If you shock a flatline, I swear I will come to your home and beat you with a wet chicken.

Beep…… Beep…… Beep…… Beep…… Beep…… Beeeeeeeeeeeeeeeeeeeeeeeeeeeee..………………Clear!………………… KA-CHUNK!!!!!!!…… Beep…… Beep…… Beep…… Beep…… Beep…………………

You know what this sounds like. You know exactly what this sounds like. You’ve heard it on practically every hospital TV show, every movie in which someone is rescued near death in a spaceship with a sickbay…over, and over, and over.

And it’s WRONG!!!

I’d like to take some time and explain why, how to not be THAT WRITER, and what you can do instead.

When a person’s heart stops in a hospital, it’s known as a code.
Codes are nuts. Doctors really do run through the halls of the hospital, and it turns into an absolute madhouse. There’s a lot to do during a code.

There’s actually too much to talk about. So let’s focus on the heart monitor, for now. One of the first things that happens during a code is that you place monitors on the patient so you can keep track of what’s going on inside their body.

The beeps you hear on a heart monitor are an audible notation of the electrical activity that is going on in the heart. The electrical activity of the heart is the signal that says when the heart muscle is contracting to pump the blood to where the blood needs to go.

That long, extended beep is a flatline. It means that there is no electrical activity going on in the heart that the heart monitor can pick up. That means the heart is not beating correctly.

So what does shocking do for a person who’s having heart problems?

Contrary to popular usage, the heart doesn’t work like a car, where you can just jump a dead battery. The purpose of a shock to the heart is to DISRUPT an electrical pattern that does not result in an adequate heartbeat. The shock stuns the heart, hopefully so it will reset itself into a normal rhythm.

This is why you don’t shock a flatline, no matter how easily-recognized it might be to an audience of uneducated viewers. The flatline means that there’s no electrical pattern to disrupt, organized OR disorganized. The heart is pretty well stunned as it is, and re-stunning it won’t help you a bit.

According to usual medical practice, here are the shockable heart patterns, and what they look like on a heart monitor:

Ventricular Fibrillation: This is when the ventricles of the heart are fluttering, which doesn’t result in a sufficient squeeze to get the blood where it needs to go. It looks like this:

Pulseless Ventricular Tachycardia: Basically, a heartbeat where the ventricles squeeze so fast that the pumping chambers of the heart don’t have time to fill…and the blood doesn’t get where it needs to go. It looks like this:

So, what DO you do with a flatline? (Also known as “asystole”)

Well, it’s a little less dramatic than what the TV would have you believe. First, you make sure that the blood is still going where it needs to go. This is accomplished with chest compression, which is the technique of pushing on the chest in a way that squeezes the heart from the outside.

(By the way, chest compressions are EXHAUSTING. In a hospital setting, there are a bunch of people who volunteer during the code for chest compressions, and they rotate in and out every few minutes. You just can’t keep it up for more than a few minutes, even if you’re in fantastic condition.)

Beyond that, you push drugs into the patient’s circulation that act in ways that encourage the electrical activity of the heart to start up again. Meanwhile, you try to figure out what caused the heart to stop beating, and try to get that problem solved.

Here’s a list of usual causes of asystole: pulmonary embolism, tension pneumothorax, very low blood pressure, very low body temperature, cardiac tamponade, heart attack, acidosis, very high potassium, very low potassium, low oxygen, drugs (medications or illicit drug use), poisons.

So, if you really, really want a flatline on your monitor, the dramatic tension of the story shouldn’t be action-adventure oriented. Yeah, there are people running everywhere and doing everything during a code, but a flatline wouldn’t have anyone diving for the paddles. The tension from a flatline would come from the dialogue between the doctors, as they discuss what could be the cause of the patient’s asystole.

And there’s a time limit, which gives you the tension that comes from a ticking clock. If doctors can’t get the heart to restart in a reasonable amount of time, the patient will likely suffer so much brain damage that it’s more reasonable to stop efforts and let them go.

So, if you have a patient with a flatline: go for relatively quiet, dramatic tension. Have a doctor with a personal stake in saving this patient’s life, watching the clock tick as she desperately tries to figure out why the patient’s heart stopped. The family, standing by, waiting anxiously and praying. The nurses and students rotating through compressions, giving nervous glances to each other as the seconds and minutes pass. The pharmacists, at the ready with the next combination of drugs to try. It’s an atmosphere that’s so thick with real tension, you don’t need to add any electrical shocks to it.

