A few days ago, we had VSA come into the department. According to EMS, the patient had collapsed while grocery shopping down the road; CPR was started almost immediately by another shopper; EMS arrived and gave the usual ACLS drugs — epinephrine and atropine, as well as defribrillating him, but the only rhythm showing on arrival was ventricular fibrillation. We shocked the patient again as soon as soon as we offloaded him onto a Resus Room bed — and (somewhat to the team’s surprise) the patient reverted a sinus rhythm with a palpable, if faint, femoral pulse.
Then the real work started to preserve circulation: intubation to manage the airway, peripheral IVs, drips of various inotropes and antiarrhythmics and sedatives to be set up, a central line and central venous monitoring, an arterial line, foley catheter, and (at the same time) beginning the therapeutic hypothermia protocol, to preserve the brain from ischemic injury. Therapeutic hypothermia is itself immensely complicated to implement, involving ice packs, iced saline boluses and iced continuous bladder irrigation to lower core body temperature below 34C.
As we were rolling the patient up to the ICU, I stood outside of myself for moment and thought, “This was all pretty awesome. We have given this poor guy a chance to live. I have a really awesome job.”
And when we transferred the patient into his bed, he began opening his eyes. We weren’t sedating him enough. But that was pretty awesome too.