Resuscitation

A dead patient arrived late on Saturday and I initiated resuscitation. It was the wrong call.

 

The history: the patient, in her 80s, had been found collapsed. She had been leaning to one side and she had facial asymmetry. She had been collapsed for an indeterminate period of time and it was ten minutes between being found and the paramedic crew arriving on scene.

 

On arrival on scene, the patient’s GCS was 3. She was breathing but stopped soon after and was then ventilated by bag-valve-mask. IV access failed and the patient was transported with bag-valve-mask ventilation. She arrived at the ED 35 minutes after being found. GCS remained 3.

 

Initial examination: apnoea, pupils 5mm bilaterally and unreactive with no brainstem reflexes. Pulse (radial) present, bradycardic, MAP = 54.

 

The patient was dead. Dead people do not have beating hearts. That was my reasoning. However brain dead people do have beating hearts. The probability of CPCR was zero. The incongruity of a beating heart led to a futile attempt at resuscitation that was continued for an additional 15 minutes.

 

The next dead patient who arrives with a beating heart will not have resuscitation attempted. Information that does not make sense cannot be processed under extreme stress. I know that I should disengage, but knowing and remembering under the circumstances are two different things.