But if you do want to dive for the paddles, and yell “CLEAR!” and have the patient twitch on the table…yes, that all does happen. But for the love of all that’s good and medically accurate, put one of the shockable rhythms on your monitor!




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If you do use this as if it were real medical information, I will come to your home and beat you with a wet chicken. Even if you don’t shock a flatline.

Published in: on January 23, 2010 at 12:22 am  Comments (98)  
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98 CommentsLeave a comment

  1. Great post, Doc!

  2. WTG, from a fellow doctor-writer.

    I will add that people used to say “Is it fine Vfib?” and shock asystole, but it is not acls protocol.

    Good luck with internal med!

    Melissa (melissayuaninnes.net)

  3. Very cool. I’ll be making good use of this. You’re already my go-to consultant for the terrible things I do to my characters, and you’re more interactive than http://www.amazon.com/Body-Trauma-Writers-Wounds-Injuries/dp/1933016418/ref=sr_1_1?ie=UTF8&s=books&qid=1264390491&sr=1-1

  4. Wow, this is phenomenal, D; and I especially love this post. Looking forward to seeing what other TV medical fallacies you debunk!

  5. This is so useful. I honestly had no idea that was bunk. I am currently relieved never to have written a flatlining scene.


  6. I love this blog already and wish to have its little flatlining babies! Thank you so much for this helpful information. 😀

  7. Thank you. Thank you SO much for this. It drives me nuts when I see doctors on TV shocking asystole. I just watched a show the other day where they were doing CPR with a ratio of five compressions to one breath. FIVE! I wanted to throw my shoe through the TV.

  8. Thanks, guys! I’m so glad you like it! Please let me know if there’s anything you want to see covered in the future; I’ll try to get to it.

    • had just seen the movie AWAKE, and it had a scene where a surgeon used a defibrillator during a asystole… lol. and being a nurse student I already knew something was wrong and that procedure is not necessary… but thats what makes fictional movies more thrilling! but good post! thanks!

  9. Great post! I could feel my ignorance abating slightly (and there being so much to know about medicine and the human body, there’s a lot of ignorance involved for me!). Please to keep doing this sort of thing.

  10. Good fill someone in on and this enter helped me alot in my college assignement. Gratefulness you on your information.

  11. […] blog posts titled, “If you shock a flatline, I swear I will come to your home and beat you with a wet chicken,&#8… how can you not check this guy out? Leave a Comment No Comments Yet so far Leave a comment […]

  12. I have just come out of hospital and I Flatlined twice. It was what my family and docter that told me. I cant get it out of my mind that I could be dead. do many people live through Flatelining.

    Your commet may help me understand more.

    Thank you.

    • Hi, ronald regan

      I want to emphasize that I am not yet licensed to practice medicine; I won’t graduate from medical school until May. This site is also focused on using illness accurately in fiction, not talking about real-life scenarios. Your doctor is really the best person to answer any questions you may have.

      That said, I can answer your general question about how many people live through flatlining, or asystole. According to UpToDate Online, 2% of people with asystole survive to hospital discharge. 11% of people with pulseless electrical activity survive to hospital discharge. (Podrid, Phillip et al. “Outcome of Sudden Cardiac Arrest”. UpToDate Online, September 2009. http://www.uptodate.com/online/content/topic.do?topicKey=carrhyth/33730&selectedTitle=2~118&source=search_result )

      I’m very happy that you made it; it sounds like you and your family have been through a very difficult experience. I wish you all the best!

      Dr. G

    • Yes they can It’s just most people don’t live past three,I know because I flatlined 32on paperwork and few off and I’m still alive but I have an icd for secondary prevention of sudden death….anyone can talk crap but I have prof I did that many times and I remember so of what went on.feel free to email me if want to talk about it cause it’s it can be hard to deal with but be thankful you’re still alive and enjoy it

  13. really interesting I cant wait to watch a movie with my girl friend and show off my new knowledge when someone flat lines.

