Heart Attacks?

[The Bloated One]

Hi everyone,

I need to show a boy of fifteen going into cardiac arrest through dialogue. Anyone know what the routine is e.g. what chemicals are administered and does the heart rate and pressure plummet?

Any suggestions welcome.

TBO

 

[Karn Maeshalanadae]

Well, usually there's the mobile defibrillator unit, sometimes they will try to administer adrenaline. Beyond that, I don't really know, not at the age you mentioned. For the elderly who are suffering a blocked artery heart attack they would probably also administer beta blockers and nitroglycerin, as well as an aspirin regiment after the emergency has passed. But youth heart attacks are often caused by underlaying problems of the heart in, ironically, those who are usually very active and athletic. They push their strained heart too far and go down.

 

[The Bloated One]

Karn,

Excellent, thanks, it gives me something to work with, especially knowing the likely chemicals.

TBO

 

[Karn Maeshalanadae]

It's not much help, but it was what I was able to give. As I said, I doubt they'd bring out anything to help clear arteries for a youth heart attack.

 

[j d worthington]

B.O.: You might take a look at some of these:

http://search.yahoo.com/search;_ylt...ttacks&toggle=1&cop=mss&ei=UTF-8&fr=yfp-t-701

 

[The Bloated One]

Thanks, JD.

TBO

 

[alchemist]

I need to show a boy of fifteen going into cardiac arrest through dialogue.

Dialogue? Is it a Harry Potter spell - dysrhythmio!!!

Seriously, "heart attack" is usually the layman's term for a Myocardial Infarction, i.e. caused by blocked arteries, and exceedingly rare in 15 year olds.

A cardiac arrest, i.e. the heart stopping, in a 15 year old, is more likely to be caused by an arrhythmia, such as ventricular fibrillation. This is likely caused by a defect of nerve conduction in the heart. In this case, it's treated by defibrillation and intravenous adrenaline at first, moving onto other drugs if needed.

The victim might experience palpitations and chest pain before losing consciousness.

How much detail do you need?

 

[Gary Compton]

Dialogue? Is it a Harry Potter spell - dysrhythmio!!!

Seriously, "heart attack" is usually the layman's term for a Myocardial Infarction, i.e. caused by blocked arteries, and exceedingly rare in 15 year olds.

A cardiac arrest, i.e. the heart stopping, in a 15 year old, is more likely to be caused by an arrhythmia, such as ventricular fibrillation. This is likely caused by a defect of nerve conduction in the heart. In this case, it's treated by defibrillation and intravenous adrenaline at first, moving onto other drugs if needed.

The victim might experience palpitations and chest pain before losing consciousness.

How much detail do you need?

Bloody hell Alchemist. Are you a Doctor. You lost me with the first word ending io ion or icular...

 

[Karn Maeshalanadae]

Alchemist is actually right, and it's not that complicated to understand.


And as I said, it usually happens to highly active, athletic youths because they just run their blood pressure up so high through their activity that they just go down. And sadly enough, it can be deadly and is usually the first sign of heart issues in such youths.

 

[alchemist]

Bloody hell Alchemist. Are you a Doctor

Afraid so, Gary.

Alchemist is actually right, and it's not that complicated to understand.


And as I said, it usually happens to highly active, athletic youths because they just run their blood pressure up so high through their activity that they just go down. And sadly enough, it can be deadly and is usually the first sign of heart issues in such youths.

Very true. Hence sensible sporting organisations pay for defibrillators and sometimes for screening of youngsters.

 

[Gary Compton]

Afraid so, Gary.

Okay I wonder if you can help me with my...Uuumm!

Maybe I shouldnt go there.

See you soon Doc!

 

[The Bloated One]

Hi everyone,


A tad more complicated. My character is in the future, so we have 150 years of progress to deal with...

I need something that has the flavour of heart failure but is not too descriptive. The dialogue below is a filler until I get this sorted. Here's the passage in context.

Any further help you can give is very welcome!

-----------------


The Chesterfield sofa materialized in the hospital emergency port at BIF headquarters, belching smoke and flames. Jules, Tarquin and Archie lay heaped on the sofa, like discarded toys on a child's bed. Rescue crews pulled them clear just before the sofa erupted in a ball of fire. Tarquin lay motionless, face up on the floor. He had a pulse, but it was faint. Professor Tommy Cramdunkle and a team of doctors arrived at the emergency port and like a Formula One pit crew they burst into life, lifting Tarquin onto a hover trolley, running diagnostics and checking his vital signs. As the hover trolley flew down the hospital corridor towards the isolation area, tubes, oxygen and flashing machinery appeared around Tarquin's body.

"Heart rate 160," said a doctor, jogging by the side of the trolley.

"30 milligrams," said another.

Tarquin's head lolled to one side, his eyes bulged and his tongue turned blue.

" Cardiac arrest!" shouted a third.

"Not on my watch," said Tommy, halting the trolley. He worked calmly over Tarquin's chest. Nobody spoke. After several minutes Tommy looked up. "He's back with us," he said, wiping his brow and signalling the hover trolley on it's way.

