From what I know , in adults at least it has been shown, that once echo
shows no cardiac activity, the survival rate is pretty much zero. Some
would say that you can stop CPR at that point....
Dr. Ron Berant
Physician lead for Point Of Care Ultrasound
Pediatric Emergency Medicine
Schneider Children's Medical Center of Israel
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On Fri, Feb 27, 2015 at 9:00 PM, Doc Holiday <[log in to unmask]> wrote:
> From: [log in to unmask]
> >... playing basketball collapses... pulseless
> --> Sounds like arrhythmia
> > Police on scene apply AED and patient is shocked and remains
> pulseless (I do not know if AED found shockable rhythm)
> --> AED shocked, so I'd assume it was shockable
> > EMS arrives documents asystole
> --> Seems the AED "fixed" what had been shockable into non-shockable...
> Bad outlook...
> > I/O started, CPR is given, 6 rounds of Epi en route, Amiodarone
> --> Amiodarone makes me assume that they must have got a shockable rhythm
> again. Did they shock some more?
> > Patient postures (arms extend and turn inward) and takes a breath
> (inhale/exhale...not stacked breath release)
> --> Can be spinal reflex or a still barely active medulla, stimulated by
> something (probably hypoxia) to throw a few miliAmps down some fibres. Not
> evidence of any signal from brain above. Likely that organ is no longer
> viable at this stage.
> > CPR and medications continue.... Patient postures and takes breath
> --> See above
> > Do you think that it is possible with effective CPR to have a
> somewhat functioning brainstem/respiratory drive?
> --> Yes. And what one hopes for.
> > Is this some sort of reflex? Any other explanation?
> --> I think so. See above.
> > Also, with no electrical cardiac activity for a prolonged time,
> would you continue once you saw these movements?
> --> Not beyond the point reached in your scenario. I'd also have stopped
> here. Appears that this patient failed to survive despite some major
> BTW, I am interested in your use of the word "pronounced", just like that.
> Is this a standard term or short form that people use over in the
> West-Atlantic? I guess so, as no-one else commented. Is this what you write
> at the end of your written record? Could you give an example of that final
> sentence as it would be written? Not complaining, but sounds a bit
> non-clinical sort of language - more like the "I now pronounce you man and
> wife" thingie...
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