  14. […] I’m studying ACLS this week! (That’s “Advanced Cardiac Life Support”.) Basically, what to do when someone’s heart stops. In a hospital, that’s called a “code”. I believe I will use the following […]

  15. […] points for NOT attempting defibrillation when the heart monitor flatlines, but instead doing what doctors actually do, ie CPR. Sure, there was nothing earth-shatteringly out of this world as regards the science, but […]

  16. […] комментария. Первый, главный – я пересказал то, что пишет автор doctorgrasshopper.wordpress.com, а не сам “совершил научное […]

  17. i have heard about this all the time in ems do not shock asystole but when i was in iraq i had a conversation with a doc we started thinking,(DANGER),when you defib a pt an electric current passes across the mediastinum causing the heart to contract an disrupt electrical activity. Well what harm does it do to shock a dead person kill them twice. We were just thinkin that the shock would cause the sa node to fire again in a traumatic arrest. would you please research this and see what you come up with, I have heard that some docs have toyed with the idea thank you for the article it was very good though

  18. […] “If you shock a flatline, I swear I will come to your home and beat you with a wet chicken.&#8… […]

  19. My wife is going through EMT training and told me the same thing. Frankly I was skeptical and decided to look it up. I just want to say, the two of you have ruined Hollywood for me…

  20. Thank god for this post, my soon to be novel would be in tatters without this!

    • me too

  21. I’m learning about dysrhythmias at the moment for my LPN. None of my teachers are cardiac experts and don’t want us to go too in depth, but I love the CV stuff! So here’s my question: if we’re not supposed to shock asystole, then why is temporary pacing allowed? Isn’t it essentially shocking the heart?

    Love your wet chicken threat. Pretty original 😀

    • Hi, Bonnie! Welcome to my blog; it’s nice to have you here!

      As far as I know, temporary pacing is used for symptomatic bradycardia, not asystole. With asystole, there’s usually some sort of chemical problem that’s interfering with the heart’s ability to contract (that’s why you have the “T and H” list:

      * Hypovolemia
      * Hypoxia
      * Hydrogen ions (acidosis)
      * Hypothermia
      * Hyperkalemia or hypokalemia
      * Hypoglycemia
      * Tablets or toxins (drug overdose)
      * Cardiac Tamponade
      * Tension pneumothorax
      * Thrombosis (myocardial infarction)
      * Thrombosis (pulmonary embolism)
      * Trauma (hypovolemia from blood loss)

      So basically, even if the heart got a signal to contract, it wouldn’t be able to until the problem is fixed.

      With symptomatic bradycardia, the problem is that the heart’s primary intrinsic pacemaker has failed for some reason, leaving only the backup pacemakers that tend to beat slower than the other ones. The heart can still beat if it gets the signal to; the signal is just coming at a slower rate than is healthy. The “shock” that temporary pacing gives is a signal to the heart to contract; it’s different than the strong “shock” that is given to stun the heart out of an inappropriate rhythm.

      Does that make sense?

      And I’m glad you like the chicken threat! It seems to have served me well! (Although there certainly are many writers out there who seem to think I’m not serious about it….see the latest episode of a show called Doctor Who…..)

      Thanks for reading, and thanks for writing!

      Dr. G

  22. Thanx, im writing a story with a flatline and this was helpful, thank you so much

    • Good luck,I am writing a book also on my flatlining as I did and as many as I did and I’ll offer to do book together if you’d like by you writing and me giving you information,believe I know a lot and have doctors paperwork can use in it sincerely hermeonia

  23. Thank you, from a fellow doctor! This drives me mad all the time in fics and on TV.
    Also, when you see a character on TV have some sort of traumatic accident, and the other characters check the pulse and shake their heads sadly. CPR, people! It works! (sometimes….)

  24. I think this is one of the most vital info for me. And i’m glad reading your article. But should remark on few general things, The website style is great, the articles is really nice : D. Good job, cheers


  26. So helpful for the fic I’m writing! Some of my writing is in magical realism, but I want the MEDICAL aspects to be totally accurate!

  27. Good post, but the first picture (under heading of VF) isnt VF, Its a type of VT called torsades de pointes.

    The difference being that torsades can have an output (like Uncomprimised VT, but unlike VF) and would be treated differently with magnesium if it was reoccuring….. Even though the treatment is the same in an arrest- still grabbing the paddles.

    • Oooh, good catch! I haven’t looked at this post since I wrote it; I should find another picture for it! Thanks for the feedback! 😀

    • Good job thanks for explaining that to everyone

  28. An interesting post. Nice to see someone paying attention to detail.

    I have a question: What would be the correct response if someone suffered a heart attack (or the heart simply stopped) due to a very large explosion, such as in a war zone? Would it simply be to give them CPR asap?

