V-Fib Arrest

Kandahar, Afghanistan


Part of the ICU Staff here at ROLE-3 - Good Friday

                                                                                                           We do other things at our hospital besides trauma.  That's a good thing for all parties.

Two days ago, during a relatively quiet morning, one of our ISAF (International Security Assistance Force) allies rolled into the trauma bay, pale and death-like, with a breathing tube in his mouth and a medic forcing air into his lungs with a bag-valve mask.  He was witnessed to have passed out, CPR was begun, and a defibrillator was hooked up - this all at his barracks, thanks to some quick-witted mates of his.  He was in ventricular fibrillation, "V-fib" in medical parlance, which means his heart was quivering as opposed to pumping blood.  Seconds are precious in this situation - you need to pump the heart using chest compressions, then shock the heart out of V-fib as soon as it is seen on the defibrillator monitor.  A brain deprived of oxygenated blood produces an "anoxic" injury which can lead to brain death, vegetative states, or other unpleasant outcomes.  We think he was lucky as chest compressions were begun immediately and he was shocked within a few short minutes.

We attacked the patient with urgency.  Central lines and arterial lines were placed within minutes while we had a runner get the necessary medications.  His ECG showed what we anticipated - a myocardial infarction - a "heart attack."  Within a few minutes we had fibrinolytic drugs coursing through his system - what we call "clot busters."  His blood pressure returned to a more normal level but we kept him on the breathing machine as we began cooling his body, as is indicated in these situations.  Patients tend to have better neurologic outcomes if you cool them to hypothermic levels for at least 24 hours.

A medical save, as opposed to a trauma save.  It was very satisfying to be a part of this one.  Our patient was flown by our ISAF colleagues to a higher echelon of care the next morning.  It would be nice to run into him one day.