You're in the bay. Once you get over to the bed,
we'll give you the story. Everything's going
to happen super fast. Welcome to the emergency
room. Okay, hey guys At the beginning of this
podcast all the way close to like episode one
maybe episode Whatever I came out and said whenever
I have like weird cases that come into the ER
that I'll be able to share them or would be willing
to share them and This is one of those particular
instances so It was my last shift at work the
one that I just worked not like the last one
as a terminal one but the last one as in like
one before a few days off. I was running some
labs to the lab and then when I get back I see
one of the trauma residents like hauling ass
from the trauma from the trauma side of the hospital.
uh toward the medicine side and when he gets
to the medicine side he makes like a hard left
and Then I was like there right there seems like
that's something that I would want to be part
of So I like walk real fast too because you never
run in the ER So if you are new nurse and you
don't know anything Or you're wanting to get
into the ER and you're new to it You never run
in the ER like never don't ever ever ever run
Is a cardinal sin and you just don't do it. So
I walk real real fast, right? I'm walking real
real fast and He goes into room 36 now room 36
is one of our big rooms and it is one of our
like real big critical rooms we have like Two
real big critical rooms in our emergency department
on the medicine side room 41 because as you're
coming down The EMS hallway from where the ambulance
bay is at it literally dead ends right into the
room right into the room so they can really like
someone could be on the Lucas device and literally
just haul ass all the way to the room and be
in a big room a big critical room without having
to make a single turn and then room 36 literally
sits right beside the CT scanner and that particular
room. Also holds a bunch of stuff and so you
can literally come out of CT You can have like
a bad some bad news on your CT got a bleed you
got something going on and so you literally just
wheel right next door to the to their to the
critical room and so we get into 36 and they're
doing compressions on this dude and He is actively
fighting The tech that is giving him compressions
like his legs are kicking up in the in the air
he's bringing his knees up trying to knee her
and the attending the ER attending and he's actively
fighting the resident that is trying to intubate
and gain an airway along with the respiratory
therapist now. I walk in and I'm like, yeah,
what the hell is going on? You know, stop compressions
homeboys like he's alive. He's awake. You know,
you're doing compression on someone who's awake.
That's going to hurt like hell. And so no sooner
than I said that, they called for a pulse check.
And so when they called for the pulse check homeboys
stopped moving altogether. He quit breathing.
He quit moving. He quit fighting. And then on
the monitor was a systole. Or if you're from
a weird part of the world that calls it a system,
I don't know who you are, but it's kind of weird
than a system, but I'm calling it a system. So
the monitor read a system and I was like, what
the hell, you know? And so they were doing their
pulse check, you know, they were doing ultrasound
for cardiac activity. So on the monitor was guess
what? Cardiac standstill. And and so we resumed
compressions. It was a witnessed arrest. So under
any other under any other circumstances, he would
have been a candidate for ECMO. If you don't
know what ECMO is, it's a really, really neat
thing where they have a machine that kind of
breathes for you like literally almost like a
dialysis machine, but it will pull the blood
out, oxygenate it and give it right back to you
without. you needing your lungs. And there's
a hospital here in the Houston area that specializes
in lung transplants or not just long organ transplants
like a transplantation hospital. And they do
ECMO all the time. And so like those people are
very familiar with ECMO, but down in the dirty
ER, you know, because these ECMO these ECMO people
love to tell us how dirty the ER is. and we're
like we know it's the ER and they do the ECMO
anyways so he was under any other normal circumstances
he would be considered a candidate for ECMO but
he ingested some sort of toxic chemical to get
high off of we don't know what it was or at least
I don't know what it is because I never stayed
around long enough to figure out what it was
that he took But it was definitely chemical induced.
