So fairly recently I was working rescue with one of the more "talkative" medics in the area when we get a call for a fall. Ugh! I don't want to start my day off with a fall! It's funny how in this job the more stressful, demanding, and even difficult the call is, the more we want it. Well...that is how I am anyway. I would rather do back to back priority 1 calls for a 24 hour period than do 12 hours of slinging renal pts to and from the chair.
Anyway, as I digress...as we are enroute to our call were we would have to put on our happy faces and BLS the hell out of this call we hear the FD state over the radio "Priority one pt. CPR in progress". My partner and I look at each other and start to speculate on the matter at hand. Keep in mind that he has already surpassed his expect amount of word I thought he was going to say to me throughout the following 12 hours. I come up with a very plausible scenario to bounce off of my partner. "Where did this pt fall from, the Moon?". He shrugs and swears and complains to the steering wheel as he drive faster now that our priority one call is real.
Upon arrival we find our friends on the FD doing CPR on average size man who was acting strange before they got there and went unconscious in front of them. They are doing great compressions and ventilations but the AED was screaming no shock advised.
The strangest thing happened after we did another round of CPR, swapped out the pads for our own monitor...the pt started breathing again and had a relatively good pulse. It was certainly a "WTF?" moment for all of us. Then he tries to sit up. We all jump in because he is now trying to roll all over the place and not exactly being the most cooperative pt at this point. I glance over at the monitor and he is in V-Tach. Then he goes unresponsive again with no pulse. Boooooooooo.....Clear! And he is hit with 200J (Biphasic) of Detroit Edison (DTE). And we start the CPR game again. Right after the shock, the pt was in a wide, regular, and very odd looking brady rhythm. However, this rhythm quickly upgraded to a much more friendly looking sinus tach at about 130.
With CPR going on immediately in the post defib phase, the FD was getting ready to drop a King LT airway when I notice the pt reaching up for his chest. STOP CPR! The pt is again breathing and has a pulse. The game of sit on the pt starts again, making placing a line that much more difficult. I find my self sitting on his knees and placing a large bore IV at the same time. Thankfully my years of military experience have taught me the importance of multitasking in stressful situations. This allowed for a good line and a bolus dose of an anti arrhythmic to be given.
We are sinus tach still on the monitor with a great pulse and BP. He was still combative and confused so we restrained him and transported him to the closest hospital where he could undergo emergent interventional cardiology. As we are transporting with disco balls and noise makers, the pt starts asking more lucid questions like "What happened", "Why am I tied up", and "Where are we going". Looks like we got a CPC 1 upon arrival and a CPC 2 immediately upon gaining ROSC.
We get to the hospital and give report to the receiving team in the ER. He was actually stabilized and immediately transported to another facility by our MICU team for an emergent CABG.
It is always nice to put one in the win column. More often than not people usually do not survive SCA out of the hospital. This was a great example of how a quick response and teamwork can really save someones life and make you look and feel like a rock star.
Thursday, December 29, 2011
Saturday, December 10, 2011
Bloody boot prints
You ever have one of those call where you end up tracking blood into the ER? Had one recently. We got the call for a laceration. Could be something crazy or it could be nothing. Well on this call, it was most certainly something crazy. Well, crazy may be a bad word to describe this call, but none the less, it was an interesting situation.
As my partner and I pull up on scene to a collection of PD and FD vehicles, we hear what I can only describe as "ruckus" and "Hootenanny" coming from the open door of where our pt is located. I use those terms in hopes it paints a better picture of the scene. For those of you that have not figured it out yet, we are very much in red neck territory. Oh and before I go any further, you don't have to live on 100 acres of farm land that more deer stands, "shine stills", and meth labs than people to be in red neck territory. Red neck territory is anywhere one who fits this description sets up shop and plants their rebel flag. So it could very well be in the middle of a trendy part of town, the burbs, or a rural area. At any rate, "abandon all hope ye who enter in" should have been on the door. Anyway, as I digress...
The Appalachian American melee that is going down in front of me is actually in the middle of a pool of blood. There is also blood everywhere! The floor of the kitchen, living room, and all over clothes. Looked like the set of an amateur horror film. And of course this particular individual didn't want to go to the hospital. Of course. Who would want to leave a 1/5th of their circulating blood volume on the floor unattended? Whatever...
