History of Present Illness:
Upon arrival the patient was laying on the walkway to the beach. FD stated that she was AAOx3. Her husband stated that she had a brief loss of consciousness. The patient denied any pain, but felt weak and short of breath. During transport the Zoll pacemaker was not functioning, it read “poor pad contact”. A new set of pads was tried without success. The patient’s perfusion status was rapidly declining, and we became unable to obtain a BP. Her ventricular rate slowed to about 10 BPM, and Epinephrine was given. The Epinephrine brought the HR up, Dopamine was then started. With the 3rd set of pacer pads the pacemaker began to get capture. The Dopamine was stopped after 1min. of administration. The patient’s perfusion status improved. Versed was administered for conscious sedation. Verbal report was given to the ER physician and care was transferred.
This was a call that I ran. The epi was a quick decision and luckily, it worked for as long as I needed it to. This wasn’t the most perfect scenario, but I improvised, adapted, and overcame the situation. Top ECG in first image shows initial rhythm, complete heart block. This is why Atropine wasn’t considered. Since Atropine Sulfate works on the vagus nerve, and the nerve is located in the atria, AV disassociation would impair the function of the med.
As you can see, the second strip, bottom of first image, and third strip on the top of second image are both post-epinephrine. Finally, the pacemaker was fixed and electrical capture is shown in the final strip. The patient’s pulse reflected full capture.
I would be happy never running a call like this again!
Just want to make it clear that this is not our protocol, and is not in any way endorsed by AHA. Read RM’s comment on administering Epinephrine to a cardiac patient. It is dangerous and was not something I wanted to do. At the moment, I felt the patient was going to code faster than I would have managed an infusion. Had I planned better and conquered the pacer problem faster, this could have been avoided.