And they said that they found some psychedelic
gummies in his pocket. So he might have just
taken an assload of those and put them in this
wonky state now. Back to the story is after the
pulse check was done. Another tech hopped on
the chest and started doing chest compressions
and homeboys started fighting her again. You
know, he brought his legs up, trying to knee
her, fighting the bag mask, trying to take his
hands and rip her off his chest, you know, by
stopping the compressions, everything of the
matter. So I was like, this is like weird as
hell, you know. And the pulse check came two
minutes later and he actually had some cardiac
activity on the monitor this time, but it was
not a shockable rhythm. And so they called for
a round of Epi and another round of CPR and then
this time I got on the chest and As I am doing
compressions on this dude, um, and I'm a pretty
good sized fella Um as I've been told I like
I know my way around the gym and I know a way
my round I know my way around a buffet table
and I like a chicken nugget or two, you know
and so I'm doing chest compressions on this dude,
and he sets up 90 degrees sets up. I don't know
how I don't know what the fuck possessed him
to sit all the way up. But homeboy was sitting
all the way up. The respiratory therapist tried
to grab him and yank him down. The intubation
failed because every time we do compressions,
homeboy wakes up. So I'm kind of like doing these
kind of calf ass compressions. like you're trying
to do compressions against a wall but you are
not facing the wall you are kind of perpendicular
to the wall and so as soon as he stood like as
soon as he sat up as soon as he sat up and the
profusion to him stopped he like passed out again
on the bed you know we resume CPR again and he
came back to life actively fighting, fighting
me, fighting the emergency physician, fighting
the respiratory therapist, moving his head left
and right to not get bagged. And and it was just
a weird ass situation. And so I say during the
CPR, I'm like, this is the weirdest fucking code
I've ever been in. And sure as shit, like the
the emergency physician called for a pulse check,
or it was actually time for a pulse check, not
the physician calling for it, but the it was
time for a pulse check. And so the ER physician
literally with his hand on the femoral without
a active pulse, and no activity on the cardiac
monitor said, as we all are aware, this is a
very interesting case. And I don't know if he
was being facetious about my comment about this
being the weirdest fucking code I've ever been
in or what, but that's what he said. And so a
long story short, man, the guy did not make it,
but we were able to knock them down with some
ketamine and rock. They were going to go with
a tommy date, but they changed it to ketamine.
And so we hit him with a hundred megs or his
ketamine Mike's or Meg's I think his mix I think
his big so either way we hit him with a hundred
of some it was either Mike's Academy and our
Meg's Academy And we hit him with a hundred of
it And then we hit him with the with the rock
and then we were able to intubate him but I will
say man like After we gave him the ketamine and
after we gave him the rock Usually well like
when I'm in trauma, you know, and we give a tomodate
and ketamine But a tomodate and rock usually
like that knocks and knocks them down pretty
good pretty fast, right? and they don't move
or whatever but this particular instance we hit
him with a hundred of ketamine and then the rock
I think it was like a Don't let me get you wrong
on the rock. I think it was like 100 maybe a
hundred and a hundred. I'm not sure But we hit
him with the with the rock and. And he was it
took him a while, so it took him about a good
30 seconds for the drugs to take hold and kind
of pull him down. And then we started working
on them and then we weren't like we didn't have
an issue with him fighting us then. But he. He
he didn't make it and. Yeah, man, like I was
just one of the weirdest cases that I think I've
ever been a part of, especially like kind of
like during a code. And for you guys that are
interested in knowing what this shit is called,
because it is legitimately a thing, apparently,
it is called cardio pulmonary resuscitation induced
consciousness, or CPR, I see, see prick, right?
So it is a legitimate thing. I did not know it
was a thing But apparently it only happens less
than 1 % of the time So out of a thousand cases
that you or a thousand CPRs that you're a part
of only one Maybe not even one you will see So
just put that in kind of perspective on how rare
this is It was definitely something new to me.
He was a young guy too. He was like in his 30s,
40s. So whatever he ingested, he ingested enough
to kill him because we weren't able to get an
organized rhythm back. We were able to deliver
one shock and that was all we were able to get.
There were no other rhythms for that. The follow
up with the ECMO stuff. He was not a candidate
for ECMO because of the the toxication that he
was under or the ingestion of that toxic substance.