    Could you please be as specific as possible, for example, how many pressures are suitable per second, and why?

    Many thanks,


    • It’s very rare for the heart to stop from a concussion such as from an explosion, but I think it has been known to happen. If the heart isn’t beating, you’d give them CPR (100 beats per minute is the current fashion; it’s the same beat as “Staying Alive” or “Another One Bites The Dust”), but CPR isn’t a cure…it’s just a way to keep the blood circulating until you can get the heart beating again.

  29. Hi! I am writing a story based on an experience i had when i volunteered at a hospital, and I was just wondering, if someone does chest compressions does anything show up on the monitor? I saw a man flat line, but i was too focused on the fact that he turned blue to notice the monitor. Unfortunately in omniscient narrator fiction that one detail is not enough!

    thaaaanks. you are awesome!

    • Yes, actually! Chest compressions do show up on the monitor, and they actually look a lot like an uneven ventricular tachycardia. You’ll get an upward deflection with every compression (I think. Next time I’m in a code I’m not running, I’ll try to pay attention to the relationship between the compressions and the monitor.) Docs stop compressions about every two minutes to analyze the heart’s own electrical rhythm on the monitor, and also to feel for pulses.

      Thanks for the great question!

      Dr. G

  30. So I’m curious. If v-tach is >100 bpm, why do chest compressions at that rate in CPR? Is it because the compressions are less effective in moving blood than the functioning heart?

    • This is because you want to try and build up enough pressure through compressions to get blood moving through the body and (specially) to the brain. Even the best CPR only produces a small fraction of pressure and vascular travel compared to the actual beating of the patient’s heart.

    • Assuming they didn’t code due to a pacemaker malfunction. I’ve seen pacemaker codes with no spikes, paced rhythms on ekg and everything in between.

  31. Thanks for the advice…I write a lot of medical fanfiction stories and this was very helpful.

    • Rock on with your bad self. I’m glad this could help!


      • It’s amazing how many people think you can shock a flatline…

  32. Deleted for uneducated trolling

    • Deleted because I should know better than to feed trolls

  33. I came upon this blog because I just flatlined 2 weeks ago. My pacemaker is in all is well but I still want to understand what happened. The first time I past out driving, without incident, had a friend with me, the next time I was in the hospital and hooked up to monitor so the docs seen it in black and white.

  34. Good Read. I have to ask what about those patients who have pacemakers implanted on them? would they still reveal flatline on ecg after they have arrested?

  35. Thank you! Just shared this on my Facebook wall after watching yet ONE MORE show who included this fallacy. My most disappointing to date was an episode of NCIS – it was a horribly run code from start to finish, involving one shock…no compressions…no meds…no asking if anyone wanted to try anything else…just dead. But the worst part was that the one shock was delivered while the “patient” was in asystole. Sigh. So, thank you! I have wiled away a bit of time this afternoon – when I should be sleeping as I work the overnight shift – reading your blog after stumbling upon this gem. Congrats on finishing residency! Seriously.

    • Hi Denise! Glad you liked it! Thanks for the kind words; I’m very much enjoying life after indentured servitu….I mean residency! Hang in there!


  36. I know this article is old but in case someone reads this comment I have a question. I’ve read in a few places that if you shock someone in asystole that actually makes it less likely for resuscitation to be successful. Why is that?

  37. I flat lined twice roughly 9 hrs after breaking my neck when I was 14.5. I was VERY lucky. To have such an awesome team of drs and nurses that night.

  38. I know someone who said she suffered a heart attack about 7-8 years ago. She said the doctors used the paddles on her 18 times. Is this medically possible for a human being to endure this and would their skin have been burned by this? Also, how long a wait is there between each time shock treatment is used? Would a doctor try 18 times? Would the patient sustain any additional damage to the heart, body and or brain from this?

    • Docs don’t usually use paddles anymore. They use pads that adhere to the skin. If the pads are correctly applied they shouldnt cause any skin damage or burns. If they were using paddles they use a gel to assist in transmission of the shock and prevent skin damage. The shocks are done following a rhythm check which in als (advanced care life support) is every 2 minutes assuming they remain in a shock able rhythm. The electricity travels between the two pads or paddles and not through the entire body. Not to mention the voltage is fairly low as its meant to interrupt the electrical conduction of the heart which only requires the normal voltage the heart is used to already.

