CPR and Dopplerable Pulse

[thegenius]

I've seen one of these, too.
Coded the guy for 40+ minutes. In and out of ROSC.
Cath lab.
No neuro responses for about a week.

I went to the pub a few weeks later, and a giant man slapped me on my shoulder.
"Are you Dr. RustedFox?"
"Maybe?"
"You saved my dad's life; he's over there at that booth. Thank you; he'd love to say hello."
Walking, talking, drinking a Guinness.

I don't know if our ICU docs at my institution would wait 10 days for neuro to recover in this kind of patient.

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[gutonc]

I am the OP and I already commented on post #2 that I can't spell

LOL

But I keep coming back to the thread for dooperable. So, even though you can, please don't correct the title.

 

[thegenius]

 

[Siggy]

This case was the exception, but it does show that some people take awhile for neuro recovery. I would expect the vast majority of these to do poorly, as the first "link" never happened. Patient did get expedited transport to the ED, but who knows how long that transport actually took.

This is the problem I have with... well... pretty much everyone else in the hospital (my ICU attendings, fellow ICU fellows, the neuro team, etc). I almost got burned in a similar manner. Worked a floor code in residency for 45 minutes (electrical storm, in and out of ROSC, defibed 12 times). Finally got him to the unit, coded again, defibed a 13th time. Talked to the family and got the DNR. 3 hours later, family is telling us he's starting to move ("BULL _____" was our response). An hour later he was sitting up. Extubated the next day, transferred for EP study, got an AICD, and was discharged.

AHA says not to prognosticate for the first 72 hours after the cardiac arrest OR after return to normothermia for patients treated with TTM. However if the patient isn't doing jumping jacks within 5 hours, everyone wants to declare the patient a lost cause.

https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-8-post-cardiac-arrest-care/#

 

[siliso]

I have wondered about same, going back to OP. If it’s not palpable is it really perfusing? Is there a point wasting seconds searching with the Doppler or proceed with ACLS until you get something inarguably palpable?

 

[deleted109597]

Fixed it for you

 

[BoardingDoc]

Fixed it for you

@gutonc is gonna be maaaaaaaad

 

[gutonc]

Fixed it for you

Dammit!

Now I'm going to have to just delete the thread completely.

 

[thegenius]

I have wondered about same, going back to OP. If it’s not palpable is it really perfusing? Is there a point wasting seconds searching with the Doppler or proceed with ACLS until you get something inarguably palpable?

I'll tell ya, everytime during CPR I don't have a pulse, and I pull out the US and get an arterial waveform....
- I don't call the code
- I spend another 45-60 minutes in the room putting in a-line, central lines, starting pressors, this and that
- the pt ends up dead a day or two later.

 

[siliso]

Or they end up losing even the dopplerable pulse again within 5-30 mins