Case summary:

An ALS crew responded to a 60s man who was reporting shortness of breath.  Crew noted wheezing on all lung fields so they gave him a DuoNeb treatment right away before any attempt to extricate.  Initial vitals were:

Vitals: BP 167/105  HR 108,  RR 20,  Sat 92% on RA

Patient was extricated and loaded into the ambulance.  The crew re-assessed while placing an IV.  The patient reported feeling better after the first breathing treatment.  While the crew was placing 12-lead leads on the patient, we suddenly became unresponsive.  The crew noted that he was pulseless, so they immediately placed pads on the patient and noted this rhythm:

The crew noted ventricular fibrillation (VF) and defibrillated the patient and started manual chest compressions.  Shortly after starting compressions, the patient woke up and push the crew off him.  Post arrest vitals were:

Vitals: BP 154/73  HR 74,  RR 20,  Sat 97% on O2

The patient was awake and alert but confused.  The crew was right around the corner from the ED so they quickly transported and handed off care to the ED. 

 Highlights of the case:

Early shocking in cardiac matters

Early defibrillation for shockable rhythms is the single most important thing to do in cardiac arrest.  This is because ventricular tachycardia (VT) and VF are more likely to convert to a perfusing rhythm the earlier they are treated.  Every minute that shock is delayed in cardiac arrest from VT/VF is associated with a 7-10% increase chance of death.  This crew immediately noticed that the patient became unresponsive, confirmed cardiac arrest by lack of a pulse and was able to place the pads and shock the patient in <20 seconds from the time of arrest.  This is why the patient not only achieved ROSC, but also showed early signs of good neurologic outcome.  This crew absolutely saved this patient’s life with their care!