“She was clinically dead” – fortunate timing, team effort save woman visiting hospital

December 21, 2016 | by Edward-Elmhurst Health

Talk about being in the right place at the right time when something terribly wrong happened. 

On the morning of Nov. 5, 2016, Tania Rients was visiting her husband, Jay, who was a patient at Edward Hospital, when she collapsed in the hallway outside his room on Edward’s 3rd floor Cardiac Telemetry Unit (CTU 3).

“I saw her through my peripheral vision and thought she was looking for (her husband’s) room when she fainted,” recalls Jennifer Stone, a patient care technician. “I yelled for help. That’s when Nikki came and assisted me.”

“She hit her head on the door on the way down is what I think happened,” says Nikki Malatesta, RN, a nurse on CTU 3. “I ran and got gloves and hit the emergency button and that’s when Amy came over.”

“I could recognize immediately that she needed CPR (cardiopulmonary resuscitation),” says Amy Heer, RN, a nurse with 12 years of experience. “I started doing chest compressions and I yelled to Nikki to grab an (oxygen) bag to do the breaths and, together, we did two full minutes of CPR.”

And so began the series of events, the “chain of life” as it’s called in the medical profession, in which Edward doctors, nurses and staff proceeded to save Rients’ life.

The emergency button that Malatesta hit activated a Code Blue, which means someone has gone into cardiac arrest and prompts the response of a team of doctors and nurses specifically created for such events.

Stanley Clark, MD, an invasive cardiologist with Advocate Medical Group, was one of those who responded to the code.

“When the nurses found her, she did not have a pulse, she did not have a blood pressure. She was clinically dead,” says Dr. Clark. “Her survival really was based on the nurse initiating rapid, appropriate chest compressions, which after about a minute, revived her and she woke up.

“It was pretty obvious that she was critically ill and we thought that she could have suffered a pulmonary embolism, a blood clot that moved from the legs to the lungs.”

Rients, a 44-year-old resident of Plainfield, was taken to the Edward Emergency Department. While there, her heart stopped again and CPR was performed again to resuscitate her. Testing confirmed that she did have a pulmonary embolism and laceration with hemorrhage in her scalp due to hitting her head when she collapsed. There was no evidence of bleeding in her brain, but she was at increased risk for this due to her fall.

After review with Bryan Foy, MD, system medical director, cardiac surgery, Edward-Elmhurst Health, and a cardiothoracic surgeon with Cardiac Surgery Associates, and Timothy Larkin, MD, an interventional cardiologist with Advocate Medical Group, the best option was felt to be catheter-directed thrombolytic therapy.

The pulmonary embolism meant Rients required treatment in Edward’s Cardiac Catheterization Lab. In another instance of “right place, right time,” Dr. Larkin and the cath lab team were already there and ready for her because they had come in that Saturday morning for a procedure on another patient.

“The two things that saved her life were, one, she was at a hospital, and two, that she was at this hospital, where we have a system to rapidly intervene, either surgically or in the cath lab, to dissolve the clot,” says Dr. Clark.

In this case, because of the possibility of bleeding in her brain, the catheter-based treatment placed a clot-busting medication directly onto the clots in her lungs, using a dose about one-fifth of what would have been given if it had been administered through an IV and circulated through the patient’s entire body.

That turned out to be critical because Rients did experience a tiny bleed in her brain, which caused her to have a seizure the next day. If the larger dose of clot-busting medicine had been given, her blood would have been thinner and the bleed in her brain could have been life-threatening.

Instead, doctors stopped the clot-dissolving medicine and inserted a filter in her inferior vena cava (the blood vessel that carries blood from the lower body to the heart) to catch any clots from entering her lungs. 

“I’ll be on blood thinners the rest of my life, and I’ll have to be careful and need to be monitored, but I can live a long, full life,” says Rients, who is certainly aware of her good fortune.

“I remember thinking, I’m really lucky to be here,” she says. “How perfectly could this horrible situation have been aligned?”

“It’s more than we have great nurses who knew how to react in an emergency situation,” says Dr. Clark. “It’s that we have a program in place. This was a team effort at multiple, multiple stages. I’m not saying she’s lucky, but boy, is she lucky.

“If this had happened to her at home or anywhere where she was by herself, I don’t think she’d be alive today.” 

Rients and her medical team share her story.

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