Dad was pretty healthy, was at work and told someone he didn’t feel well and needed to leave (mind you he hasn’t missed a day in years and years, so I think he must’ve felt really off.) He took two steps out of the back door at his workplace and went to the ground. Found about 30 mins later by the next coworker than opened the back door. They said they called 911, started their defibrillator that did give a shock, ambulance arrived and took him to ED, it looks like he was there for only 10 mins. Is that how long they “try?”He was a sharp young fit 61 year old. I mean, he was even at work. He was in good shape. And they never gave a cause of death really. But would this be cardiac arrest? As his only child, I just wanted to get an opinion of a professional. Thank you all.
Vital Signs
8:00 CST Peripheral Pulse Rate 0 Bpm LOW
Respiratory Rate 12 RR
Oxygen Delivery Ambu
Height cm 182 cm
Ideal Body Weight Calc 76.91 kg .
General: Unresponsive CPR in progress, not alert
Skin: Cool, Bilateral anterior knee abrasions greater on the right than the leftNot dry
Head: Abrasions to patient's forehead.
Neck: Trachea midline
Eye: Pupils fixed and dilated.
Ears, nose, mouth and throat: I gel supraglottic airway in place
Cardiovascular: Weak femoral pulse present only during CPR. No pulse without CPR
Respiratory: Breath sounds coarse and symmetric with bagging. No spontaneous respirations
Gastrointestinal: Soft
Musculoskeletal: No deformity
Neurological: Unresponsive, no spontaneous movements
Psychiatric:
Medical Decision Making
Differential Diagnosis:: Cardiac arrest, cardiac dysrhythmia, ventricular fibrillation, ventricular tachycardia, acute myocardial infarction, syncope, overdose, cerebral vascular accident, intra cranial hemorrhage.
Rationale: 61-year-old male presenting via EMS in cardiac arrest. Found down by coworkers who started CPR and delivered 1 defibrillation by ED. Reportedly in ventricular fibrillation on EMS arrival with 2 unsuccessful defibrillation attempts and 2 mg total of IV epinephrine prior to arrival. Here he is unresponsive with fixed and dilated pupils, asystole. No improvement with continued chest compressions, bagged ventilations via the I-gel and 2 additional doses of IV epinephrine. Left tibial IO placed in ED. Bedside ultrasound with complete cardiac standstill and patient was pronounced deceased at 8:10 AM. Discussed with wife in ED..
Documents reviewed: Emergency medical system run report.
Procedure
CPR
Time: 08:00:00 .
CPR was performed: In addition to other critical care activities, Per American Heart Association (AHA) guidelines.
Performed by: Nurse, Tech.
Supervision: I directly supervised the performance of CPR on this patient.
Total time: 10 minutes.
Line Placement
Consent: Emergent.
Indication: Venous access.
Monitoring: Cardiac, blood pressure, continuous pulse oximetry.
Location: Left, Proximal tibia.
Preparation: Sterile field established, landmarks identified, Alcohol prep.
intraosseous line: 16 gauge needle, 1 attempts.
Post-procedure: Adequate blood return observed, Adequate fluid flow observed.
Complications: None.
Performed by: RN.
FAST ultrasound
Confirmed: Patient, procedure, and site correct.
Consent: Emergent.
Indication: Cardiac arrest.
Chest findings: Complete cardiac standstill.
Abdomen findings: N/A.
Performed by: Self.
Impression and Plan
Cardiac arrest
Reported ventricular fibrillation
Plan
Condition: Expired.
Disposition: Time 08:10:00, Expired.
Counseled: Family, Regarding diagnosis, Regarding treatment plan, Patient's family understood.
Notes: Portions of this note were transcribed by a trained medical scribe. I, personally performed the history, physical exam, and medical decision making, and confirmed the accuracy of this information in the transcribed note.
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They did everything they could, but unfortunately his heart couldn't be restarted. They tried everything. And his pupils were fixed and dilated, which is a sign that his brain had already been without oxygen for too long and had died.
