When I was in the military, I was always busy. I worked in the ER, was a preceptor for the medic students, ACLS/BLS/EMT instructor, etc, etc, etc. I thought I would be less busy when I got out of the military and only had to work and go to school. Turns out I was wrong. My need to be constantly busy has made me a glutton for over time. Hence why I just worked 60 hour this past weekend. I did a 12 on Friday and then a 48 from Saturday to Monday morning.
So I was a bit tired at the half way mark with my 48. We didn't get a lot of sleep but we didn't have that many calls. I guess that is the silver lining right there. The back half of my 48 however, was a different story. I think we ran 8 or 9 calls and most of them were a bit of a challenge for some reason. We had the diabetic with a sugar of "low" that was a bit of a vascular challenge that ended up getting a 24g in his thumb to get the wake up juice, a chest painer with a serious case of denial, and to top it all off, a cardiac arrest.
The arrest was a bit of a mess. Well, more so normal. It was a witnessed arrest with a short downtime. However, the presenting rhythm was asystole. We work the code per protocol. I had trouble getting the tube and had to stop, bag, suction, and try again. I got it on the second try but I was having a bit of trouble getting the tube past the chords, but we made it happen. The initial EtC02 was not too bad for an arrest (25mmHg) but there was a lot of fluid in the lungs and it compromised the detector. We had good chest rise and fall, colormetric changes (go for the gold), and no sounds over the epigastric area. The tube was in, but there was just a lot of stuff that needed to be either in the suction container or on the floor.
Oh and this pt was another vascular nightmare. No EJs, my partner bent the I/O needle (probably is own endogenous catacholamine circulation), and so on. One of our friendly neighborhood fire fighters got the line. Thanks man, we always appreciate the help. So 6 rounds of drugs later the pt is in a sinus PEA at a rate of 75. We have exhausted all of our options and made the call to medical direct if they want us to transport the pt or not. The result of that conversation was "time of death 0'dark-30". Surprised this MD didn't have me do bilateral needle decompressions again.
It was now time for the worst part of my job, breaking bad news. I would much rather work arrests and transport them just to avoid such difficult situation. However, that would not be safe for the crew, beneficial to the pt, or the family most of the time. However, in order to be a true professional, one must step outside of his or her comfort zone and do the appropriate thing. In this situation you have to be blunt and not use terms like "passed away", "no longer with us", or "is in a better place". You need to be clear and say "your loved one is dead". Then we have the horrible task of having to get signatures and insurance information. I hate that part of the job. Ugh!
After all of that, the second worst part of working an arrest is the paperwork involved and the clean up. Usually the clean up is faster than documentation. Our new e-pcr software can be very time consuming with involved calls like this. Usually putting all the drugs/interventions in chronological order is the most time consuming. I did use my full code IPhone app for this code and it really helped out. It helped us to swap out CPR providers and kept good track of our ALS interventions. So it helped cut down on documentation time.
Overall, I am (probably) not going to work a 48 again anytime soon. Oh well, clean the truck, write the report, and get 10-8 as soon as possible. Off to the next adventure.
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