The other day I was working my pseudo regular shift when a call went out for a seizure in the middle of an intersection right down the street from one of the hospitals we go to on a very regular basis. According to FD, PD, and by standers, the pt had stopped his motorcycle at a red light, put the kick stand down and then slumped to the ground.
Since details were sketchy at best, I will just give you what I have from the time we arrived on scene. Our sister agencies that responded with us did a fabulous job of surrounding the pt and making a pretty safe environment for us to work. Not too bad for the middle of a busy intersection. So from my seat in the ambulance I see a fire fighter holding c-spine on a male pt with a motorcycle helmet on. As we get out with our super hero reflective vests and walk up to the pt, I notice he is not breathing. We quickly and carefully get his helmet off and it was then I realize that the pt is in full cardiac arrest. I cut off his shirt and then received a crazy look from one of the fire fighters when I told him to start CPR. It was one of those "You gotta be !@#$% kidding me", kind of looks. Now I have been known to be a smart ass on scene from time to time. Nothing rude, just fun little jabs at my fellow responders. However, the middle of a busy intersection with a patient in full arrest is neither the time, nor the place. At any rate, he reluctantly started CPR.
Now that BLS measure were implemented, ALS and transportation were being organized and deployed. My partner threw on the pads while I attempted to intubate the patient, breaking many of my own rules of intubation. I will explain in a minute. So our "seizure" patient is in course V-Fib and received 200J of home grown, biphasic DTE energy. He jolted and we again started CPR while my partner secured vascular access.
Now on to me and breaking my own rules of intubation. As emergent of a procedure as it was in this particular situation, the first step is to not rush. Broke that rule. Next, I didn't get the pt positioned properly for the greatest view. I tried to placed the tube without the external auditory meatus with the menubrium. It's a great way of ensuring that you goose the tube instead of being the man with the plan and passing it through the chords. So I didn't have greatest view when instrumenting the airway. Lessons learned. Oh and attempting to intubate with sunglasses on may look cool, but you won't be able to see shit.
Now, back to the intersection of CPR and defibrillation. In the short period of time it takes to shock, get an IV, shock again, attempt to intubate, package, shock, and transport down the street (literally) to the hospital, the patient received 6 or 7 doses of electricity and remained in V-Fib the entire time. Calling report was interesting to say the least. BLS ventilations and using a cell phone at the same time probably looked a bit funny to John Q. Public passing by.
So we code him in to the ER and take him to resus where the docs use the glidescope to make intubation look like the easiest thing in the world and start pushing some meds. They work him for a few minutes but end up calling it.
This was one of those calls that really drives home the point that anything can happen doing this job and to expect the unexpected. EMS will always throw you a curve ball. You just have to be ready to recognize it and adjust your actions accordingly.
