Case
Hi this is the ER attending calling. I have an ambulance on route from a local high school. They are telling me that they have a 15-year old male who was at wrestling practice and collapsed. The coaches were trained in CPR and said that the boy was not breathing and did not have a pulse, reportedly. They had an AED at the gym and hooked it up to him. The system stated that a “shock was advised” so they actually shocked the kid! The kid has a pulse but was down for about 10 minutes. The EMTs tell me that the kid feels fine and wants to go back to practice. I told them to go ahead and bring him in but I doubt this is real. He’s too young to have a cardiac arrest, right?
What am I thinking?
As has been previously demonstrated, sudden cardiac arrest in a young person is a very real though rare event. My first thought is to bring this adolescent to medical attention immediately and start a workup to understand the details of the event, hopefully leading to an etiology.
When a young person suffers a cardiac arrest and is unsuccessfully resuscitated it is devastating not only for the family, but for the community. Pediatric cardiologists are often inundated with patient visits and phone consultations after such events as families are concerned that the same event could happen to their child. Their anxiety, while understandable, is not born out in the statistics as sudden cardiac death occurs in an estimated 1 per 100,000 persons when excluding infants and those above 18 years. Unfortunately, etiologies for the sudden cardiac death in the young is often undetermined.
What is encouraging, in this case, is that the coaches were appropriately trained in resuscitation and had an automated external defibrillator (AED) on the premises. A rapid and coordinated first-response can be life-saving. While we often hear of the shocking events of unexplained deaths in the young, we do not often hear about the “saves” that occur based on the actions of bystanders. Empowering yourself with knowledge about how to perform resuscitative measures may lead to saving someone’s life. More often than not, it will be to save someone that you know or love. The American Heart Association encourages everyone to learn and administer “Hands only cardiopulmonary resuscitation (CPR)” in the event of a sudden cardiac arrest while calling for help. “Hands only CPR” can be described simply as pushing hard and fast (100 bpm) in the center of the chest and allowing for full chest recoil between every compression.
The next key to survival is becoming comfortable with an AED. Workplaces, schools, churches, nonprofits, and other public or private organizations have taken measures to incorporate AEDs for safety of their communities, but more can be done. Beyond having an AED in place, it is important for people to know when to get one and to be comfortable with how to use one. Although it may go without saying, an AED should be only used on an unconscious patient. AEDs are intended to be “user-friendly” and provide instruction as to where to apply pads and how to operate. Some will even provide instructions on how to perform CPR. With pads applied and compressions paused, an AED determines the rhythm and whether a shock would be advised (see Fig. 27.1 ). If a shock is advised, the user should clear the patient and press the shock button immediately followed by CPR. The AED will continue to analyze the rhythm throughout the resuscitation process and breaks from compressions should be kept to a minimum.
