Thursday, February 28, 2013

Vital Signs During a Cardiac Arrest Scene

I am writing a scene in which a patient goes into cardiac arrest and eventually flatlines. Can you provide a blow by blow of the vitals? What is a bad BP level and how does that progress from caridac arrest to flatline. For example, it might start BP at 110 over 50 and then go above 180. How might a doctor or a member of the crash team say them (e.g., "BP is 180 over 50. Heart rate is 92 and climbing.") Are there other vital signs to look out for?

Hello, Paco.

It’s A, B, C, D. Airway, Breathing, Circulation, Defibrillation.

In a cardiac arrest, the vitals we’re interested in are: respirations—is the patient breathing or not? Pulse—is there one, and what is the heart rate if there is? Blood pressure—which is only present when there’s a pulse. If your patient has no pulse, no need to check a blood pressure—you can’t get one!

During the cardiac arrest, the rhythm will be asystole (“flatline”—no heart beats) ventricular fibrillation (a jerky irregular rhythm) or ventricular tachycardia (a very fast rhythm that generally produces no effective blood pumping action).

As the code blue starts, the person in charge of the resuscitation will keep their fingers on the pulse—often at the groin. Someone will be doing CPR. If the patient doesn’t have a breathing tube down, someone should be holding a mask over the patient’s face and be pushing air in with a bag—(“bagging the patient”)

For any of the above rhythms, the defibrillator will be tried first, at a charge of 300 joules, to shock the heart into rhythm.

So, you’d have:

“No pulse. Start CPR.” (someone starts CPR)

“Charge to three hundred Joules.” (High-pitched whine as defibrillator charges, beeps when charged)

“Everybody clear.” (everyone steps away from the patient and the bed. The person in charge of the code gets the paddles and places one in the center of the patient’s chest, one on the left). “Clear.” (the shock is delivered). “Rhythm is bradycardia at thirty.” (slow pulse, 30 beats a minutes)

Check to see if there’s a pulse. If yes, try to get a blood pressure. It can be low. For simplicity, consider 90/50. Turn up the IV fluids to expand blood volume. If patient is breathing on his own, transfer to ICU if patient not in ICU. A normal pulse is 60-100. A normal BP is 120/70. Too low is 80’s on the top number.

If the shock isn’t successful:

“Resume CPR.”

Epinephrine will be given IV:

“Give an amp of epi!” (CPR continues while this is happening; wait a few seconds for drug to kick in)

“Charge to three sixty.” (360 joules)

If successful, as above. If not, continue CPR, bagging, and give an amp of bicarb (helps correct pH), an amp of atropine (speeds up heart) and another amp of epi. Another shock.

At some point, the person in charge of the code is going to “call the code,” meaning stop due to no success and little likelihood of succeeding with continued effort.

Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.

Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
Find her fiction at

1 comment:

  1. Hi Kelly, I run simulations for nursing students and we do a code blue every semester. I don't have any emergency experience with adults. You mentioned above that the once a patient regains a pulse the blood pressure MIGHT be 90/50. If the patient comes back in sinus tachycardia wouldn't the blood pressure be higher than that? Or would a patient come back tachy?