So recently, I have been working a steady schedule of rescue and it seems as though my partner and I will work an arrest every shift. Good practice, I guess. This call was a bit of a mess though. Mainly because of the thick viscous and sometimes chunky (gravy-ish consistency) fluid that was pouring out of his airway that never really stopped. I mean it looked as though there was a good liter of it next to his head when all was said and done.Gross! Now let me paint you a better picture of the situation.
My partner and I first get the call for someone bleeding. No specific reason why this person is hemorrhaging or where the blood is coming from. So we get there just as the local FD is applying the AED pads. "NO SHOCK ADVISED. BEGIN CPR" is heard through the doorway. As we walking we see a middle aged pt with black-ish fluid/stuff on his face and in his mouth. So we quickly switch the AED pads over to our monitor thinking that this will be an easy pronouncement, and the monitor says...PEA. Great. So we start CPR in this very cluttered and cramped bed room and start the process of ACLS care.
Now I am at the head of the pt and start to work on managing the airway. This putrid black liquid just keeps coming out of his mouth. It clogs up the suction machine several times and I even had to pull off the yaunkauer off and just use the tubing from time to time. Bagging is basically impossible right now. Repositioning, suctioning, and BLS maneuvers were not giving us good chest rise. As I said earlier, this fluid just keeps coming. So while I am continuing to stain the carpet with this horrible death gravy, my partner is getting a line, a CBG, and pushing drugs. The pt is still in PEA so mostly just epi after epi. We did find out that the pt had a CBG of 60mg/dL. We corrected that with no change in status.
Great CPR is being done right now and the airway is still not clear. So I guess better now then never, I attempt to find what might possibly be chords in the sea of black that is still coming out of this persons mouth. Nothing. Try to bag again with basic airway adjuncts and more suctioning. Still nothing. I try one more time as the FD is getting a combi tube ready. Again nothing. Better drop the humility airway (hate to admit it, but medics sometimes have to put their ego aside to place the most appropriate airway. Me included). So the airway is placed and immediately black garbage pops out of the top of both tubes. Again, gross! So suction and more suction to both tubes just to be able to use the damn thing. Finally we get the tubes clear and the correct one receiving positive pressure ventilation. Which still needs a bit more suction. Ugh!
ACLS protocol is still being followed and we are reaching a point where we should terminate resuscitation. We call the local hospital and don't get any crazy orders this time before calling the code. Time of death, right meow. Now we have to break the news to the family.
Don't ask me why I said I would do it, but I did and I feel I did an especially bad job at it. Now I have done these many times and have had to break the news to family. But for some reason, I think I just F'd this one up. I was to the point and didn't use euphemisms but it just didn't go well. I will spare the details, but I need to look at this as a learning experience.
So we finally clear and clean our truck and get a new drug box. Just to reiterate, messiest code ever. Ugh!
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