I remember the conversation between Al Majkrzak, MD, and myself as we entered mile nine of the Detroit Half Marathon, a lighthearted argument over our college football loyalties. People screamed and cheered from the sidewalks as we curved through the streets of Detroit. In the midst of this discussion, my co-chief resident and I looked toward the edge of the race at a small gathering of people, where someone was clearly in distress.
Explore This IssueACEP Now: Vol 35 – No 05 – May 2016
We came upon a middle-aged gentleman who was down, pale, and unconscious. No pulses to be found. We signaled for someone to call emergency medical services (EMS) and started compressions right there on the road with runners whizzing by left and right. With some additional help, we continued to do round after round of compressions but continually lost pulses after each check. With no meds or supplies and nothing to monitor but a pulse and his mental status, we were a little outside of our usual comfort zone. By the fourth or fifth round of CPR, the patient started to awaken. “It’s either a ventricular rhythm or asystole,” noted Dr. Majkrzak given the man’s loss of pulses after each round.
After approximately 10 minutes but what felt like an eternity, EMS arrived. Sure enough, the pads strapped across his chest showed ventricular fibrillation. I’m fairly used to yelling “clear” and pressing the shock button in front of a large crowd in a resuscitation bay, but doing it on the road with a thousand onlookers was a bit of a surreal experience.
After the shock was delivered, we saw a resulting sinus rhythm on the monitor, with the large ST elevations that were to blame for the patient’s situation. Lights and sirens blaring, EMS promptly took him to the local emergency department. We looked around at each other after the dust had settled. There was no note to sign, no attending to discuss the case with, no ICU to call for admission. It all felt very familiar yet very foreign at the same time.
I learned two things from this experience. The first should almost go without saying, but CPR really works. Although seemingly obvious, experiencing the success of CPR firsthand in someone who has recently collapsed is something to behold. We watched as the patient’s perfusion improved after each round of CPR. By the end, he was stating between each compression, “You’re … hurting … me … ouch … ouch … my … chest … that … hurts,” but would continue to go unresponsive with each pulse check. He would follow simple commands to squeeze our fingers with compressions even while in ventricular fibrillation. If dozens of rounds of what feels like futile CPR in the resuscitation bay have jaded me, then this experience certainly re-demonstrated the importance of high-quality CPR.