I'm very sorry about your loss. Unfortunately, even with the best attempts, out of hospital cardiac arrest has very poor chances of survival. It's hard to know what caused the cardiac arrest without an autopsy and more history - sometimes it could be a stroke that precipitated it, sometimes it could be a heart attack or arrhythmia, but no matter what, he was just down for too long.
Again, I'm very sorry for your loss.
Ok thank you for breaking it down for me. I’ve worked in medicine before and I try to believe ethically they did all they could.
He had been a little “irritable” and seemed overwhelmed” about two weeks prior. Never saw him like that before. Had a family gathering and he normally balances and manages everything, every dish that’s being cooked, staying on top of the dishes to put them away as folks are done, letting the dogs in and out to potty, you know, all that normal stuff… But he seemed a little off and overwhelmed by it all. Unorganized a bit. It was just a touch off, wasn’t even enough for me to pull him aside and say, “you doing okay pops?” 🤗
Thank you for replying. Just trying to put it all together. 🫶
That could have been anything and not at all related to what happened to him. That could have just been the holidays - you didn't miss anything.
Unfortunately sometimes bad things happen with no warning or good reason :(
I try to see the positive. I am actually very fortunate to have him as a dad in the first place. But also I had these thoughts as I was sitting over him in his casket, I was smoothing his hair with my fingers. He never got old. He never went blind. He never went deaf. He was never feeble or weak, I mean he worked up until his death. Literally. He never became bedridden and he to be changed. He was literally here one moment and then gone. What a blessing actually. I see it as a most merciful way to pass and I only wish for the same. 🙏🏻
That is a very insightful view you just expressed. I try and comfort myself with very similar reasoning to cope with my own father death in his 40’s. That was so much more humane than my uncle and aunt withering away in a nursing home.
Doesn’t make it easy, fair, right or un-traumatic though.
I bet he would tell you how proud of you he is if he could speak right now. He will always still be alive in your heart., in your words and your deeds. You are his legacy- so he endures.
Gentle hugs OP 💔
Oh thank you so much. I am so sorry to hear of your own father’s passing at a young age. Way too young. May his legacy also live on, and thank you for sharing and keeping his spirit alive too.
Yeah it was very hard but Zi still think of him every day and it’s been 38 years since he passed. I even named my son after him.
I am so sorry for your loss though. I know it hurts and that it will take time for you to be able to process it all.
Sending you gentle hugs 🫂
Im definitely on the quick-death bandwagon. I watched both of my parents slowly suffocate from emphysema/COPD and COPD/aspergillosis, and it’s just a horrible way to go (don’t smoke, people. Really). I’m not looking for sympathy — just wanted to illustrate that the alternatives can be highly unpleasant. I think both my parents would rather have died like your dad did.
Agreed, that's how I'd like to go too
You’re not wrong OP. My mom dropped suddenly from an aneurism, and while I’m still sad she isn’t here with me today (this was 6 years ago), I also recognize that the way she passed suddenly may be the kindest way to go.
I am terribly sorry for your loss, losing a parent suddenly is hard.
OP, this is how I feel about my mom. She died in a very similar way (and at 62) and actually the medical professionals’ replies to your post even help me, 7 years later. These doubts are normal, but your response above is a healthy one. My dad didn’t die this way. It was not pretty, and it is not how he wanted to die. And that is very haunting and awful for me even after 11 yrs.
I usually say going this way is best for the person who dies, and in some ways worse for us they leave behind because of the shock. And ultimately, we want peace for our loved ones, not suffering just so that we have time to say goodbye.
I’m very sorry for your loss. Losing a parent isn’t easy, but like you, I’ve found that looking for the positive helps. I’ve had two loved one pass in the blink of an eye in the past 3 years and, while it’s hard because I didn’t get to say goodbye, I think for them it was good way to go. As you said, they never became weak, never suffered, never had to slow down. One day they were alive and active, and the next they were gone.
This post sounds like he had family, like you, who loved him very much. I’m sorry for your loss.