  39. Hey, i just wanted to let the doc know, i used this info for something i wrote and even used the phrase ‘It wasn’t like in the movies, only a gentle twitch, like waking from a dream of falling’… and it came out wonderfully well! Thank you, doc!!!!

  40. Help! Okay, I’ve written myself into a corner and I need some advice here. I am writing a sci-fi adventure story, and my character has a tracking device implanted in her. Another character uses an automated external defibrillator to deliver an electric shock to her body to disable the device. Now I am stuck because 1) AEDs aren’t supposed to shock a heart that is beating correctly and 2) If I have my other character pull a Fonzie and bang on the machine until it does what I want it to do, will it kill my character? What sort of damage will it do and what would it feel like? I don’t want to take the easy way out of “she’s actually a robot so none of this matters anyway.”

    • You could jiggle the wires. The artifact might imitate vfib and trigger a shock. But the electrical impulses only travel between the paddles. You’d need to place them in the right spot to disable the device.

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  42. Remarkable! Its in fact amazing article, I have got much clear idea about from this piece of writing.

  43. Great article, but 2 things. Monitors don’t give a continuous beep during asystole, they are silent. The continuous beep signifies the defib is charged, and ready to shock. You have to press the charge button to get there. Second, you VF graphic is actually Toursade de Pointes VT.

  44. […] you here! As far as I know, temporary pacing is used for symptomatic bradycardia, not asystole. Download If you shock a flatline, I swear I will come to your home … | […]

  45. As a paramedic, I just want to say THANK YOU! That sh*t drives us crazy. Great writing too.

  46. As a paramedic, I just want to say THANK YOU! That sh*t drives us crazy. Great writing.

  47. Bless you–I just wrote a post elsewhere on the exact same subject and a friend directed me here.

    I used to have a friend who’d call me when I was working in the hospital and she’d hear the monitors alarming. “did someone flatline?” she’d ask. Used to drive me nuts, she never did quite believe me that I’d never seen a flatline, and you can’t shock a heart that isn’t beating. lol

  48. Just curious? Did it happen to you? I know to call a code, crash cart, epi, Vaso, then hopefully achieve a shockable rhythm.

  49. Hello,
    I have no medical experience, except that I was one of those unfortunates that went through this experience in Oct 2012.
    My good fortune is that I survived and am well today, thanks to the fantastic ER staff in Cameron Hospital, Angola IN (Dr Huntington & Co.)
    I was told that I received 30+ shocks and chest compressions to the limit. (I was aware of 2, and was very aware that my mortality was in question; but it is very curious that there was no panic dread or fear involved. It was matter of fact acceptance).Dr Huntington could have chosen to cease treatment at any time, but he didn’t. Instead, I was chilled in some kind of ice blanket (I am told) and transported by air to the regional medical facility where the medical procedures were performed that caused my survival today. Today, every day is a gift, thanks to those diligent folks at Cameron ER.

    • Well seems to me I just found the other person in the world who flatlined close to as many times as I did and I’ve been trying to find out who the other person who and knew it happened a year or so before me, mine was July 13,2013 please email or text me please or pm on facebook hermeoniapennell@icloud.com,2709037904 is cell and facebook is hermeonia Pennell……this is to James mainly but if anyone else has questions please feel free to contact me and I’ll answer

      • We’re the only two to have flatlined 30+times and still be alive and doing fine well as can be expected

  50. You are so interesting! I don’t believe I’ve read a single thing like this before. So great to find someone with a few unique thoughts on this issue. Seriously.. thanks for starting this up. This site is something that’s needed on the internet, someone with some originality!

  51. My husband (not legally)passed away suddenly from something, and because his mother said she was Jewish and didn’t want him cut on(desicrated) no autopsy was performed he was only 51and died at home. Jeff had severe stomach pain and said he was constipated this was around noon. the pain got worse over the day, he began vomiting and couldn’t keep even a sip of water down. He was in so much pain he was beside himself, at around eleven o clock at nite he started behaving a bit strange, making motions with his hands like he was pulling spaghetti out of his mouth, not sure where the bathroom is, an odd expression on his face, this lasted for a minute and then went away but the abdominal persisted he said he would go to the E.R if not better by morning. When i got up at seven am. He was in the chair and looked to be asleep, but he wasn’t sleeping at all, he was dead. I desperately need to know what could have caused him to die. I can’t get over the initial shock, lost 50lbs in six months, and i don’t want to live anymore i have horrific anxiety that i might live another five to thirty years. Maybe understanding why he passed would help a little. Also six months before he was hospitalized because of a blood clot that delivers blood to his right leg and couldn’t be removed because his Dr. Said it was too dangerous.

