Tuesday, December 18, 2007

Arrival of the White Beast

It's not even the Winter Solstice, and it is here in full force. Over the past week we've gotten three major storms dumping a total of approximately a foot of snow on us up here. The shoveling and plowing that has gone on has been immense in effort all over the area. And there have been numerous people that have had cardiac-related events over the past week or so.

In two 911 shifts I've worked since this past Thursday I've dealt with two cardiac arrests. The first one was on Thursday, a 72 year-old female who was being helped out of her house by her daughter to go to a doctor's appointment. She dropped two steps above the sidewalk. Her daughter and husband got her to the ground with, from what I understand, some difficulty because of her size. When we got dispatched, it was for an outside fall. I know I immediately got really suspicious when Fire Alarm didn't send an engine company as well. We were maybe three minutes away from the location of the call when we were advised that the severity level of the call was upgraded from Bravo to Delta, and we were asked if we wanted a pump. My response was simple: send them!

We got on scene and found this woman on the ground with her daughter by her side and her husband wandering around the front yard like he was lost. Before I got a look at her, I asked my partner to get out an oxygen tank and a non-rebreather. When I got to her and saw that she was extremely cyanotic and that she was both pulseless and apneic, I asked him to get a back board instead. At that point the engine rolled up, and as soon as they saw what we had they got going to help us. We got her off of the ground and onto the truck, and CPR got started. The patient had history of COPD, and she'd been taking high doses of steroids, plus she was also taking Coumadin. So she bled well when we tried to get IV access on her. Our last resort was an 18 gauge in her right external jugular; both of her arms we toast and she had open sores on her legs, so IO access was not possible. But the EJ was patent, plus I got a 7.5 ET tube in with visualization of the tube passing the vocal cords and a positive tube check. She got two rounds of 1:10000 Epinephrine and two rounds of Atropine. We got V-Fib after the two rounds of drugs so we shocked her and managed to get a rhythm back.

She survived 24 hours in the ICU.

The second was yesterday afternoon, a 36 year-old Hispanic male who'd been outside shoveling snow about an hour before we got called. It was witnessed by both of his sons, maybe 8 and 5 years old. Fire was already on scene when we arrived doing CPR. They got one shock before we arrived, but the patient was not shockable after that. We put the patient on our monitor (the AED's that the Fire Department uses have no monitoring) and found that he was in asystole - no cardiac activity at all. We got him out of the house and onto the truck, same as before except that we were able to get a 20 into his left AC. He also got two rounds of drugs, an 8.0 ET tube confirmed the same way as the other patient, but no return of electrical activity. When we arrived at the ED with this patient, the attending was the same doc that was there with the female patient I had. We looked at each other, the first words out of my mouth were, "ah, we meet again, Dr. S." His response was, "you gotta stop bringing me dead people, MM. You've already had your quota this month." And it went like that.

Poor guy had no chance. The suspicion is that either he had an undiagnosed AAA, or one of his coronary arteries underwent a major failure. Either way, I hope he didn't know what hit him.

My friends that I work with are starting to refer to me as a "shit magnet" again. It happened before I went to CCEMT-P school, then it let off for about a month after I got back. Lately, it's been all downhill.

The other noteworthy thing to mention is that I may be going to court at some point. At 1:00-ish Monday morning we were sent to deal with an unconscious person in a taxicab. We arrived on scene, PD was there, Fire was there, and they were all standing next to the passenger side door of the taxi, laughing and joking. When I got there and asked what was going on, the lieutenant from the pump told me that the young man sitting in the front passenger seat was rather impaired. I went over to assess him: he didn't respond to me yelling in his ear to wake up, lifting his arm over his head and dropping it to see if he was move it or stop it, or grabbing his sterno-cloidal-mastoid muscle (the one that connects the shoulder to the neck) and squeezing hard while, again, yelling in his ear. So, I grabbed an ammonia inhalant out of the first-in bag, broke it open, and put it under the guy's nose, again while yelling in his ear to get him to wake up. And he did.

He punched me in the head, caught the bridge of my nose, and sent my glasses off of my face. I backed out of the taxi and told the police officer standing next to the door, "he's yours." I got out of there, the cops pulled him out of the car and handcuffed him, and the guy was asking "what did I do?" The cops told him that he'd punched me and turned him around to face me. I was pretty pissed off - I started yelling at the guy, and my partner had to pull me away. Later, when word had gotten around about the incident, some of the folks I work with asked why I didn't return the favor. It's actually pretty simple - if you lower someone to their level, you're no better than they are.

Sometimes it doesn't pay to do your job, does it?

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