So sorry for your loss OP. We never have enough time with loved ones. But I think your father's passing was what many of us hope for when it's our time. A full healthy life and a quick and likely painless death 🫶🏻💙
I'm sorry for your loss. I'm glad that you had a very positive experience with him and in a way it is good that he was able-bodied until his passing.
Unfortunately, he seems to have died before he was found. Medicine is limited in its capabilities.
Use this as a reminder for yourself and other family to get regular check ups with your doctors, especially for heart-health.
Sorry for your loss. The hard truth is that unwitnessed cardiac arrest is really bad and has terrible outcomes. After 10 minutes the brain has already suffered terrible damage. If your dad was found down for presumably 30 minutes he had no chance of surviving.
I can't imagine going through that, I'm tearing up a lil. I'm very very sorry for your loss, sending you the biggest hug and loving vibes, thinking of you and your family ❤️ 🫂
Hey OP, I’m very sorry for your loss. I’ll give some clinical context:
The amount of downtime here and your father’s exam on arrival are why the ER unfortunately ceased resuscitation after 10 minutes. 30 minutes is an eternity for the brain and other vital organs to be without oxygen, and there is effectively a 0% chance for neurological recovery even in the unlikely event they got his heart restarted. His physical exam - particularly his fixed and dilated pupils - support this. They took a look at his heart with the ultrasound machine, and describe it as “cardiac standstill,” meaning the heart tissue itself was likely dead from lack of oxygen.
In totality, all of that put together unfortunately suggests resuscitation is futile. They coded him for 10 minutes while they likely sorted all of this out, but when they recognized he had no chance of meaningful recovery they were ethically correct to terminate resuscitation. It would be standard of care in this scenario.
This is a horrifying thing to have happen to your Dad and causes extra trauma on top of the already unimaginable grief. The only silver lining is that I can tell you loved and cared for him greatly and he sounds like a great man from what you’ve described in the comments. May his memory live on forever with you and your family.
I am very sorry for your loss. I know you are trying to make sense of it.
On arrival to the ED, he was in a fatal arrhythmia. One of the common causes of this arrhythmia is a sudden massive heart attack. But without an autopsy, no one knows for sure.
Unfortunately your father went 30 minutes before he was found. That is 30 minutes without blood flow. That is an eternity. His chart says he was cool on arrival which is a symptom of lack of blood flow. Finally when they ultrasounded his heart, there was zero movement which meant his heart was dead and nothing was going to change that.
They really tried but there’s no coming back from that kind of downtime in any meaningful way whatsoever. The fixed and dilated is an additional indicator that he was gone by the time he got there. Immediate intervention for a fatal arrhythmia is what can prevent the fatality.
They did everything they could OP and in these circumstances, it was never going to bring him back. I’m so sorry for your loss.
Op i was with my partner (m49) when he fell over in front of me from cardiac arrest. I started cpr within a minute and the paramedics took over in 8 minutes, and he still didn't make it. Its like only a 5% chance basically to survive outside a hospital, I've learned since then. I'm so very very sorry for your loss. And my partner died so quickly I know by his face he didn’t realize what was happening and was unconscious in the blink of an eye. He never suffered and your dad didnt either.
I’m so sorry that you & OP have both lost someone unexpectedly. I appreciate you weighing in. I hope you are doing OK.
The timeline is somewhat unclear but based on what i can gather, he was down out of hospital for 30 mins. No idea how long it took him to reach hospital but based in the epi and shocks delivered by EMS, he must have been under EMS care for at least 6-10 mins before the hospital. Then an additional 10 mins of resuscitation in hospital. Thats a very long time down. If he was found in hospital and resuscitation was started immediately, I would’ve stopped efforts sooner than ~ 46 mins post arrest for sure. If they had been successful at that point, there would had been a very high chance of serious long term neurological complications and i can’t confidently say he would have left hospital.
He was down for at least 30 minutes prior to ems arrival. He had dilated and fixed pupils which could indicate the brain was without oxygen for too long. He heart ultrasound showed cardiac standstill so no movement in the heart and the brain was done for. I’m so sorry for your loss
Sorry about this,
In my system he would have been treated where he collapsed. But the treatment given here appears appropriate.