It was the long stretch of dark, cold days toward the end of January when the Christmas lights are packed away and most of us have already watched our New Year’s resolutions shatter into a million little pieces. I was working my night shift as an ER technician when our unit coordinator received notice we were receiving a working cardiac arrest secondary to suspected opioid overdose. Neither pulses nor breathing had returned in the field and IV Narcan had already been administered. The patient had been found unconscious in a snowbank on the side of the street in her neighborhood with a needle sticking out of her arm. With little optimism among our crew, we began to set up our resuscitation room for the arriving patient.
Pulling her over from the EMS stretcher, we immediately noticed how cold and wet she was. A light jacket which was barely long enough to cover her midriff served as her only insulation against the snow. A lump of paper-white skin, bluish-gray fingers, and terribly chipped red nail polish lay lifeless on our stretcher as we continued resuscitation efforts.
I stood by, observing the scene and acting as a “go-for”, prepared to fetch any equipment or supplies that were needed, as well as waiting for my turn to perform chest compressions. I had a perfect view of the patient at the moment that she came back to life. Sort of. Her head lifted and her eyes shot open. Her arms reached for the endotracheal tube which was placed down her throat for ventilation. Our ER crew immediately stopped CPR and held her arms in place so the patient couldn’t pull on any tubes or wires. Observing the ECG monitor, our physician placed the ultrasound over the patient’s heart. She watched for a few moments, perplexed, and requested a femoral pulse check. Two nurses in unison responded “nothing.”
I’ve seen a lot of interesting and amazing things working in the emergency medical environment, but what I watched next shocked me. The doctor removed the ultrasound probe and ordered our crew, “Resume CPR.”
Our techs and nurses were a bit taken back. “She’s awake…,” someone replied.
“She’s pulseless,” our doctor said. “Resume CPR.”
Reluctantly and with plenty of confused eye contact among our team which spoke much louder than words, CPR continued and the patient was physically restrained to avoid self-injury. We ended up sedating the patient with medications while we continued compressions. Eventually, the patient’s heart began to beat on its own, faintly but independently.
This was a case we still scratch our heads about to this day. The patient made her way to the ICU, required a Narcan drip to maintain her respiratory status, and eventually did succumb to the stress on her body and passed away. Neuro did not believe she would have resumed normal brain function even if she did come around from a cardiopulmonary perspective. The real question is how the patient could exhibit such activity and strength while pulseless and unresponsive! We undoubtedly believe the combination of hypothermia and opiate-induced coma was the culprit, yet not a soul in the ER that night had ever witnessed anything like this. We all learned, regardless of our experience, that we should always expect the unexpected.