Cardiac Arrest. Pearl #1 Recognize cardiac arrest.
This sounds obvious, but it is not always so. Early cardiac arrest can present like a seizure or syncope. The patient’s eyes may be open and they may have agonal breathing. Get the pads on! Too many times I have shown up on scene to see first responders tell me the patient just had a seizure or they are breathing, and everyone is standing around. I admit when I first started, I didn’t always instantly recognize what was going on. When I was precepting, we had a patient with chest pain who all of a sudden he started seizing. I reached for the valium (our benzo at the time). My preceptor shook his head. "Look at your monitor," he said. VF.
Get the pads on! Even if the patient snaps out of it before you can act, always get them on the monitor. Be vigilant. Several times early in my career I have had witnesses tell me the patient had stopped breathing and needed CPR before coming around. Those reports did not seem consistent with the alert, talking patient I had in front of me. I poo-pooed their stories, only to have the patient suddenly rearrest on me. Any patient with syncope or seizure needs the monitor on and a self-resolved cardiac arrest should be considered
Check out these two blog posts for great videos that show early presentations of cardiac arrest, many that self resolve only to rearrest later.
From EMS 12-Lead
What it Looks Like: Cardiac Arrest
Pay particular attention to the video "Diagnosed Seizure," which shows a female going into cardiac arrest while on an EEG and EKG monitor. You can her rhythm go into torsades and her breathing turn into only an occasional gasp, yet the observers fail to recognize she is in cardiac arrest.
https://youtu.be/YV3b9Dcy_2A
The video of basketball player Hank Gathers shows him collapsing, briefly getting up, and then collapsing again, and never receiving CPR.
https://youtu.be/Kia8j3TDyL4
From EMS Basics
What it Looks Like: Cardiac Arrest and CPR
Bottom Line:
Any active syncope or seizure, consider the patient might be in cardiac arrest. Any resolved episode of seizure or syncope, consider that the patient might have suffered a self resolved cardiac arrest. Get them on a monitor, and be ready to slap the pads on.
Stay tuned for: Pearl #2 Precharge your Defibrillator
