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Very unusual, never seen or heard before.


*With good wishes *


*Dr (Prof) Suresh Gupta*

*Senior Consultant, Pediatric Emergency and Critical CareInstitute of Child
Health, Sir Ganga Ram Hospital, New Delhi*

*President: STEP: Society for Trauma and Emergency Pediatrics*
*Society for Trauma and Emergency Pediatrics <http://stepindia.org.in>*

On Thu, Feb 26, 2015 at 6:54 AM, Mittal, Manoj K <[log in to unmask]>
wrote:

> It might have been agonal breathing (not noticed during active CPR even
> though he might have been doing it intermittently) and decerebrate
> posturing related to cerebral edema from hypoxic ischemic encephalopathy.
>
> With sudden, witnessed arrest, it may be better to err on the side of
> caution-overdoing the CPR!
>
> Thanks,
> Manoj
>
> Manoj Mittal, MD
> CHOP
> ________________________________________
> From: Pediatric Emergency Medicine Discussion List <
> [log in to unmask]> on behalf of Niel Miele <
> [log in to unmask]>
> Sent: Wednesday, February 25, 2015 7:05 PM
> To: [log in to unmask]
> Subject: Just when you thought you've seen it all...
>
> Group:
>      Your opinions on a strange development in a case would be welcome:
>      Teenage boy, previously healthy, sickle cell trait, playing
> basketball collapses
>      Found to be pulseless.
>      Police on scene apply AED and patient is shocked and remains pulseless
>         (I do not know if AED found shockable rhythm)
>      EMS arrives documents asystole, secures airway, I/O started, CPR is
> given, 6 rounds of Epi en route, Amiodarone
>      Arrives at hospital approx. 30 minutes of down-time.
>      Compressions held to check for rhythm--asystole, ultrasound of heart
> shows no activity:
>        Patient postures (arms extend and turn inward) and takes a breath
> (inhale/exhale...not stacked breath release)
>      CPR and medications continue.  Again, stop to check rhythm:
>        Patient postures and takes breath
>        Pupils sluggishly reactive
>      Continues for a total of 30 more minutes, and is ultimately
> pronounced.
>
>      Autopsy not yet available.
>      Do you think that it is possible with effective CPR to have a
> somewhat functioning brainstem/respiratory drive?  Is this some sort of
> reflex?  Any other explanation?
>      Also, with no electrical cardiac activity for a prolonged time, would
> you continue once you saw these movements?
>
> Niel
>
>
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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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