Today started like any other day at my current place of employment. Coffee in hand I show up early to get the truck ready for a day of slinging medicare/medicaid pts around town. Luckily to my surprise, my partner called off and so did one of the medics at one of the out stations I am used to working. Rescue is much better than just posting and doing transfers. We still did a transfer, but we are not at that part of the story yet. So I get assigned to go work my 12 hours of mandatory fun on the rescue truck or "car" as they call them here. I am still getting used to that.
Now since I have already had my caffeine bolus for the morning, I am ready to be productive while my partner takes a nap. I worked on homework and my newest goal, studying (and passing) the FP-C exam. For those of you out there that don't know what that is, it is the Flight Paramedic Certification. I figure I might as well give it a shot. Who knows. You have to at least try for something even if the odds are stacked against you. Today's topic was CVA management. Interesting topic and let me to the idea of flash cards.
Anyway, we were paid to do homework and sleep for 4 hours or so before we received our first call. Then the tones go off for a male pt under 50 who is not breathing. We moan and groan and take off priority one. After all, a body in rest likes to remain at rest. We get out to the "park of mobile estates" to find the FD providing excellent BLS. BVM, OPA, CPR, and AED all placed and going. It was a witnessed arrest and and we started our ACLS portion of the resuscitation. The AED stated shock advised. So, "I'm clear, your, clear, every body clear" then POW! 360 monophasic joules to the myocardium. CPR was immediately resumed. At this point we got our monitor on there and saw course V-Fib. We have a chance to save this guy. My partner was having trouble placing a line due to the mess that was this pts vascular system due to was appeared to be some recreational use of "substances". I place the line and we continue the resuscitation effort per protocol. At this point, we have an ETT tube confirmed with both ascultation and capnography. I have to say I really love capnography. What a great tool. Initial ETCO2 was 9mmHg and was as high as 25 during our resus efforts. Good CPR and a chance for survival. Win or loose, it is good to know that what you are doing is not futile.
Another interesting piece of info to point out is that I had a chance to use my code marker on my phone again. It is a great tool for documentation and time keeping. However, my partner didn't know I had this app on my phone and thought I was texting or checking my facebook page during the code. Ha! I showed it to her later and she got the picture. Still, the main thing point out for this call was the use of ETCO2 for tube placement and confirmation, as well as eval of resus efforts.
So we do what we can on scene and transport the pt priority one to the local ER. Upon arrival we give our report, help with compressions, and clean up the truck as best we can. They work the code for another 20 minutes. Calcium chloride, bicarb, and more epi is pushed. I guess they didn't read the newest ACLS guidelines. But then again, I am no MD. They can do what ever they want. Or so it seems anyway, after a few unsuccessful central line placements and a FAST exam with the ultrasound machine, they call the code.
Busy call to say the least, all the CPR and lifting was alot of work. However, I tweak my back lifting the gurney with the 95 lbs lady we transfer for cardiac cath. WTF?
Anywho, the more and more I do this, the more and more I realize I can not do it for ever. I like medicine and enjoy what I do, but I also am hungry for more and more knowledge. That is why I am challenging the FP-C exam next year and that is why I am furthering my education and career. One of these days I will be done with school. One of these days. Until them I will be studying until the tones go off again.
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