So after a phone call to medical control, a set of handcuffs, and an excellent bandaging job by the FD (good job as always guys), we are off to the hospital. Just FYI, the phone call to med control was not for the handcuffs. I left out the details of the call on purpose. Anyway, an IV is placed and a fluid bolus is given. The pt at this point is telling dirty jokes and being very much the social butterfly. However, as soon as you ask him about his medical history and what happened, the mood changes and he turns away. Ugh!
Upon arrival to the ER the doc asks if the bleeding was arterial or venous and if there was what appeared to be "spurting" patterns on the wall. Answer to the question was "no". So I give report, hand off care and go to finish my paperwork. However, as I walk out of the pt's room I notice bloody foot prints on the floor. Those foot prints belonged to me. I tracked blood, mud, and whatnot all over the ER. You have to admit that a bloody foot print is a eerie sight to see. Especially when it is yours. At least the blood wasn't mine.
As my partner and I pull up on scene to a collection of PD and FD vehicles, we hear what I can only describe as "ruckus" and "Hootenanny" coming from the open door of where our pt is located. I use those terms in hopes it paints a better picture of the scene. For those of you that have not figured it out yet, we are very much in red neck territory. Oh and before I go any further, you don't have to live on 100 acres of farm land that more deer stands, "shine stills", and meth labs than people to be in red neck territory. Red neck territory is anywhere one who fits this description sets up shop and plants their rebel flag. So it could very well be in the middle of a trendy part of town, the burbs, or a rural area. At any rate, "abandon all hope ye who enter in" should have been on the door. Anyway, as I digress...
The Appalachian American melee that is going down in front of me is actually in the middle of a pool of blood. There is also blood everywhere! The floor of the kitchen, living room, and all over clothes. Looked like the set of an amateur horror film. And of course this particular individual didn't want to go to the hospital. Of course. Who would want to leave a 1/5th of their circulating blood volume on the floor unattended? Whatever...
So after a phone call to medical control, a set of handcuffs, and an excellent bandaging job by the FD (good job as always guys), we are off to the hospital. Just FYI, the phone call to med control was not for the handcuffs. I left out the details of the call on purpose. Anyway, an IV is placed and a fluid bolus is given. The pt at this point is telling dirty jokes and being very much the social butterfly. However, as soon as you ask him about his medical history and what happened, the mood changes and he turns away. Ugh!
Upon arrival to the ER the doc asks if the bleeding was arterial or venous and if there was what appeared to be "spurting" patterns on the wall. Answer to the question was "no". So I give report, hand off care and go to finish my paperwork. However, as I walk out of the pt's room I notice bloody foot prints on the floor. Those foot prints belonged to me. I tracked blood, mud, and whatnot all over the ER. You have to admit that a bloody foot print is a eerie sight to see. Especially when it is yours. At least the blood wasn't mine.
Now how exactly did you get out here...on top of that?
Fairly recently I was working a fairly busy 24 hour shift out in my usual coverage area. We did our fair share of calls during the day, but nothing that was too exciting or in this case, blog worthy. So we get back to the station to hopefully settle in for what we always hope is a slow, quiet, uneventful, and basically filled with hours and hours of sleep. However, just the lights go off in the station, so do the tones. Ugh! Now what! Do people know not to get hurt or have a medical issue after 10pm?
The call is actually right down the street (figuratively) for a traffic accident. So far it doesn't really get our adrenalin pumping. That is until the dispatcher states that it was a roll over and the pt had been ejected from the vehicle. Lights and sirens, here we go!
3,2,1 we are on scene with the FD who had shown up just a minute or so before us. The collection of metal and plastic pieces that used to be a car was now nothing more than a heap of twisted metal. Mechanism of injury = bad. But where is the pt? Sometimes under the haze of midnight, flashing lights, and the flurry of activity between passing on lookers, PD, and fire, things can get a bit hectic. However, we find our pt awake, in pain, and on top of what I thought was the front windshield. As it turns out it was actually the rear windshield. WTF? How did you do that?
