Quick actions save man’s life

With the start of the new year comes the start of many resolutions: eating healthier, exercising more and saving money. As a physician, I am, of course, very supportive of people trying to better themselves and their health. And I am there in an emergency if things don't go exactly as planned.

On what had been a reasonably quiet day at work, we were startled when the EMS radio went off. You could sense the urgency in the paramedic's voice. She was bringing in a young man who had suffered a cardiac arrest while playing basketball.

As is our routine, my emergency department team quickly prepared for his arrival. The respiratory therapist was ready in case we needed to put a breathing tube into his trachea. The pharmacist was ready with lifesaving medications. The nursing staff and paramedics in the department were ready to put in an IV, continue chest compressions and administer medications.

When they arrived, he was on a heart monitor that showed a normal rhythm. I reached for his wrist and Dr. Erika Kube

was relieved that he had a very strong pulse. The lead paramedic then gave us the whole story.

Jim had been playing basketball at the gym. His friends said they thought he was a pretty healthy guy and recently had been exercising more often because he was trying to shed a few pounds. He was running down the court when he suddenly stopped and fell forward. The other basketball players ran to his side and realized he was not OK. They called for help and a gym employee ran to get an automatic external defibrillator.

The gym staff immediately started CPR and applied the AED. The defibrillator analyzed Jim’s heart rhythm and then delivered an electrical shock to his heart. They then resumed doing CPR.

Paramedics put Jim on their heart monitor, put an IV in his arm and put a mask over his face to help him breathe. Because he had a strong pulse,

they were able to stop doing chest compressions. They loaded Jim onto their cot and rushed him to the waiting ambulance. The paramedics continued to help his breathing and monitored his heart rate and rhythm on their cardiac monitor. Jim arrived at the emergency department a few minutes later.

As I evaluated him, I noticed that he was starting to move his hands. Jim was pushing away the mask. I leaned toward him and could hear that he was trying to talk. We pulled the mask off his face, and he slowly started speaking.

He was confused about what had happened. He last remembered being in the gym, playing basketball, and then his memory went blank. I tried not to bombard him with questions, but we needed to get as much information as possible. He said he had been feeling well while at the gym and that nothing like this had ever happened to him before. He didn't take any prescription medications and he didn't smoke or use any illicit drugs. He was just a normal healthy guy, he said.

Everyone was relieved that

Jim had regained a pulse and was awake. That is not something that we see very often in the emergency department. It was hard to imagine that he was talking to us.

Jim’s EKG didn't show any signs of

a heart attack, but it had some subtle abnormalities that made me suspect a condition called Brugada syndrome. It can be caused by a genetic mutation that affects one of the electrolyte channels in the heart muscle. It can lead to an abnormal heart rhythm that can cause cardiac arrest.

About 25 percent of people who have Brugada syndrome have a family member with a history of it. Jim said none of his siblings or parents had any history of it but he had a cousin who died suddenly many years prior and they never figured out exactly what had happened. Other causes of the syndrome include some medications, electrolyte disturbances such as abnormally low potassium levels, and using drugs such as cocaine and alcohol.

Jim was hospitalized and ended up having an automated cardioverterdefibrillator implanted inside his body. The device monitors his heart rhythm and will deliver a shock to terminate an abnormal rhythm.

The cardiologist also recommended evaluating Jim’s family members to see whether they carry the genetic mutation that causes Brugada syndrome. Jim was discharged to home just a few days later. Thanks to the quick actions of his friends, the gym staff, the EMS providers and the rapid use of the AED, Jim survived what could have been a life-ending event.

Dr. Erika Kube is an emergency physician who works for Mid-ohio Emergency Services and Ohiohealth. drerikakubemd@gmail.com