Posted on 01/02/2023 6:34:29 PM PST by V_TWIN
usually after a cardiac arrest a patient will be therapeutically cooled to try to preserve neurologic function. This requires lower the body temperature and the patient is left intubated and deeply sedated. this usually lasts about 24 hours then sedation can be lightened. There is usually no definitive assessment of neurologic function for at least 48 hours post arrest although there are good and bad signs you can see earlier. The prone positioning is not usual and makes me wonder if he aspirated or something else happened to his pulmonary function but it sounds as if it was brief and pulmonary function is improving. None of this gives any information about prognosis. His neurologic function will determine that. I have seen people with much longer CPR recover completely but he may have also suffered devastating injury in that time. There is no way to know or guess until they tell us
Thanks! I didn’t consider aspiration. While I think a Vax injury has not been ruled out, sometimes a cigar is just a cigar.
Still a little lost on the anterior position question. Do you mean supine and prone?
In other news it is absolutely standard to imitate mechanical ventilation on AClS. Additionally this was a witnessed field arrest. I would be quite surprised if the patient were not cooled (induced hypothermia) for neuroprotection.
When you ask about what ti do for PE or pericardial pathology this is apples and oranges. ACLS is mean to achieve ROSC (return of spontaneous circulation). ACLS is initiated only in the case of absence of pulse. Pericardial pathology that causes arrest is usually tamponade secondary to rapid accumulating effusion. This is different than the pericarditis associated with vaccines. The literature reports that those pericardial are brief and self limited. They are not effusions but rather inflammation of the pericardium. All cases this far have resolved.
Massive pulmonary embolus as in the case of saddle emboli and tamponade are obstructive shocks. There are four types of shock. Hypovolemic, cardiogenic, distributive and obstructive. Obstructive shock generally gives PEA. Pulseless electrical activity is usually organized rhythm with no cardiac output and this not something you defibrillate. It is not an electrical problem. It is a mechanical problem. The hemodynamic goals of obstructive shock is “full, fast, and tight”. Because cardiac output (the product of stroke volume and heart rate) is rare dependent as stroke volume is fixed the only way to raise output is to increase heart rate. In the normal adult heart there can be increases in stroke volume by increasing contractility (inotropy). Therefore the goal in what you asked about is to maximize preload (volume expansion — bolus IV fluid) and augment after load and rate. The presses that is both chronotropic and vasopressor is epinephrine. Of course the main treatment is fix the obstruction such and thrombolysis with PE or pericardialcentesis for tamponade.
Is mechanical ventilation typical (Recognizing that this report may not be accurately reporting that mechanical ventilation is a modality)?
supine and prone - yes. Awesome explanation. Thanks for the education!
mechanical ventilation is typical through the cooling period for approx 24 hours after arrest as the patient is deeply sedated. Once through that period there are 2 primary reasons he would still be on a ventilator. The first is a pulmonary reason such as aspiration, pulmonary contusion from cpr etc. This may be the case here as he is still requiring 50% O2 last I saw. the second reason would be severe neurologic injury taking out the respiratory center (which generally does not require increased oxygen levels on the vent as it is not a pulmonary problem). The first is survivable the second is not
I am finally catching up for the story. Patient probably was prone ventilated because of ARDS. He would be considered full stomach and when he arrested my guess is he aspirated. Aspiration pneumonia is a horrendous condition. He also could have flash pulmonary edema due to acute congestive heart failure or pulmonary contusion from the hit or cpr. Lots of reasons for airspace disease. If this were PE prone position would be minimally helpful if at all helpful.
Either the NFL is lying or ESPN is lying...or maybe they’re just “mis-remembering”.... about the 5 minute warm-up...
The sin is the coverup, from Professionals at the Highest Level...
https://twitter.com/jeffphowe/status/1610350311088046080
https://twitter.com/bubbaprog/status/1610352295107072000
Thank you for the response and the education! I have a suspicious streak, as you may have gathered. I do not expect that if there has been any thrombolysis that it will become public. Thanks again.
Week 17 Buffalo-Cincinnati game will not be resumed; neutral AFC Championship Game site being considered
NFL Commissioner Roger Goodell informed all clubs of his decision earlier today, after speaking with the Bills, the Bengals and NFL Players Association leadership.
“This has been a very difficult week,” Goodell said. “We continue to focus on the recovery of Damar Hamlin and are encouraged by the improvements in his condition as well as the tremendous outpouring of support and care for Damar and his family from across the country. We are also incredibly appreciative of the amazing work of the medical personnel and commend each and every one of them.”
Among the key factors in arriving at this decision:
Not playing the Buffalo-Cincinnati game to its conclusion will have no effect on which clubs qualify for the postseason. No club would qualify for the postseason and no club will be eliminated based on the outcome of this game.
It would require postponing the start of the playoffs for one week, thereby affecting all 14 clubs that qualify for postseason play.
Making the decision prior to Week 18 is consistent with our competitive principles and enables all clubs to know the playoff possibilities prior to playing the final weekend of regular season games.
Cancelling the game between the Bills and Bengals creates potential competitive inequities in certain playoff scenarios. In an effort to mitigate those inequities, NFL clubs will consider tomorrow in a Special League Meeting a resolution recommended by the Commissioner and approved today by the Competition Committee, consisting of two elements:
1 - The AFC Championship Game will be played at a neutral site if the participating teams played an unequal number of games and both could have been the number one seed and hosted the game had all AFC clubs played a full 17-game regular season. Those circumstances involve Buffalo or Cincinnati qualifying for the game as a road team and are listed below:
Scenario 1
Buffalo and Kansas City both win or both tie – a Buffalo vs Kansas City championship game would be at a neutral site.
Scenario 2
Buffalo and Kansas City both lose and Baltimore wins or ties – a Buffalo vs Kansas City championship game would be at a neutral site.
Scenario 3
Buffalo and Kansas City both lose and Cincinnati wins – a Buffalo or Cincinnati vs Kansas City championship game would be at a neutral site.
2 - If Baltimore defeats Cincinnati in Week 18 it will have defeated Cincinnati, a divisional opponent, twice but will not be able to host a playoff game because Cincinnati will have a higher winning percentage for a 16-game schedule than Baltimore will for a 17-game schedule.
If Baltimore defeats Cincinnati and if those two clubs are schedule to play a Wild Card game against one another, the site for that game would be determined by a coin toss. If Cincinnati wins the Week 18 game or if Baltimore and Cincinnati are not scheduled to play one another in the Wild Card round, the game sites would be determined by the regular scheduling procedures.
“As we considered the football schedule, our principles have been to limit disruption across the league and minimize competitive inequities,” Goodell said. “I recognize that there is no perfect solution. The proposal we are asking the ownership to consider, however, addresses the most significant potential equitable issues created by the difficult, but necessary, decision not to play the game under these extraordinary circumstances.”
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