    • Knowing isn’t going to help hun. I’m sorry but the issue isn’t WHAT he passed from. Instead it’s about WHY your hanging on. You haven’t truly, fully grieved. Until you get help from a professional or someone who knows what they are doing. Once you have done that and truly grieved, you will realize that it doesn’t, and never did, matter what he passed from. Just WHO he was and WHAT a life he had. Hope this helps.

  52. […] a heart which is, as far as I can tell from the preceding narration, not fibrillating. They could’ve used a more vague term such as ‘jump-start’ and we’d have […]

  53. My mom flatlined 4 year’s ago just before the midnight hour on Halloween, it was just as you described, the doctor performing cpr for 20 minute’s before I screamed stop(by then I knew without oxygen to her brain her chance of a normal life were slim), nurses all around,and all I could do during the cpr was pray for a miracle which never came, that was a life changing event for my tender heart to witness plus have to be the one to order the doctor his attempts at cpr as she had extremely low blood pressure to begin with when they attempted to put my mom on a vent and that’s when she flatlined.

  54. Thank you for sharing this, it settled and arguement. 🙂

  55. I learned this in first aid, however I asked a doctor about it before, and he said if he were out of other things to try he would shock a flatline, because it had a small chance of restarting the heart. Is there any truth to this, or was I speaking to a janitor with a stethoscope?

  56. Great post, really enjoyed reading and learned a lot.

  57. Thank you!!! Glad to know there are others out there. Correcting and “trying” to educate hundreds of thousands of IDIOTS!! I was beginning to think I was just a cynical asshole. Good to know there are more, fighting the good fight. #NoPeeingInGenePool

  58. If you would please read this and answer, I would be so appreciative.

    In a nightmare 2 years of tragedies that continue, after my Father (my hero) died mysteriously while up in Ohio, my Mother I adored became ill suddenly (while with me in S.C.) and bedridden in my care. Hospice came in; yet, I would not have them if I had it to do over.

    Mother revived a few times with Vitamin K; yet, one day she became unresponsive, and I had to call EMS to take her to the hospital.

    My Mother did not have a DNR; yet, they were not supposed to do CPR chest compressions since she was so frail. They were supposed to keep her hooked up to the medicines and oxygen though.

    As I frantically waited and demanded to be let in ICU, they unplugged my unresponsive Mother from the medicine (IVs) that would “keep her alive at least through the night” as I was told by my doctor who is now head of the AMA, Her IVs were out and she had no oxygen on when I was finally let in.

    They said she’s around the corner, told me to kiss her goodbye, said her HEART HAS STOPPED, and said she was GONE; HOWEVER, the monitor did not flatline for at least 15 minutes if not much longer. I was in shock, so I can’t recall. Her eyes were clear brown and they yellowed over 15 minutes later. If her heart had stopped, why did the monitor not flatline for at least 15 minutes?

    I demanded answers from the hospital CEO, my physician, and all who said they met all the next day over my questions which says clearly I asked the right questions.

    I owe this to my Mother (and I am in so much physical pain many days, but I refuse to enter the hospital where she died). I need to decide about very serious spine surgery that can only be done a few places, but won’t have it until I can at least get answers over Mother’s and Daddy’s deaths.

    My question here is for help please (and keep in mind, with no DNR, they never should have taken the meds from her arms and the oxygen off): Weren’t they negligent for unhooking her w/o a DNR? The time has surely passed for suing, so that’s not what this is about (although murder is murder). I just need answers.

    This is my basic question:
    If her heart had truly stopped, then why did the monitor continue to beep fairly strongly for 15 minutes at least before flatlining (… and her eyes not yellow over for that long also)?

  59. Brain damage or no brain damage, it’s immoral to let a patient die on the table because they will be injured in another way. Amputation anyone? This is devaluing life because of their “quality of life” or own personal experience. Their life is worth more than a handicap and selfish, foolish pronouncements of death by others.

