The Patient
This 41-year-old woman was no different than a hundred others we've had before and since. She complained of shortness of breath - not pain really, just a smothering feeling in her chest. Her family didn't seem very concerned for her, almost as if they'd seen it all before. Her discomfort started about four hours before we arrived, and she couldn't seem to make it go away. She had medical problems including high blood pressure, but nothing specifically related to her heart.She'd just returned from a cruise, flown back from the East Coast about two weeks before. Three or four days before this, she'd started feeling "sick." She couldn't describe it any better than that.
The Drive
We placed her in the ambulance and I considered the idea that this could be a heart attack. Women do not look the same as men when they have heart attacks, and I was concerned that this could be one of those times.The cardiac monitor (the thing with all the squiggly lines that always beeps in the movies) showed a small possiblity of some sort of damage starting in the heart. It was faint, though, and could easily have been nothing at all. All these clues were enough to give her nitroglycerin and morphine for the chest discomfort.
She also got aspirin to thin her blood - just in case.
During the transport to the hospital we talked about her vacation, and my upcoming cruise as well.
She was in mid sentence when I noticed it.
Ventricular Fibrillation
There is a disconnect between the heart and the brain. When the heart stops beating, there is still blood, oxygen, and nutrients in the brain to keep it alive and conscious from as little as a few seconds to as much as a minute or so.When I noticed the ventricular fibrillation (quivering of the heart that produces zero blood flow), she was still talking. In fact, she didn't stop until I asked her if she was OK. She stopped talking, looked me in the eye, and seized. It's quite common to seize during a sudden loss of blood pressure in the brain.
We had just arrived at the hospital when her heart stopped. I yelled for my partner to come back and give me a hand. We quickly found the defibrillator patches and attached them to her chest. At this point, she was still taking a gasping, snoring breath every 10 seconds or so (called agonal breathing).
We shocked her. I've been doing this a long time and rarely do I see the type of muscle reaction this woman had to the defibrillator. It was almost like TV. The shock stopped her heart and allowed it to reset, almost like restarting a computer. We performed CPR until her heart took over on its own - about a minute.
HELP!
Since my partner and I were the only people in the ambulance and we were busy with the victim, we didn't have enough hands to get her unloaded and into the hospital. Worse yet, we're actually in the hospital's parking lot, ten feet from the ER doors.I grabbed the radio microphone and simply announced to the hospital that our chest pain patient had gone into cardiac arrest - would they please send someone outside to give us a hand. I didn't even wait to see if they heard me. Help arrived soon after.
The woman recovered fully and even thanked us when we left the hospital. She was awake and talking, something that rarely happens with cardiac arrest victims.
The Point of the Story
This woman's ordeal illustrates the unpredictable nature of heart disease. I was pretty sure we had a handle on her chest pain (I wasn't even convinced it was cardiac related). We were chatting about vacations no less.Learning CPR is probably one of the most important things we can all do to protect our loved ones from the worst case scenario. Recognizing the symptoms of a heart attack is also essential in getting the help you need before the worst case scenario happens. I'm not sure how well this woman would have done if she wasn't right in front of an emergency healthcare provider when her heart stopped.
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