So a couple of things today. First of, as a "part timer" I have run 555 calls to date. I will not go into the who, what, when, where, or why that number was brought up, but it is still an interesting bit of information.
Now for what I feel is the more interesting topic of one of my latest rescue shifts. We were busy pretty much all day. I didn't even have a chance to eat until about 6pm. I ended up getting pad tai. Now I am not sure if it really was that delicious or I was that hungry, but man was it good. I will have to hit that place up again. Anyway, as I digress...we finally get back to the station around 9pm. Just in time to watch an episode of American Dad and grab some shut eye.
Unfortunately, the tones go off about an hour and change later for "one unresponsive" in our coverage area. So we hop in our trusty rescue truck and roll out priority one. En route we hear over the radio via the FD radio that we have a priority one patient and that CPR was in progress. Great. So I start going though the protocols and algorithms in my head and start my documentation as best I can before we arrive on scene.
Quick question here, why is it that most people die on the toilet? I'm not trying to be disrespectful or callous, but I have been doing this long enough to have run into that situation more than I would like to admit. At any rate, good CPR/BLS care is being provided by one of my favorite FDs in a cramped little bathroom in a nice clean little home to a run of the mill retired medicare recipient. They have also placed a combitube. Not my favorite airway, but hey it was working and it didn't perforate the trachea. Works for me. Oh and the AED stated "no shock advised". PEA at a rate of 50 in what appeared to be a junctional-ish rhythm.
So the ABC's of BLS care are all taken care of. Now it is time for some ALS interventions.With such cramped conditions, starting the IV was a bit of a backwards affair. I placed a 14g EJ. Partially because I could and partially because I could justify it for the resuscitation attempt. So the line is good and we get our first epi on board and swap out our CPR pumpers (thanks again guys). As we go we hook up the EtCo2 monitor to the combitube and get a reading of 25. Not bad. Since this was a pseudo witnessed arrest with minimal down time, I could see this possibly being a case that we transport.
As time goes on and epi after epi is pushed and people are switching out to do CPR, we start to reach the point where we should probably terminate resusitative efforts. After all, five epis is a lot. So I get medical control on the phone at one of our friendly neighborhood ERs and give them the scoop. Old person, down approx. 10 prior to EMS arrival with 30min of ACLS care and no ROSC at any point. The pt was still in PEA which was kind of odd. I am attributing that to the short down time. So the doc orders 2 amps of Bicarb and an amp of Calcium chloride. OK, I could see that. I would probably tried it anyway. Then came the order out of left field.
The MD asked me to do bilateral needle decompressions and let him know what the response was in 5 minutes. He would stay on the line. It was a bit odd having the phone to my ear and actively running a code at the same time. So the needles are place in the 2nd intercostal space at the mid-clavicular line and no drastic rush of air is noted. Conclusion, no pneumos. The pt is still in PEA at a rate of 30 in the same junctional-ish rhythm. I was surprised to have him call it at that point and not request us to transport. So we discontinued resusitative efforts at that point and printed our final strip (asystole) and broke the news to the family. They were very understanding. My heart goes out to them.
I have to say it was a bit of surprise to have such a stubborn arrest pt that never went into v-fib. We then spent the next hour and change cleaning up the truck and finishing the documentation for our code. Goes to show you that you never know what will happen on call or in a code for that matter. Until next time.
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