My Very First Time Using Defibrillator

Chains of survival

The title may sound corny or rather sappy, but the first time of doing something particular is mostly so memorable. This was a real scene that took place at the ER when I and a friend of mine were on call one Tuesday morning. Really just a couple of days after my ACLS training. So it was a real test for me, though I already saw plenty of similar case prior to the ACLS. I wanted to perfom a more algorithm-based medical intervention for ACS case like what I had been trained to.

This is what ventricular fibrillation looks like

So there come a 50-year-old man with a chief complain of having chest discomfort or much like chest pain. The pain was dull as if there were weighty thing being put on his centre of sternum and on area to the left of it. But he was unable to point out precisely where the pain was originating from. He also felt that the pain was somewhat referred up to his back. There was neither nausea nor vomitting, but he was having cold sweat. He was fully awake with GCS score of 15. Blood pressure 140/90 mmHg, heart rate 80 times per minute, respiratory rate 22 times per minute, temperature 35,6oC. History of type-2 diabetes, chronic hypertension, and dyslipidemia were all denied (but I was skeptical, just like House says: Everybody lies!). Signs and symptoms suggested that he might be suffering from acute coronary syndrome, but since it conveys a wide range of causes, we needed some more detail examinations. We set IV line access, giving oxygen through nasal cannula (NC). We run ECG test on him (which laterly suggests STEMI with wide anterior infarction) while giving order to the nurses to administer aspirin (to be chewed), clopidogrel, plus sublingual ISDN. Unfortunately before those medications could even be administered, the patient collapsed (mostly caused by unbearable pain). We advised an injection of 3 mg morphine, but in short he fell into cardiac arrest. No carotid pulse was palpable. Such a nightmare for both the family and healthcare poviders. I shouted to start the chest compression before I ran quickly to get the defibrilator machine which had been in its absolute dormant period for too long since nobody knew how to operate it. But not again after my ACLS training. I was highly determined to come all out this time. Once the defib machine was set, I ran a quick look using the padles. The ECG suggested a pulseless ventricular tachycardia (VT) which was an absolute indication to perform the electric therapy of defibrillation (the other being ventricular fibrillation (VF) and polymorphic VT (Torsades de points)). I gave him a 360 joule shock (since it was a monophasic defib machine) followed by 2 minutes of CPR and an injection of 1 mg epinephrine (following the VF-pulseless VT algorithm). After 2 minutes I ran another quick look, the ECG suggested normal sinus rythm and palpable carotid pulse. We assumed he already came to ROSC (return of spontaneus circulation). We were ready for secondary survey. We fetched a deep breath. Thanks God. Did it end there? No. The patient is losing his carotid again in just five minutes. The ECG read sinus rythm, so it was a PEA (which was an absolute contraindication of defib, the other being asytole). The chest compression was soon started following the PEA-asystole algorithm. After a few cycles it turned into VF again, I did the defib. No amiodarone was available in the hospital. So adrenaline kept being in use. It’s a drug than can boost peripheral resistance and increase the contractility of heart muscles. Then it turned into asystole over and over again until we decided to cease the long series of CPR of 45-60 minutes. We did our best, but our patient wasn’t granted a second chance. It should always be reserved for God's privilege.