ROSC to the LAB

It was that time of the week for me. I did was working my agreed upon extra shift and I was lucky enough to grab a 24 hour rescue shift. Hopefully I can get some sleep and some studying done. But If I have to only choose one, I will go with sleep every single time. I can always do homework the following day. And since I have not mastered that whole doing homework in my sleep thing, I will have to make the sacrifice. Too bad for us there was not a whole lot of time for either one of things. Gotta love rescue shifts for that.
     We stayed pretty busy throughout the day. Nothing too exciting or challenging, just busy. Before we knew it, we missed lunch and were probably going to miss dinner too if we didn't make something happen soon. Most of that shift was blur so I think we just broke down and gave into the golden arches or some other poly-saturated fast food, deep fried guilt.
     It is now 2 hours past my bed time and we FINALLY get cleared back to the station to hopefully get some sleep. Apparently Murphy and his damn law were watching because no sooner did I get my boots off did the tones drop. Great. As I am tying my boots up again the radio/pager is going off in that "explain to me why this was a good idea" kind of way. I don't catch most of the call, but I do hear CPR in progress. GREAT!
    My partner and I respond priority one to the location which happens to be very close to one of the local fire departments. This is actually a very good thing for the pt. We get there to find a moderately old person in full arrest with the FD doing a great job as usual with the BLS care. We get the story as we work on our ALS stuff. It was a sudden and witnessed arrest and CPR was started right away.
     We throw the pads on for our monitor, my partner is working on getting a definitive airway, and I start working on getting vascular access. We have some trouble obtaining both of these thing initially but the tube gets placed and we get a line. And now it's about that to do a rhythm/pulse check. And wouldn't you know it, we got a pulse and a fairly good looking sinus rhythm. TIME TO GO!
     As the pt is getting packaged up for transport and loaded into the ambulance, he arrests again. Thanks buddy. I could have done without that. But we do some CPR, give some epi, and shock him back out of vfib and into NSR. This time I take advantage of the decent BP and throw in a second line. And by the time this is all said and done, we are pulling into the ambulance bay.
     As we are unloading, giving report, transferring to the gurney, and swapping leads, the second IV I placed enroute gets pulled out. WTF!? But it's OK, he still has a pulse and a perfusing rhythm. The 12 lead shows elevation in II, III, and aVF. Sounds like my friends from the cardiac cath lab are going to be getting a call very shortly.
      As the cath team starts to show up, we are starting to get more of a story and history on our ROSC pt. Apparently this person is the proud owner of 13 previous stents and a slew of other medical issues. I swear he was being kept alive by beta blockers, Metformin, and medicare.
     Once all the players were in place and the pt was placed in the cath lab, I was able to start my report. But I wanted to watch the cath too, so I did my documentation from the comfort of the control room. When they shot their first films, I could see the RCA before any dye was pushed. The Pt's entire RCA was stents. It was amazing. Not to mention the fact that he ended up with an additional stent as well.
      I have to admit, it is nice to be able to put one in the the proverbial win column from time to time. Especially when they go from dead to a live. And in true EMS fashion, it took longer to do the documentation than it did to do the call. But that is OK, because we spent the rest of the shift bouncing from post to post like zombies with drivers licenses but instead of brains we just wanted sleep.

Costumes, kegs, and brides maids, oh my!

     So there I was, right...sleeping at the rescue station, minding my own business at 0'dark thirty when the tones go off. I release a string of profanity that I am sure most of the block heard. But hey, we gotta job to do, right? Right. No earning money sleeping (see what I did there?) tonight.
     While enroute to the location of our call for a car v/s tree, my partner and I coming to full consciousness and start asking the obvious question. Why are they at this particular location so late, how did they hit a tree, and how drunk do you think this person is? Much to our eventual and retrospective surprise, all of those questions were actually answered. So we do our lights and siren thing and pull up on scene to a complete melee of "WTF"?
     At first we assume that there is some sort of party going on due to the amount of people out and about. However, it's not your normal party when the first person you notice is a man in a dress. Again, WTF? There painted faces, a lot of beer, and a group of women wearing matching dresses. As it turns out, there was a wedding and a Halloween party going on at the same time. You can't make this stuff up.
     Now our pt is what many would call a "good ol' boy". All 290 lbs of him. And he is about as drunk as you can get without being in a coma. Now alcohol can make people do many things. For some people, it causes them to regress to an earlier state of consciousness. In other words, it makes them act like children. Judging from the amount of ETOH this Appalachian American had ingested, I figured he had regressed to about 5 years old. He was barely cooperative and when you would tell him to sit still, he would for about 3 second, move his arms while you are taking a blood pressure or doing some other medical procedure, and then say that he didn't or something else to that remark. Ugh! Frustrating to say the least.
     However, drunky McDrunkerton had very abnormal vital signs and needed to go to the hospital whether he liked it or not. The problem was that he was probably not going to go willingly. Thankfully the police officer on scene gave the guy two options: ER or jail. And with a lot of hemming and hawing, "Cletus" opted for the hospital. Don't worry. You can get arrested once you sober up. Oh and when he finally blew for the cops, I thought the machine was going to explode. It was waaayyy too high. I would be dead with a level like that. It was almost 0.5! I don't know how he was even conscious...well, yes I do. He was a big fat redneck with years of beer drinking experience. I'm sure he has a story or two of getting too drunk in a deer stand and falling to the ground. But I digress.
      So after way too much talking, this guy finally gets in the back of our truck. There he proceeds to try and insult my partners medical abilities as well as his general intelligence. He wasn't exactly please and I am sure he got in a few zingers that went way of this drunk guys head. Probably for the best.
      Since I was driving us to the hospital, you would think I was the lucky one. Not so much. One of the bridesmaids rode with us to the hospital. Great. Nothing like a drunk redneck woman who is half crying and trying to explain to me what was going on and further perpetuate the myth that the guy in the back of the truck wasn't driving the car that struck a tree. We have "Cletus" in the back and "Brandine" in the front. If my ambulance was any more classy at this point, it would have turned into a limo. I also kept getting the question "Is he going to jail?" I don't know. I'm not a cop. Do I look like a cop? Well now that I think of it, most people do think we are either cops or fire fighters.
     At any rate, we show up to the hospital to a thrilled ER staff and hand off care to the clinical team. As soon as he was moved over to the bed, "Click" went the hand cuffs. It only made the situation worse, but that is not my department. A big "I'm so sorry" to the ER that had to deal with this guy, but unfortunately it was their turn with Drunky McRealtree.