NO, we didn't super charge/over shock our pt on this call! That just happens to be the total amount of joules we used between all of the defibrillations that were administered. Crazy, huh? Yup. But lets go back to the beginning...
So there we were, right. Working a 24 hour rescue shift in the usual location when we were dispatched to the neighboring city for "one unconscious". As my partner that day said, we "wee-wooed" all the way there. She is a trip and a lot of fun to work with. While enroute we hear that CPR is in progress. Great. It was kind of expected, but you always hope that it doesn't take that turn before you get there.
However, upon our arrival the local FD was there doing their awesome BLS thing. They are always on top of it. They had already shocked this pt twice with the AED and dropped a King LT. If you don't know what that last thing is, google it. So really, half the work is already been done. Plus, the awesome autopulse (CPR machine) was called for and was being delivered shortly. We swap the pads over to our monitor to find very coarse VFIB and give our first shock at 200J. POW! And start more CPR. Things are being yelled out, needles are placed into veins and bones, and the pt is placed on the autopulse. This not only does better CPR, but it also frees up an extra set of hands to get things moving. It sounds funny, but it is a great machine.
And speaking of the placement of needles, there were obviously a lot of people working on this pt and space was at a premium. I had to cut the pts pant leg to be able to place the IO. While doing this, my partner had to catch one of the FD guys from falling back on me. Good catch too! That could have resulted in disaster! I really didn't' feel like explaining to my superiors as to why one of the local FD personnel had an IO sticking in/out of his thigh.
So anyways, we now have good vascular access and can start pharmacologic therapy. "FIRST EPI IN" as the autopulse squeaks away doing compression after compression.This made the act of carrying this pt down the stairs a bit odd. But the job was done. And just as we secured our squeaking life support device, pt, and all to the gurney, it was time for the next EPI. Then slam goes the doors, shock goes the defibrillator, and we are off like a shot! Priority one to the closest ER.
While enroute another IV is started. More specifically, an EJ. This was perfect because it was just in time for some more medication. This time it is the antiarrythimic that is being given. It was easily pushed through the EJ and was flushed by the pressure bag in turnout gear. Shortly there after we not only see a spike in ETCO2 (look it up) but a decent rhythm on the monitor. Tada! We officially have ROSC! And, AND with a good pulse. However, this does not last very long. There ventricular ectopy started pouring into what was once a very pretty sinus tach. Then pulses were lost as the rhythm went from order to chaos or as those with an ACLS background like to call it, VFIB. But it's ok, we have the tools to hopefully correct this. Charging! CLEAR! And shock goes the monitor...NSR immediately with pulses. SWEET! Unfortunately we have to go through this process about 4 times before we get to the hospital. However, by that time we got the second dose of arrhythmic in and the ventricular ectopy calmed down to just an occasional PVC.
Now that we have a pule, a blood pressure, a rhythm, and all that goodness it was time to take a closer look at what just happened and to organize a report that I can shout at the ER staff without them getting mad at me. What was the down time? What was the hx of the pt? Was it witnessed? Is that peridefib ST elevation or is this a true complicated STEMI? Oh btw, CLEAR! POW with another 200j of Detroit Edison that promptly converts VFIB back to ST.
Upon arrival to the ER I shout out the report quick, fast, but not in too much of a hurry so it could be understood. The post arrest 12 lead was accomplished showing NO ST elevation but the pt was still sent up to the cath lab. Hopefully for some worthwhile intervention.
As hectic and chaotic as the call was, it could have been much worse. It was actually one of the better calls where everything went right and all the pieces and players fell into place. Good job to everyone involved. We may never know what happened to this pt, but they certainly received a 150% effort on the part of everyone involved.
*I am sure all the defibs don't add up to 1600 in this little glimps of what is my professional life. However, the total number of defibs did equal that number. For the sake of time and ease of telling the story some details were left out and/or forgotten.*
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