that takes you through 10 cardiac arrests which have been caught on video;
I think it’s worth reviewing these videos (and their associated dialogue) semi-regularly, and for those who are relatively new to the profession, remember that experience is what you get when you don’t have any !
Apparently, prior to arrival, our case looked something like this..
I was listening to one of the excellent SMACC Chicago panel discussions on the management of traumatic brain injury recently, and it occurred to me that the pathophysiology of patients presenting in cardiac arrest secondary to head-strike might be under appreciated pre-hospital.
After checking-in with a few colleagues to see if they were familiar with the concept of Brain Impact Apnoea, I thought you might find this quick summary from Life In The Fast Lane useful;
Here’s the ‘It’s a Knockout’ panel discussion from SMACC Chicago;
TLDR; It seems that the mechanism of a head-strike, leading to respiratory arrest, which then progresses to cardiac arrest might be poorly understood in the pre-hospital setting. Attending a scene where a patient is in arrest post head-strike might be averted by simple airway management.
Where I work, summer is just about upon us – here’s a reminder of some important points from the gang at EMDocs;
So, it turns out that there are a couple of theories as to how external compressions make the blood go around;
Esmolol use in refractory cardiac arrest – interesting evidence shows a potential benefit;