A story from way back when...
So I have a paramedic for all of about 3 months and have not had anything too crazy yet. Sure, in the ER I have seen it all and done it all (or that is how I felt at the time) but out on the road as the lone ALS provider, I was still very green around the gills. I'm not sure where that analogy came from, but it is still applicable. At any rate, I am working my second job for the local ambulance company down in Mississippi. We did a few transfers and maybe a rescue or two but the day wasn't super exciting. Until we get the call "Control to 99. Priority 1. Details on the way". OK, so we put the info into our GPS and head on out that way. Since we are covering most of what seems like the southern most portion of the state, it was a bit of a drive to get there. While enroute, dispatch calls to tell us "CPR in progress". Great. This is going to be a lot of work AND it's my first arrest ever as a medic.
This was it. This was a big stepping stone from student, to third rider, to new employee. Getting your first arrest ever as a medic is a big deal and can really be a bit unnerving. You want to do the best job you can, not screw up, and hopefully get a pulse back. Unfortunately, that last part doesn't always happen and new medics tend to take that personally. I don't feel I did, but anyway, back to the story.
As we arrive on scene after what felt like an eternity, my partner and I see one of the local deputies doing CPR in the passenger seat of a parked car. The seat was at about a 45 degree angle and he was pounding away at her chest. Not the greatest position for such maneuvers. So in a very hurried manner, my partner and I pull out all the equipment and place the gurney next to the car where our pt is then promptly placed on gurney, secured, and CPR continued.
Now let me try and paint a slightly better picture of the situation. When we arrived, our pt was in the passenger seat of a four door sedan when she arrested. She was in her early 90s and was about to go to the store with one of her family members when she suddenly collapsed. The family then called 911, started CPR, and when the Sheriff's deputy arrived, took over CPR. Our pt was all of 90 lbs if she was soaking wet with change in her pockets.
Thanks to my endogenous catecholamines that were circulating, I was very much thinking from my brain stem. I thew on the defib pads and immediately forgot how to work the monitor. $#@! Thankfully I had a spasm of lucidity and was able to get to the pads view to see what was going on. And in true mega code fashion, it was course VF. Very course VF. We deliver our first shock. POW! 360J of Mississippi power go coursing through this poor pt and her arms and legs go flailing all over. Actually I was almost hit in the face due to poorly securing her to the gurney. A total rookie maneuver, I know.
And to continue the trend of rookie moves, I hastily attempted to intubate my pt right there in the chaos of this rural MS drive way. So between my blade placement, probably rocking back the blade and just not being an expert on laryngoscopy, I could not see !@#$. So in true protocol driven medicine I reach for the combi tube. They are OK airways when they work, but they do not protect from aspiration and are actually pretty rough on the soft structures of the airway. This is especially true when you have a new guy jamming it in with all of his might. So push, push, push and the tube goes into place. And I am sure we bagged WAY TOO FAST as well. But we load up the pt into the waiting ambulance and I ask who is coming with me, the fire fighter or the deputy? Both look at each other as though they had an unspoken game of "1,2,3 Not it!". Then the good o'l boy fire fighter begrudgingly hoped into the truck and took over CPR. The doors then close and we are off like a shot.
I opted to start an IV enroute since enough time was taken on scene. I tried for an EJ on the right side but it infiltrated. Great! Now what? I can't drop drugs down this monstrosity of an airway that I have in place. Is her face getting bigger? Anyway, I have to get an IV...and bag...and watch the monitor...and not fall on my ass. I thought to myself, are all arrests like this? So I opted to try the other EJ since I would allow me to do the least amount of moving around the cabin and not interrupt CPR. Oh BTW, CLEAR! POW! Shock delivered at 360j the pt has been in course VF this whole time too.
At this point, I am able to calm down ever so slightly and reassessed the situation. I have good compressions going, an airway in place, and an IV. Is her face getting bigger? Anyway, I am glad I had the fire guy with me, because he did CPR for me while we transported priority 1 to the closest hospital. His CPR seemed almost lazy because of the little amount of effort he had to put into it due to how big he was and how tiny the pt was. BTW, this hospital was about 20 minutes away going priority 1. Great.
Now I may be new, but I knew my ACLS protocols inside and out and was doing my best to follow them as closely as possible. I just kept grabbing boxes of drugs every few minutes and pushing them though my one good line. Everything is going well so far on my end...well maybe.
Her face IS getting bigger. One of her eyes is bulging and her face and neck appear swollen. When I reach down to touch it, she feels as though she has rice krispies under her skin. Apparently when I went all KER-SMASH with the combitube and tear went the trachea. No bueno! I can't take out the tube to reattempt intubation, and I don't have an airway alternative. Oh sorry, clear! SHOCK! And CPR continues.
I am sure I repeated myself multiple times when I called report and sounded a bit shaken. Hopefully they cut me some slack. I doubt that they did though. After I hang up the phone and continue to multitask between airway and drug therapy, I look at my jump bag and see that I am running out of just about everything. We better be at the hospital soon! My partner yells back from the front "2 minutes out!" and I am slightly relieved. However, that last 2 minutes felt like an eternity.
When we get there I scream out my report to the staff in this tiny little back country ER. I probably didn't need to do that. Damn adrenalin! My fire fighter rider is drenched in sweat, the staff gives bicarb and calcium, and I have no idea what to do next. They pronounce the pt a few minutes later and disconnect her from the monitor.
Unfortunately for everyone there, another arrest rolls into the ER 5 minutes after we get there. Good it won't me just me that has to do a mountain of paperwork. The arrest that followed mine was an intentional OD that was rearresting and coming back every few minutes. So it was a bit more of a challenging call than my arrest.
Thankfully the staff was good to me and didn't bite my head off for anything. They asked me what I had given for documentation purposes and I realized we gave 8 epi, 3 lido, fluids, and about 8 or 9 defibs. I am surprised that this LOL who CTD didn't just disintegrate.
Everyone remembers their first arrest or first really bad call. They usually don't go as well as planned and even can get screwed up more often than not. It is a right of passage and mine was no different.
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