48 hours of fun, a 26.2 mile race, and a few lives saved.

     This weekend I worked 48 hours. Two 12 hour shifts and a 24 hour rescue shift. Shift number one was the most eventful and exciting. The rest of the weekend was pretty "run of the mill" as far as EMS goes.
     My partner and I had two very good and very successful calls this weekend. The first one where he was the lead medic, was a LoL (Little old lady) in CHF. She was confused, not talking well, had a very low sat of 74%, and her lungs sounded like a washing machine. We started treatment right away. As my partner put her on the monitor and looked for a line, I put this LoL on high flow o2 and got the drugs ready. She responded well to initial treatments but would de-sat once you turn the o2 down. I asked about CPAP, but since I was driving it wasn't my call. We did prepare her for it though, explained to her what was going to happen once we got her to the hospital.
     The second call of that successful day was initially dispatched out as a cardiac arrest in one of the worst places ever. Lets just say that the unofficial acronym for the area suits it and that the location was 10+ stories tall. So we get there and take all of our gear up to the "Penthouse" and were met by PD who told us that it was "obvious death". When we walked in, the smell was overpowering. Now I have smelled some pretty bad odors doing this job. This place was top three. I can see how PD thought the guy was dead. However, if you looked at him for more than 0.5 seconds, you could see that he was breathing. Luck for us he was all of 90 lbs and was an easy extrication. So his vitals were as follows BP (per monitor) 40/20, Pulse 41, resps 8, and CBG (that's blood sugar) read "low". You almost could not feel a central pulse on this person. So treatment consisted of the typical IV, 02, monitor, D50%, atropine, and a multiple fluid boluses. We also warmed him up with blankets and turning the heat up in the truck.
      The funny thing about this call was that with someone like this with a BP in the toilet, I was able to get a 16g IV in the AC. However, I was unable to get a second line in the other arm. This got me thinking, I could have attempted the saline push against at TQ technique. This is a fairly simple procedure to put a bigger line in a pt where you can only get smaller lines (22-24g) in. What you do is you place the smaller line in the pt and leave the TQ in place. Then using that smaller line, you push 50-60cc of NACL with the TQ in place. This causes the viens lumen to expand from the pressure and allows you to put a bigger line in. 18 or bigger. This is a great technique for pts that are hypovolemic for any number of reason. I wish I knew about this when I was deployed.
     Finally, my friend Stephanie did an excellent job on an arrest that occurred during the Detroit Free Press Marathon. She not only acted quickly and professionally but her actions resulted in an honest to god save! The pt she treated was not only extubated recently, but is completely neurologically intact. Way to go girl! Great job.