can't defibrilate while flatlining
defibrilation stops the heart when it is in a rhythm where it isn't beating properly, such as vf. If you are flatlining, as in this film, the heart is already stopped. Therefore defibrilation is pointless.
sharewait, what? That sound wrong to me. Granted, I'm NOT a doctor or anyone with medical training (beyond being CPR certified for decades now), but I used to work in a hospital where all the staff took turns working on the "code team" who responds when someone's heart stops beating--we would bring in the crash cart and do a defib on the patient. The way the doctors trained me for this was to tell me that I would only be called to do a defib on someone once their heart has stopped beating--i.e. they are dead--so I couldn't make matters any worse for them, only better. If they had a heart beat of any kind, even irregular, the non-medical members of the code team would stay out of the way and let the medical staff intervene. My role (if I was the closest person to the location of the patient) was simply to run in with the defib, take a pulse, and then use the defib machine if the person had no pulse.
Every time I get CPR certified the instructors always say that doing CPR on a person with no pulse is very unlikely to restart their heart just from chest compressions, but if I can get my hands on a defib machine, we have a decent chance of restarting a heart if we can use it pretty soon after their heart stops beating. They say that the addition of the portable defib machines in gyms and public buildings has significantly increased survival rates.
I would love to know more about this. Do you have medical training? If not, can someone with medical training explain this to me?
BTW, I know they sometimes use a defib to shock the heart back into regular rhythm--I have a friend who periodically has tachycardia (extremely fast heart rate) and on more than one occasion she has had to go in and have them do defib on her to shock her heart back into normal rhythm. But that's not all that machine is for, as I understand it. It also works (sometimes) on people whose hearts have stopped. Doesn't it???
First, let me say, I used to be a staff nurse. I did some work on coronary care.
When your heart goes into ventricular fibrillation, it basically shakes and trembles like a jelly. You will not, though, have a pulse in the wrist or neck to feel, as the heart isn't really beating properly. The monitor won't show a flat-line though. What it does show, is a very wobbly line. Because the heart is only 'trembling' it isn't pumping blood sufficiently around your body to oxygenate you.
The de-fibrillator, when they put the paddles on the chest and shout CHARGE 250!! is stopping the heart (that is in its trembling state, or VF, aka ventricular fibrillation) for a split second in the hope that it will restart back again in a normal, or sinus rhythm.
Now, when there is a flat-line, or asystole, the heart has stopped completely. Again, there is no palpable pulse, but this time the heart isn't trembling, it has stopped completely. To shock when the heart has stopped is pointless, as the shock would be stopping a stopped heart.
Some people have little defibrillators in their chest for when their heart goes into that very fast rhythm, and it will automatically shock them to get them back to sinus rhythm. Pacemakers do a slightly different job.
I understand it is all very dramatic, but it is completely inaccurate.
If you have any more questions, feel free to ask and I'll do my best to answer.
Interesting! Thank you for taking the time to educate me...even though I was working in a hospital at the time, I was trained to take the pulse manually (at the carotid) in the event of an emergency--and I suppose if someone is in v-fib, it would feel the same to me as if they were in flatline when I take their pulse at the neck...? That would explain a lot.
I have a further question if you don't mind. Is it fairly common for a person to start out in v-fib (rather than flatlining) when they have a heart attack or other kind of cardiac emergency? I'm just wondering why the CPR instructors make such a big deal about the positive impact portable d-fib machines being readily available has had on survival rates from heart attacks. Maybe it's more common for a person's heart to struggle/quiver for a while before giving up the ghost entirely...? That would certainly make sense to me, but as you know, I have very limited knowledge in this area. Is there anything that CAN be done once someone flatlines, or is it all over for them once they reach that point? Is medication any use at that point? I'm thinking of that vivid scene from Pulp Fiction, with the injection straight into the heart...or any other intervention?
There was one incident while I was working at that hospital, where a man walked in off the street and asked to be admitted because he wasn't feeling right. My immediate impression was that he was coming down from a pretty big bender (my guess was that he had been using meth continuously for quite a while). He talked to us for a minute or two, and then suddenly he went rigid, his eyes changed somehow (hard to describe how, but they suddenly looked dark or blank), threw out his arms to either side, and fell straight backwards, landing flat on his back, unconscious. It was my day to be on the code team so the nurse I was standing next to went to take his pulse (no pulse) while I ran for the code cart. As soon as she checked his pulse, the nurse called out to me "we can go ahead and do the code for practice, but we won't be getting him back. He was dead before he hit the ground." I thought she was crazy because he had been walking and talking just seconds before!
Sadly, she was right. In spite of the fact that we did DF within a minute or two of the event, we never saw any signs of life. The doctors did everything THEY could do, too (of course), but...nothing. When the code team debriefed about it later, the nurse explained to me that she knew he was dead immediately because he had fallen straight backwards and did not try to bend at the waist or take a step backwards to try to prevent himself from hitting his head on the ground. She said it was a hard-wired reflex in humans to bend at the waist when falling backwards to protect our brains from death by impact (and that we do it even when we are unconscious as long as we have brain stem activity going on), and when he made no effort to prevent that, she knew he was already gone. Now that I think about it, maybe he went straight into flatline rather than starting out in v-fib? And maybe the nurse knew there was no way to get someone out of flatline...?? Would she have been able to tell he had flatlined using a stethoscope instead of checking the pulse manually? I don't recall if she used a stethoscope but that would make more sense.
Obviously I still think about this incident often, even though it's been 24 years since it happened. That was the first and only time I've witnessed a human death at close range. Hope I never see it again. I've got tremendous respect for nurses and doctors who deal with this kind of thing regularly.