They’re not dead until they’re warm and dead? Ceasing resuscitation in drownings.

I’m afraid this is a bit of a less cheery post than usual and it goes against the FOAMed grain of resuscitating everything regardless of likely outcome. But hey, my post on breaking bad news  seems to have become a late hit so perhaps cheery is not in this season.

So, it is late February, the temperature outside is 39 degrees Celsius, (for our northern colleagues, that is summertime down here and hot) and your ED is full of bruised cricketers, boozy barbequers, overheated grandmothers and sunburnt teenagers when the ambulance deliver you an 18 month old baby girl in cardiac arrest. She was not seen by anyone for perhaps an hour until a family member spotted her in the family swimming pool.

On arrival in ED the patient is in PEA arrest with no spontaneous respiratory activity and an initial temperature of 25.7 degrees.

Because of the tender age of the victim you continue to cycle through your arrest protocol for 60 minutes at the end of which the child is asystolic.

You are about to call it a day when someone pipes up with the old chestnut “you’re not dead until you’re warm and dead”.

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Cardiogenic shock and thromobolysis (with some more challenges thrown in)

It is mid afternoon in your busy regional ED when the triage nurse calls for help. A 57 year old woman who drove herself to hospital managed to tell her that she has been having awful pain in her chest when she collapsed, collecting her forehead on the windowsill on the way down. You poke your head through the triage window to see her looking up at you from the floor, clearly not well.

By the time you unstick your head from the triage window the patient has been moved onto a gurney. She is awake but with a clouded conscious state (confused mumbling, eyes open but not fixing and focusing, localising to pain) and his vitals are HR 40, BP 60/-, RR 26 with end of the bed wheeze, SpO2 not readable, afebrile. She is bathed in sweat and pale.

This is her 12 lead ECG

Image

What to do? Read on and see what you think.

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