Emergency Medicine News:
Letter to the Editor
I enjoyed Dr. Christine Butts' article in Emergency Medicine News. (“Ultrasound Predicts Cardiac Arrest Survival,” EMN 2017;39:18; http://bit.ly/2j4nczh.)
In addition to allowing bedside docs to determine which patient could potentially be resuscitated and if they should continue efforts, the use of ultrasound in cardiac arrest also allows for the inverse: Efforts should be continued if the heart has contractility, even if there is no palpable blood pressure.
Back in the Jurassic days of emergency department ultrasound, Sharon Croom Amaya, MD, and I wrote what we thought was one of the first published uses of cardiac ultrasound in EM during CPR to determine if continued efforts would be productive. (Ann Emerg Med 1999;33:344.) A 72-year-old patient had no obtainable blood pressure and no pulse despite continued efforts. We placed our “trauma” probe over the heart and saw that it was fibrillating. Switching from asystole to ventricular fibrillation protocol, we shocked the patient into an organized rhythm with obtainable blood pressures.
We've come a long way since those days.
Andrew Langsam, MD
Santa Fe, NM