What kind of tests are performed by a paramedic on an adult after CPR has resuscitated them from a drowning in a bubble bath?

January 9, 2009 6:40 AM

What kind of tests are performed by a paramedic on an adult after CPR has resuscitated them from a drowning in a bubble bath? I am writing a novel and this is part of the plot, and I suspect that they must do something, but I don't know what. If anyone knows anything, you have my thanks!
posted by Sully to health & fitness (9 comments total)

Others will give more info, but the key to resuscitation for someone whose heart has stopped is not the CPR so much as the defibrillator.
posted by ClaudiaCenter at 6:58 AM on January 9 [1 favorite has favorites]

Well, they look and listen reeeeaaallly carefully.

There are many reasons for the lungs to sound not-so-clear, and several different things which can be done to help. There's no immediate test other than listening, and possibly looking at some x-rays n stuff or what's come out of someone's mouth or lungs, though x-rays most commonly only confirm what you hear-- many times you'll hear badness before anything unusual would show up on imaging. Other lab tests can be performed to help determine the cause of said badness, but not necessarily its presence.

I'm taking "drowning in a bubble bath" to mean the presence of fluid in the lungs. This can happen for a number of reasons, including, well, fluid in the lungs from the start, problems with the lungs, problems with the heart, problems with the blood, and problems with someone having a Capri-Sun straw jammed into his chest and said straw being connected up to a giant vat of Capri-Sun, or, trauma.

Anyway, to answer your question, it would be helpful to know what circumstances prompted the initiation of CPR, and to what degree the person was resuscitated. If they're intubated, they're probably going to have to be on a vent. Vent management can be complex, and is dependent upon what the (presumptive) diagnoses are. Testing, adjustment of vent settings, and management of said diagnoses in an effort to prevent someone from drowning in a bubble bath are dependent upon what's going on.

Sorry I can't be more specific. MeMail if you've got any other questions.
posted by herrdoktor at 7:07 AM on January 9

Actually, if the heart has stopped you wouldn't defib (unless you're on House MD). That's reserved for serious ventricular arrhythmias, among other things.

IANAP (paramedic) but I'd imagine that the priorities would to stabilize the pt (ABC - airway, breathing, circulation) and get them to the hospital asap.
posted by sero_venientibus_ossa at 7:10 AM on January 9

Tests? Pulse, to make sure it's there. Blood pressure, to make sure it's adequate. They'd count breathing too, though there's not much more to it than that. Probably use a pen light to test for pupil responsiveness. They'll check the airway to see if anything is blocking it. They'll hook a finger up to a portable pulse oximeter to test for oxygen saturation. They'll also ask basic questions to make sure the person is oriented to person/place/time.

But most of all they'd take the person to the hospital. You don't get resuscitated without a ride to the ER. Paramedics are just that: "para" + medics = "beside"/"near" + medics. All they do is try to keep patients stable long enough to get them to the hospital. So the paramedic is going to do very basic observations like pulse, breathing, airway, and orientation so they can give that information to the nurse at the ER.

sero is right though: defibrillators are not used to "restart" the heart. It's a "de-" "-fibrillator," i.e. a device intended to stop fibrillation, particularly ventricular fibrillation, which is one of the few things that will kill you right quick if not immediately reversed. Like within a few minutes quick. Flat-line heart rhythms are not defibrillated.
posted by valkyryn at 7:27 AM on January 9 [1 favorite has favorites]

According to the first aid course I did: CPR is intended to keep the patient alive until he/she gets to hospital. It serves to pump oxygenated blood around the patient while their heart isn't up to the job. Contrary to the name, it won't resuscitate the patient.
posted by emilyw at 7:28 AM on January 9

IANAD, but if this is for fiction, you should read CPR Clean Pretty Reliable.
posted by jenfullmoon at 7:29 AM on January 9

Part of the answer also depends on the level of training of the responder; EMTs and paramedics are not the same thing. Another thing that will make a difference is how close they were to actually dying; if they needed intubation, for example, they would be left intubated (and tests to confirm proper tube placement performed as described in the link) and their breathing would be assisted with a portable ventilator or bag-valve-mask device. In addition to a pulse oximeter as mentioned above, they would probably be hooked up to an EKG monitor and blood pressure cuff. Feel free to memail me if you want more details.
posted by TedW at 7:48 AM on January 9

A good (if old) article on the incorrect use of defibrillators on TV.
posted by EarBucket at 9:00 AM on January 9

Whoa!
Thanks to you all.

I went to that TV Tropes site and
realized that all my knowledge about
this was informed by bad television.
It is truly humbling.

Still, I have need for my character to
be up and running quite soon after
this near death experience.

I'm going to try to ground the scene
in truth, insert an ambulance, CPR
on the way, her heart starts to flutter
in the ambo, they've got to de-fib,
and she's revived, then they do that
battery of tests. They didn't crack a
rib but they will mention that it's
possible.

And THEN she's up and running.

Thanks to everyone again.
I don't know what fiction writers
did before google and AskMeFi.

Make crazy shit up, I suppose.
posted by Sully at 10:00 AM on January 9