Posted: 1/7/2026 2:36:43 AM EDT
[Last Edit: Alaskagrown][Edited]
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I had my first case of CPR Indiced Consciousness last week. That has.to.be one of the worst things ever... I got called to Panda Express for a 62 year old, Loss of Consciousness. We arrive on scene and he is laying supine. Strong irregular radial pulse alert and oriented. Says he was walking in and felt lightheaded and went down. Wife says all of a sudden she and her friend looked back and he was on the ground. He has Afib takes metoprolol and eliquis but missed this mornings dose. As my partner is getting the blood pressure cuff i he says "I am feeling light headed again" we roll him onto a mega mover. And he has a convulsion and head turns up and to the right. My supervisor walks in right before this she feels a weak thready irregular pulse and his breathing is agonal not unlike seizure quasi-apneic respiration. I tell my partner to get he 4-lead on but he is too diaphoretic. Lift him onto the stretcher and I note he isn't breathing anymore and I can't palpate a carotid. We start CPR and get pads on him. Vfib we shock and my partner states the bagging compliance is poor so I agree to move to an Igel. He bucks the igel with an intact gag reflex so I tell her to throw in an NPA. Police arrive and grab the Lucas get that thrown on and rhythm check vfib shock again and now the Lucas is going. Lucas pauses for breaths and I watch vfib dance across the screen. Meanwhile he is starting to become alert and is asking for the Lucas to be taken off because he can't breathe. As we start moving to the truck it's time for another rhythm check he is fighting to try and remove the Lucas, I stop the Lucas and he starts going down Vfib again. Start the Lucas and he starts fighting again. Wound up giving Ketamine for sedation, the full 450 of Amio (300 and 150 respectively) and 2 doses of cardiac epi. All told shocked 9 times the last 3 were dual sequential. The hospital worked him for 20 more min (@60 min total) until he devolved into asystole. It was a weird paradox having a clinically dead individual asking you to stop doing the only thing that you could do to enable them to ask you to stop. He was perfusing so good he ripped the wrist straps off of the Lucas. Wound up talking to the doc afterwards for advise/things I could have done different he said that we did pretty much all that could have been done and that the ketamine being the first med was probably the most humane thing we could have done. It was wild and hopefully I won't ever see that again. My supervisor said that the was the most impressive CPRIC she had ever seen. |
| Yeah pretty much. CPR induced consciousness is when the compressions are good enough to get oxygen rich blood to the brain that the person "wakes up" usually they try to get the CPR to stop because it hurts but don't have the strength to really do anything. My latient became combative, was sedated and ultimately expired in the hospital. |
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Wow. Three cheers to your team and their effort. You gave that guy every fighting chance possible. When I go all Fred Sanford I hope they're as on the ball as you guys. I'm not kidding. The last time I was in an ambulance the driver, a good friend, shouted out to me "Hey man, if you feel like you're starting to die on us be sure to get my attention. This is the New Guy's first day and he's in way over his head." The New Guy though we were bull shitting until the flight crew met me at the ER triage. I work with paramedics every day who are calm, cool, and professional even when they're head is on fire. Nothing but respect for the profession. Having said that, losing sucks. We all know that it comes with the territory, but losing just plain sucks. Take the lessons learned from this one and carry it forward to the next. |