So he wasn't a candidate for ECMO. And the cardiologist
didn't have anything else to add. The ER team
didn't have anything else to add. The only thing
that I was going to suggest if we were to get
another cardiac rhythm that was shockable was
DSS or double shock sequencing. If you're not
familiar with what that is, I'm not sure how
prevalent it is, but apparently it yields about
32 % greater results, greater outcomes than just
a single shock sequence. And there's no there's
no benefit for a triple shock sequence so my
understanding of DSS or double shock sequencing
is that you will have two defibrillators at the
bedside and you charge them up to the same the
same voltage right so for our case it was like
two sixty two something we'll just say 360 because
that's a good even high number so we charge them
up to 360. And and what you would do is you have
two pads, you have the pads placed, you know,
at the same spot, just kind of beside each other.
And then you will deliver a shock, one shock,
and then immediately after you hit the button
on one defibrillator, you hit the button on the
other defibrillator. And so it delivers like
almost two simultaneous shocks. that are really
close together. And apparently, according to
the AHA, the double shock sequence will yield
you a 32 % greater chance of good outcomes or
better outcomes. Now, how prevalent that is,
I don't know. But that right there is something
to kind of keep in your back pocket. You have
this new idea of double shock sequence or double
shock sequencing. Now, Surprisingly, I did not
learn about DSS or double shock sequencing in
nursing school or in TNCC or ACLS or PALS or
any other formal formal education. I actually
learned it from you guys heard me talk about
this company before this compendium company.
It is a company out of Germany and they make
pocket guides. That are a legitimate pocket size
they're not like a pocket drug guide that is
a thousand pages thick but it just happens to
be you know, like a four by eight size No, they're
like legitimate pocket size. They're about four
four by eight Four by eight and they have like
two three hundred pages in them or maybe even
just a hundred pages Like I have the OB one rub
beside me right now And it's one of the thicker
ones that they've come out with, and it has 350
pages. And it's about like an inch and a half
thick. So it's a very, very compact size. But
yeah, this company, Compendium, I was reading
through the cardiology Compendium pocket guide,
and I ran across DSS, the double shock sequencing.
And I thought that shit was weird. I was like,
I never heard of such. So I got on the Google
like everyone else does. And I did a Google search
on the interwebs and I found out that a that
double shock sequencing is a legitimate thing.
And B, it is highly effective. Now, some other
weird shit that they have in the companion guide
is like five percent saline. Like if you thought
three percent was a lot. There's five in ten
now. What the hell are you ever going to do with
ten percent saline? I have no fucking idea or
even five percent, you know because we hardly
ever use three percent You know, we're closer
to using man at all than using three percent
saline And I'm just assuming because of the rapid
fluid shifts that you're gonna get with that
because like that right there is ridiculous But
can you imagine like five percent or ten percent?
I guess going to be like pushing like Coconut
oil to the IV like it has to be like thick thick
thick But either way ma 'am That right there
is just like the weirdest like the weird case
of that I have as of recent Not all of my stories
are trauma. I do work in medicine actually quite
a bit more so than I do in trauma, but but I
do like to share the weird stories that I get.
I do see a lot because I'm at the busiest level
one trauma center in the United States, according
to Google. And we are like a 1300 bed hospital.
And the ER might like the ER work and can easily
hold Easily like 160 patients, you know 60 There's
like 60 beds and then you have a hallway For
each that brings you up to 120 and then some
of those Some of those hallways can be extended
out two three fourfold So easily like 160 patients
and the ER alone Um, and then, um, you know,
it just opens a door for some weird shit to kind
of come in the door. And so that right there
was like the weirdest case that I have as a recent,
uh, this, uh, CPR induced consciousness or C
prick. Um, so it's a thing. Um, don't stop your
compressions for some boy down and keep the per
compressions going. because yeah he's not like
he might look awake he might seem awake but he
is not awake so keep doing your thing alright
guys that right there is the weirdest that was
like the weirdest case that I have as of recent
keep on listening to the learning material and
as weird shit keeps as weird shit keeps popping
up at the ER I'll be letting you guys know alright
peace out