    • My haunting thought though is that my Mother did NOT have a DNR,and legally as well as morally, it was not their call to “unplug her”.
      She was unresponsive which is why I called EMS; however, after demanding repeatedly, when they finally let me in the doors to ICU, the monitor was beeping strongly as opposed to a flatline. They said to kiss her goodbye. They said she was dead.
      They had unplugged her IVs, taken off her oxygen, and there was no flatline for quite a while. I saw her eyes yellow over 15 minutes later. Was she dead 15 minutes prior as the monitor beeped on or was she dead as a result of all the support being removed? This, I asked the CEO who said staff met all the next day over (and I also wanted the notes from that night and the mtg. which I did not get).
      I should have gotten an attorney.
      My haunting question will always be, “Was she dead or did they kill her?”
      I agree with you about the quality of life; yet, my stand is the legal DNR, and she did not have one which is a final legal choice we have that we make while healthy and sane, and it meant it was not the Angel of Death Nurse’s call to unplug her nor was it really mine that soon. Murder is immoral also.

      • I don’t know if you’ll see this since it’s been so long since you posted the original question, and caveat that i am not a medical professional but I was raised by one.

        If she had a pacemaker, then that could have been what you saw on the monitors and you only got a proper flatline when the sensors were removed. Pacemakers will continue to show a regular spike on the heart monitor even after the patient’s heart has stopped.

        It could also be that her condition was so severe that anything they could have done to save her *would* have killed her due to her frailty. (So if CPR was the only thing they could do and they had orders to not perform CPR, then they might just pronounce her like this.) As for the yellowing over of the eyes, this happens essentially due to the eyes drying out (actually more complicated than that, but that’s the general idea), which doesn’t happen immediately after death, it takes time to set in.

        • you’re right so I hope the person see’s your post and one I just posted and mine happened 6yrs ago flatlined 32+ after one dr gave up on me the 3rd time so now I have icd for life and I was only 43 at the time 49 now

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  61. Great article, clears up the ‘myth’ – Thanks!

  62. You just saved me from an embarrassing mistake. At least I knew enough to research! Love your blog!

  63. Hi Dr, i am a paramedic student in my second year studying for Advanced Life Support (ALS) in Namibia. My question is related to the meds administered during an active cardiac resuscitation mainly Adrenaline and Amiodarone Hydrochloride, our protocol guidelines state that (in short) : AMIODARONE simultaneously
    non-competitively blocks both α and β adrenergic receptors antagonizing
    tachycardia, hypertension and oxygen consumption of the myocardium.It primarily blocks potassium channels
    however also have blocking effects on sodium and calcium channels of

    ADRENALINE is an endogenous catecholamine that directly stimulates
    the α (alpha), β1 (Beta) and β
    2 adrenergic receptors. The primary
    beneficial effect during cardiac arrest is derived from its ∝ receptor
    stimulation and resultant effects being increased peripheral
    vasoconstriction therefore increasing peripheral vascular resistance.

    With that said during a resuscitation of a patient presenting with a VF or a PVT we are taught to administer a shock, proceed with CPR then administer adrenaline 1mg/ml and after 2 min CPR we administer 300mg amiodarone bolus. my question is; looking at the pharmacological action of both these drugs it looks as though they are antagonists each one doing the opposite of what the other one does, i was wondering how then is the simultaneous administration of these drugs going to result in a positive outcome if they would antagonize each other at the end of it all?

  64. […] a look at this excellent post on another blog which covered this topic before me (and better than I did). It’s an excellent […]

  65. I flatlined 32 times on paperwork and brought back the first time by my boxer jumping and giving compressions while doing woo woo noises they do and barking to get me help and there’s more to store……I’m the 2nd of two in the world the other I don’t know any info on.

  66. So the writers of Chicago Med know what they are doing with codes. Wish they would tone down the As the Med Turns vibe. Although it is very laughable amongst all the serious medical stuff. Supposedely the episodes are based on real cases. There is some weird stuff out there! I do appreciate the way psychiatry is represented. The ER Psychiatrist is one of the smartest, most compassionate doctors on the show.

  67. I’m a aicd patient of flatlined 34plus times before stopped counting and only reason they kept up was because I was fighting to come back so if anyone has questions you’re more then welcome to ask me and I will best to my ability to answer your question and being able to remember it. There’s a lot of things you go through when you flatline I am only the second person this is ever happened to in the United States. Sincerely,
    Herminia Pennell

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