Letter to the Clinical Editor

Dr. Kern,

I have a question about the use of opioids in a patient that has an un-witnessed arrest that is brought to the cath lab emergently. The situation involved a patient with an un-witnessed arrest with the patient’s family administering CPR. The initial ECG by the EMS team showed asystole. Conversion to a supporting rhythm occurred after administration of ACLS medications. A CT scan was negative. The cardiac angiogram showed only an old occluded RCA. The patient was noted to have discomfort due to assumed pain response. The interventional cardiologist gave verbal order for Benadryl and hydromophone to be administered. The response was as expected and the patient, though unresponsive throughout, seemed more relaxed.

After all was said and done, the nursing staff was questioned about the use of opioids on the patient, because now there needed to be a waiting period to do the necessary testing to determine whether the patient had brain death. I have never heard of such a consideration when working in the cath lab before and wonder what we’re getting into in this culture of all considerations for the patient? Is this something new to the emergent patient population that now has to be looked at differently or an overboard response from a non-involved hospital person with a different viewpoint? I would appreciate your response as I am preparing to continue the discussion regarding this perception.
A Director of Cardiac Services

Thanks for your question. I’ve never heard of a complaint or concern regarding patient care for such a sequence of events. The resuscitated patient may or may not have significant brain damage, and it is unknown whether he senses pain. If in the judgment of the treating physician, the patient would benefit by being more comfortable with Benadryl and morphine, and the result is as you describe, no one should be critical of helping the patient. The delay for assessment of brain death is an irrelevant and greedy concern about reducing length of stay. The person critical of this minor and benign treatment should examine their motives.

MK