"He's damn strong," said one of the doctors, as they took Tarquin into isolation.

------------------------

 

[alchemist]

A few points on the medicine. The modern sequence of events would be --

• Airway, breathing and circulation (pulse) assessed
• Connect defibrillator while someone gives CPR
• Defibrillator shocks or not, depending on what type of arrest it is. Asystole, or "flatline" on the monitor, is the most difficult to treat, as you can't shock it. You have to --
• Inject adrenaline (or epinephrine as the Americans call it).

There's a couple of other factors, such as maintaining an open airway, but the above should impress a non-medic. Also, one team member commands, but doesn't do anything hands-on.

The Chesterfield sofa materialized in the hospital emergency port at BIF headquarters, belching smoke and flames. Jules, Tarquin and Archie lay heaped on the sofa, like discarded toys on a child's bed. Rescue crews pulled them clear just before the sofa erupted in a ball of fire. Tarquin lay motionless, face up on the floor. He had a pulse, but it was faint. Professor Tommy Cramdunkle and a team of doctors arrived at the emergency port and like a Formula One pit crew they burst into life, lifting Tarquin onto a hover trolley, running diagnostics and checking his vital signs. As the hover trolley flew down the hospital corridor towards the isolation area, tubes, oxygen and flashing machinery appeared around Tarquin's body.

"Heart rate 160," 160 is the pulse rate of someone jogging. No pulse at all is more effectivesaid a doctor, jogging by the side of the trolley.

"30 milligrams," 30mg of what? It has to be named. 150 years into the future, I'd suggest something that sounds like adrenaline/epinephrine e.g. NEONEPHRINE, EPISYNTH, or since the corporations have taken over, MITSUBISHIRINEsaid another.

Tarquin's head lolled to one side, his eyes bulged and his tongue turned blue.

" Cardiac arrest!" shouted a third.

"Not on my watch," said Tommy, halting the trolley. He worked calmly over Tarquin's chest. Nobody spoke. After several minutes Tommy looked up. "He's back with us," he said, wiping his brow and signalling the hover trolley on it's way.

"He's damn strong," said one of the doctors, as they took Tarquin into isolation.

------------------------

I'd suggest this sequence of dialogue....

Medic 1: No breathing...no pulse (starts CPR)
Medic 2(at the defibrillator or monitor) : It's flatlined.
Medic leader: Cardiac arrest! Give 30 milligrams of Episynth.
Medic 2: No good. It's still a flatline.
Medic leader/Tommy: Not on my watch.

It's just up to you to make that sound exciting , although materialising couches sound very cool.

 

[The Bloated One]

Alchemist,

Thanks, I'll go with your procedure and just try and put it into the future.

Yes, time travel using couches, dentists chairs, commodes, ejector seats, sedan chairs, trucks and vans is quite a challenge to write!

TBO

 

[The Judge]

I'm not a medic, so I can't compete with alchemist's knowledge, TBO, but one thing I do know from my own (admittedly googled) research is that the several minutes working on his chest isn't likely. It looks good on ER, but most cases of CPR end with the patient still dead and with broken chest bones/ribs into the bargain, and if it takes several mins then brain damage has occurred anyway, so if he recovers he's a semi-vegetable.

If in your book medicine has advanced in the 150 years from now as much as it has in reality in the last 150 for us, then I'd expect some kind of machine/device to take on the CPR function to avoid the risk of broken bones. CPR as we know it would be for emergencies in the field or for trained non-medics to use. I think they'd also have something to avoid the risk of brain damage, like a helmet or an injection to cool the body down -- I think I'm correct in saying that if the brain/body is cold it's more likely to recover in full working order, but alchemist can doubtless put me right if not.

 

[The Bloated One]

Judge,

Good point. i am looking for some sort of encapsulation to take care of the nitty gritty as he flies down the corridor and freezing him would be pretty cool (sorry!) in visual terms.

Question for Alchemist - If the body was suddenly encased in ice, would that help?

TBO

 

[Vertigo]

I don't remember the exact details but there was a case up here in the highlands some years back where a winter hill walker fell into a frozen stream and was sucked under the ice. It took sometime for them to get her out and by the time the helicopter got to them she was technically dead, their words not mine; no pulse no respiration. I seem to recall that they revived her in the hospital after nearly an hour and she was fine. The conclusion being that the extreme cold of being trapped under the ice is what saved her life. I also believe this is an area currently under research not only for emergencies but also for surgery.

Note, you wouldn't want to actually freeze them, this creates all sorts of problems with crystals forming and damaging the cells. Once you have actually frozen flesh (frostbite) it is very difficult to thaw it again without damage, the flesh that was frozen will almost certainly die; goes black and eventually falls off, pretty gruesome.

 

[The Bloated One]

Vertigo,

This is YA fiction, so I'll leave out the frostbite!

