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Yesterday I saw a cardiac arrest. In fact, two cardiac arrests, in the same person.
The person was an obese woman around the age of 60.
I only came in at the very end of the surgery, but from what I could gather as I entered the OR the patient had had blocked arteries in her legs, and was having surgery to clear up the blockage (i.e. recanalization of femoral popliteal bypass).
The surgeon had just finished the surgery. It looked like a success. She was perfectly stable. The anesthesiologist was beginning to wake her up (e.g. putting in a reversal agent).
Suddenly, she went into cardiac arrest. Someone hit to call for help - code blue, resus team needed stat! The alarms in the OR went off and the lights at the entrance of the OR began flashing so people could see which OR needed assistance (since hospitals have hallways full of ORs).
At the time, near the end of surgery when I walked in, there were only a handful of people in the OR. Maybe 5 or 6 people. In a matter of seconds, there were about 20-25 people. (A senior anesthesiology resident later told me there didn't need to be so many people in the OR.)
A medical resident jumped on her chest and immediately began chest compressions (CPR), while the head anesthesiologist began barking out orders to get more IV access into the patient, fill up syringes with various drugs so he could push the meds, etc. It was all quite chaotic, but from what I could tell everyone was doing their jobs well enough.
They were able to get a heart rate, blood pressure, and so forth again. Everything looked fine. The patient was somewhat conscious again. She was waking up, breathing, but was doubtless exhausted, to say the least.
After several more minutes, when it looked like she was stable and medical staff were no longer needed, well over half the staff began going about their business again.
At this point, there were maybe 10 people in the room including me. While I was talking to a friend about all that just happened, we looked over at the anesthesia machine and noticed the patient's BP begin dropping precipitously. I think it started at 80/50, but then it dropped to 70 (systolic, i.e. the top number), then 50, then 20, then it actually read negative somehow on the machine, all within a matter of seconds.
Of course, the anesthesiologist and other staff noticed as well, and they began CPR again. Another mad rush to save the patient's life.
While the doctors and nurses were rescuing her, my friend and I noticed her left ear had gone dark blue and purple. It was cyanosed. Not enough blood perfusion, not enough oxygen circulating. Bad news.
Eventually the medical staff were able to resuscitate her once again. They got her ready to be transported to the cath lab, where they'd have a better chance to figure out what happened to her as well as to fix it (e.g. the leading theory seemed to be a rogue blood clot). They attached equipment to monitor her vital signs, made sure she had a defibrillator on her bed in case she went into cardiac arrest en route from the OR to the cath lab, bag valve mask ventilated her so she would be oxygenated, etc.
I still don't know what happened to her. Hopefully I'll find out next week when I return.
As for what directly necessitated the code, I thought she had gone into VF (ventricular fibrillation, which is a type of erratic beating of her heart). However, another staff member told me he thought she had in fact gone into asystole (which means flatlined and no heart activity).
Either way, one thing was for sure: she was teetering on the brink between life and death.
As a med student, I don't know much in any case, and thus I wouldn't have been allowed to do anything, but I wish I could have done something to help. Still, it was medically instructive for me to watch.
As I watched, though, I wasn't actually thinking about medicine. Instead, the overriding thought I had in my mind was how close she was to crossing over from life into death, and hence into either heaven or hell. One second she was perfectly stable and ready to emerge from her sleep, and then in a flash everything changed and she could have died on the operating table. She may have in fact died in the cath lab for all I know. How near to eternity we are, and usually without even realizing it.
As John Wesley once said to his brother Charles Wesley: "I desire to have both heaven and hell ever in my eye, while I stand on this isthmus of life, between two boundless oceans."