Apparently this pt was not wearing a seat belt and was subject to the totally random injury pattern/movement of the vehicle when it rolled more times than a hot dog at 7-11. As it turns out, the pt was actually laying on top of the rear windshield. Apparently he felt he needed to take it with him on his 20ft flight from his vehicle to the lawn of the person that I hope called 911. Now I am very much an advocate for the whole "Seat belts save lives" concept, but this guy was very much the exception. If he had his belt on, he would have to be cut out of the jungle gym that was now the front compartment of his vehicle. Then things would have to get more complicated, helicopters would need to be called, injury would probably be worse, and so on.
So what we start the typical trauma/pre-hospital checklist with a sense of urgency. A,B,C's are good but our pt with the wreck any NASCAR driver would be proud to have caused looks uncomfortable to say the very least. Oh and our rapid trauma assessment (eyes and scissors) revealed that it would have been a very bad idea to roll him to the right side since he had what could be either a hip or femur fracture. Either way, a bunch of orthopedic badness that requires surgical intervention.
At this point he is carefully manhandled in a calm and professional way to ensure he is packaged properly for transport to a trauma center. His vitals are stable-ish but due to the injury and the crazy damage to the car, we felt it would be a good idea to get two big antecubital lines in this particular pt. My partner and I both pop in 16g IVs and I am sure the collective thought process in the back of this ALS rig was "boom goes the thunder".
And now we are off towards the interstate to take us to the trauma center so this pt can make it to a surgeon, preferably an orthopod. The ride is uneventful and the pt is well enough to tell a couple of dirty jokes and complain about the "great roads" we have in the area.
As we roll into the trauma bay, report is given and care is transferred to the trauma team. Sometimes you can get complacent with the idea that nothing other than diabetics and COPDers live in your are, but severe trauma can happen anywhere.
The call is actually right down the street (figuratively) for a traffic accident. So far it doesn't really get our adrenalin pumping. That is until the dispatcher states that it was a roll over and the pt had been ejected from the vehicle. Lights and sirens, here we go!
3,2,1 we are on scene with the FD who had shown up just a minute or so before us. The collection of metal and plastic pieces that used to be a car was now nothing more than a heap of twisted metal. Mechanism of injury = bad. But where is the pt? Sometimes under the haze of midnight, flashing lights, and the flurry of activity between passing on lookers, PD, and fire, things can get a bit hectic. However, we find our pt awake, in pain, and on top of what I thought was the front windshield. As it turns out it was actually the rear windshield. WTF? How did you do that?
Apparently this pt was not wearing a seat belt and was subject to the totally random injury pattern/movement of the vehicle when it rolled more times than a hot dog at 7-11. As it turns out, the pt was actually laying on top of the rear windshield. Apparently he felt he needed to take it with him on his 20ft flight from his vehicle to the lawn of the person that I hope called 911. Now I am very much an advocate for the whole "Seat belts save lives" concept, but this guy was very much the exception. If he had his belt on, he would have to be cut out of the jungle gym that was now the front compartment of his vehicle. Then things would have to get more complicated, helicopters would need to be called, injury would probably be worse, and so on.
So what we start the typical trauma/pre-hospital checklist with a sense of urgency. A,B,C's are good but our pt with the wreck any NASCAR driver would be proud to have caused looks uncomfortable to say the very least. Oh and our rapid trauma assessment (eyes and scissors) revealed that it would have been a very bad idea to roll him to the right side since he had what could be either a hip or femur fracture. Either way, a bunch of orthopedic badness that requires surgical intervention.
At this point he is carefully manhandled in a calm and professional way to ensure he is packaged properly for transport to a trauma center. His vitals are stable-ish but due to the injury and the crazy damage to the car, we felt it would be a good idea to get two big antecubital lines in this particular pt. My partner and I both pop in 16g IVs and I am sure the collective thought process in the back of this ALS rig was "boom goes the thunder".
And now we are off towards the interstate to take us to the trauma center so this pt can make it to a surgeon, preferably an orthopod. The ride is uneventful and the pt is well enough to tell a couple of dirty jokes and complain about the "great roads" we have in the area.
As we roll into the trauma bay, report is given and care is transferred to the trauma team. Sometimes you can get complacent with the idea that nothing other than diabetics and COPDers live in your are, but severe trauma can happen anywhere.
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