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1/24/2013 Josh Cooke RN, CEN, CFRN, NREMT-P, CCEMT-P, PNCCT-P, A.A.S. Wings Air Rescue Clinical Nurse Educator On December 28, 2012 at 15:43 Wings 1 was requested to launch to a tertiary care facility in North Carolina in reference to a 58 y.o. male diagnosed with an Anteroseptal MI. Patient was to be taken straight to the JCMC Cath Lab. Wings 1 arrives at 16:01 and initial patient contact was made at 16:05 Found a 58 year old male lying semi-fowlers on the ER stretcher, CAO x 4 c/o retrosternal Chest Pain ( 3 of 10) and Nausea. Patient reports that onset of pain was at 15:00 just after eating lunch. Patient’s pain radiated into his left shoulder and he was extremely diaphoretic upon EMS arrival. Pre-hospital interventions include 02 via N/C, 12 Lead, IV, NTG SL x 3, and 324 mg Baby ASA PO. 1 1/24/2013 Past Medical History Surgical History Previous MI in 2010 with stent placement in LAD Testicular CA PCI Appendectomy Cholecystectomy Testicular Surgery Social History ETOH everyday Smokes 1 pack /day Family History Allergies N/A PCN Current Medications ASA Celexa Coreg Flomax Klonopin Losartan Pravastatin 2 1/24/2013 EKG BMP CBC Cardiac Markers Additional IV access CXR NTG Drip Morphine 2 mg IV q 5 minutes prn Heparin bolus 4000 units then 1000 units / hr Zofran Despite interventions, patients pain level remains (3 of 10) At 16:22 the flight team departed the ER with the patient in preparation for take off While patient was being loaded onto aircraft, he experienced SCA with V-Fib noted on the monitor A precordial thump was performed and an immediate defibrillation was administered at 200 J biphasic CPR was initiated immediately and with BVM / OPA ventilations at 8-10 breaths per minute Patient was taken back into ER for further resuscitation efforts ACLS Protocol Followed both V-Fib and PEA Multiple Epinephrine 1:10,000 1 mg IV Vasopressin 40 units IV ETI 8.0 ETT on first attempt by flight crew with Capnography monitored throughout resuscitation Amiodarone 300 mg IV followed by 150 mg Lidocaine 1mg / kg H & T’s (Sodium Bicarbonate) After approx. 45 minutes of resuscitative efforts and after ER physician had already spoken with family about ceasing efforts, ROSC was obtained. First evidence was ETCO2 increase to 63! 3 1/24/2013 ETCO2 and SP02 maintained WNL Therapeutic Hypothermia initiated Norepinephrine Drip titrated to maintain Systolic BP / MAP / Maintain CPP and End Organ Perfusion Placed on LTV-1200 Ventilator NTG drip d/c at onset of arrest and remained d/c because of hypotension Patient loaded onto aircraft and flown to JCMC at 17:41 4 1/24/2013 Patient was delivered to JCMC Cath Lab at 18:06 where he underwent PCI / IABP 100% blockage of LAD After undergoing 2-3 days of Therapeutic Hypothermia (32-34 degrees Celsius) patient was rewarmed 2 weeks Post Arrest discharged home and currently undergoing Cardiac Rehab at a local hospital near his residence in NC!!! Experiences periods of confusion, otherwise fully cognitive with no neuro deficits In my opinion this was a true miracle of God A call that will stick with me for a lifetime Proves that with teamwork, proper communication, and appropriate interventions anything is possible! 5
