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View Full Version : Cardiac arrest presenting w/no pulse, but normal sinus rhythm



crunchyblanket
03-20-2013, 12:35 AM
I really should know this as I've done Basic Life Support courses in which the examiner has gone into some depth about sinus rhythm, etc, but....is it possible for a cardiac arrest patient to have no pulse, but for the sinus rhythm to appear normal?

The situation I'm trying to set up is this: an A&E nurse receives what seems to be a normal cardiac arrest patient, but it turns out that there's a curse on the patient which causes his heart to literally disappear. What I need is some kind of glaring sign that this is not a typical cardiac arrest - something which would look almost like an 'X-File' of sorts.

Anyone know more about cardiology/emergency medicine than I do?

- Crunchy, more used to ENT than A&E

asroc
03-20-2013, 12:46 AM
There's PEA (pulseless electrical activity) where there's a detectable rhythm on the EKG but no pulse. PEA can look like a normal sinus rhythm.

c.e.lawson
03-20-2013, 01:13 AM
Hmmm. The EKG monitor, or telemetry monitor, picks up electrical signals from the heart, so if the heart "literally" disappeared, then I don't see how there could be a rhythm on the monitor. Or a pulse. Unless the heart is still there, but only invisible?

crunchyblanket
03-20-2013, 01:42 AM
Hmmm. The EKG monitor, or telemetry monitor, picks up electrical signals from the heart, so if the heart "literally" disappeared, then I don't see how there could be a rhythm on the monitor. Or a pulse. Unless the heart is still there, but only invisible?

The idea I had was that the heart has disappeared, but the curse 'fakes' the electrical activity. I wanted there to be something unusual about there being electrical activity to prompt them to look into the case in more detail.

Of course, since it is actually possible (duh, forgot about PEA) I might have to go with something else here...

c.e.lawson
03-20-2013, 02:41 AM
Is your patient going to live or die? It sounds like he will die and die soon, if there really is no heart. So they probably won't get a chest x-ray in time to see the absence of a heart. Of course, if it's like the T.V. show ER, then they'll crack his chest open right in the ER and try to do direct cardiac massage. :) Then they'll REALLY find out he doesn't have a heart. I don't know the actual frequency of opening the chest in the ER vs the operating room. Good luck with your plotting.

crunchyblanket
03-20-2013, 02:59 AM
Oh no, he's dead as a doornail :) They don't find out about the disappeared heart 'til the autopsy (theoretically, anyway)

asroc
03-20-2013, 03:02 AM
If I remember my ER internships correctly a cardiac echo is a common (standard?) procedure in a case like this, to check if there is a reversible cause. That's a quick and noninvasive bedside test, so they ought to notice a missing heart long before any surgery.

crunchyblanket
03-20-2013, 03:06 AM
If I remember my ER internships correctly a cardiac echo is a common (standard?) procedure in a case like this, to check if there is a reversible cause. That's a quick and noninvasive bedside test, so they ought to notice a missing heart long before any surgery.

Aha, that would actually work really well. Is an echo commonly utilised in most cardiac arrest scenarios, or just unusual ones (such as this?)

asroc
03-20-2013, 03:25 AM
Aha, that would actually work really well. Is an echo commonly utilised in most cardiac arrest scenarios, or just unusual ones (such as this?)

That's somewhat outside of my area of expertise (I only bring 'em in) so don't quote me on this, but I think it's mainly used if the cause of the arrest isn't known/obvious.

ebbrown
03-20-2013, 04:37 AM
PEA can look like sinus in the absence of a pulse as the previous poster mentioned. When we have coded patients for extended lengths of time and have given multiple doses of Epi, the heart can also do a spasm thing where it is not beating on its own but is throwing a rhythm out. At times like that we do pull out the bedside ultrasound to see if the heart is truly beating. However that is in a Level 1 trauma center. At most hospitals without those resources you would not see the bedside ultrasound, in my experience anyway. Hth ;)