Thanks,

TBO

 

[alchemist]

I'm not a medic, so I can't compete with alchemist's knowledge, TBO, but one thing I do know from my own (admittedly googled) research is that the several minutes working on his chest isn't likely. It looks good on ER, but most cases of CPR end with the patient still dead and with broken chest bones/ribs into the bargain, and if it takes several mins then brain damage has occurred anyway, so if he recovers he's a semi-vegetable.

If in your book medicine has advanced in the 150 years from now as much as it has in reality in the last 150 for us, then I'd expect some kind of machine/device to take on the CPR function to avoid the risk of broken bones. CPR as we know it would be for emergencies in the field or for trained non-medics to use. I think they'd also have something to avoid the risk of brain damage, like a helmet or an injection to cool the body down -- I think I'm correct in saying that if the brain/body is cold it's more likely to recover in full working order, but alchemist can doubtless put me right if not.

Theoretically, effective CPR can keep someone's brain unharmed for hours. In real life though, as you say, it's more difficult. Incorrect technique, fatigue, broken ribs, aspiration (the arrestee vomits and it gets inhaled) and some complications I can't remember all combine to mean it's limited. Still, the most common mistake in CPR is lack of vigour, so the odd broken rib is the lesser of two evils.

As for cooling, as Vertigo says, there are many documented cases of people drowning in icy water for up to half an hour, and still making full recoveries. It's a bit beyond my speciality, so I had to google for these links to how this fact is used in medicine...

http://www.heart-valve-surgery.com/...10/10/17/ice-cardioplegia-open-heart-surgery/

http://www.anl.gov/Media_Center/News/2005/ET051028.html

Judge,

Good point. i am looking for some sort of encapsulation to take care of the nitty gritty as he flies down the corridor and freezing him would be pretty cool (sorry!) in visual terms.

Question for Alchemist - If the body was suddenly encased in ice, would that help?

TBO

The main question is, do you really need it? I read the whole passage as taking no more than five minutes. It's totally plausible for an experienced team to administer CPR for 5 or 10 minutes, while the rest do their thing, and Tarquin to emerge unscathed. If you do want cold, then whole ice seems so last-century. Your medics could use some form of energy field to encase the body in cold, or the injection of ice crystals as in the above examples.

And what does Prof Tommy do? Does he do something to get the heart working again? Or does he do something to make the heart work artificially (as The Judge suggests) temporarily, until he gets carted off to Intensive Care, stable but still needing to have work done? It all depends on what level of future-tech you're using, and since it's YA, how much you need to tell.

I'd imagine that in 150 years, it will all be automated. Perhaps an injection of nanobots soon upon arrival, to monitor all the body's systems. Tommy could also use them to infiltrate the heart's muscles, helping them to pump blood until they can get the heart to work of its own accord.

 

[Varangian]

The Bloated One,

I'm a paramedic so might be able to help.

If Paramedics are there on scene they will take over CPR, establish an airway (such as a Laryngeal Mask Airway, or if they are Intensive Care Paramedics an endotracheal intubation tube). IV Access will be established quickly (usually in the left or right ante cubital fossa, or failing that, anywhere they can get one). 1 MG of Adrenaline will be administered every 3-5 mins followed by a good flush of normal saline (20-30 mls). Adrenaline does several things but the main reason it is used in cardiac arrest is for peripheral vaso constriction. Having said that, there is talk of Adrenaline being withdrawn in cardiac arrest, because although it does cause peripheral vaso constriction (which forces the blood away from the extremities and back to the core) it also causes an increased oxygen demand on the myocardium.

Rate of CPR will be 100 compressions per minute. With an advanced airway established it is uneccessary to cease CPR in order to deliver the two breaths. Shocks will be delivered once every 2 minutes as long as the patient is in a shockable rythym (ventricular fibrillation or pulseless ventricular tachycardia), if the patient is in asystole (flat line) no shock will be delivered, CPR will simply continue. Shocks will generally increase in power, the first will be 200 joules, the second 300 joules and the third and subsequent shocks will be 360 jules.

If after 20 minutes the patient has not returned into a spontaneous rythym (even for a second) that supports circulation, then generally the paramedics will "call it", that is to delcare life extinct.

However, considering the age of your character, they will work long and hard.

Intensive Care Paramedics will also be administering magnesium, Sodium Bicarbonate 8.4%, and they also have some other funky things they can do with the defibrillator (like pacing, which means that if a return of spontaneous circulation is apparent but the pt is in bradycardia (a very slow heart rate), they can pace the heart (that is give very small electric shocks that forces the ventricles of the heart to contract, so between each natural heart beat, the ICP might administer 3 paced shocks (so the heart will be 3 times the rate it was prior to pacing).

Despite what ER and these other fantastic Hollywood TV shows would suggest, cardiac arrests outside of hospital (and usually even in hospital) have very poor outcomes. I have attended many cardiac arrests, only started work on 4 (all the others were in rigor mortis etc.) and got exactly zero of them back.

If the patient has a witnessed cardiac arrest (witnessed as in witnessed by the paramedics or nurses) they usually have a far better prognosis for survival.

If you'd like any more information please don't hesitate to ask. I cannot, however, divulge specific details on any jobs I have been to.

Hope that helps mate.

Keith