Wednesday, December 19, 2007

Blown Away

That's how I'm feeling as I write this. I have to say that I'm tired, and sick, and sad. Tired because I worked in Goffstown last night and got no sleep. Sick because I'm undergoing some transition with the prescription medications that I take and it is leaving me feeling rather unwell. Sad because I witnessed yet another family lose a loved one early this morning.

Got dispatched at 1:06 AM to a residence in Goffstown for a 30 year-old male, not conscious, not breathing. As soon as I heard the pre-tone I had a bad feeling about the call, but it wasn't until the dispatch came over the air that I thought to myself, "shit. Here we go again..." I worked with Greg, otherwise known as "two phones" because he used to carry two cell phones everywhere he went. It took a long time to figure out why.... TP and I got out the door in less than a minute, and as soon as we got on the road and headed to the location of the call, we had a pump join us. Got to the house, the police were already on scene, and the patrol supervisor, Sgt. C, told us that CPR was already in progress. He also told us our patient was big.

We got inside the house and went to where the patient was. Two officers were doing ventilations and compressions on this really big kid - approximately 6'3" and maybe 350 lbs. He lived with his parents, and they told us that he'd talked with them 15 minutes before he went down, no sign of anything wrong. Only medical history of untreated hypertension, has sleep apnea, is a smoker and a drinker. I had the officers continue while we were getting ready, and once I was set up I had an 8.0 ETT and the equipment I needed to intubate this patient. However, I was unsuccessful in 3 attempts simply because he had a difficult airway. I could partially visualize his vocal chords but I couldn't get a tube past the bend in his hypopharynx. So we ended up placing a combi-tube, which I was able to determine was working appropriately. Greg was working on IV access - the patient had nothing in his upper body, not even any EJ/IJ visible in his neck. He did manage, however, to get access in one of his feet, a 20 that worked but was somewhat positional.

The monitor showed asystole for us - the cops' AED gave them a "no shock" advisory, so we got him out of the house with considerable effort and loaded him on the ambulance. Reconnected him to the monitor, no change, continued CPR. Gave him a total of 3 rounds of drugs on the way to the hospital. When we got there, we got him inside into Cardiac 1, and my friends Dr. S and Dr. L were the physicians on. Dr. S just looked at me as we walked through the doors and said, "whatever you do, don't go on vacation the same week as me." Dr. L was a bit more business-like, wanted to know what happened, what we did, etc. He asked me if we'd gotten a blood glucose or given him any Narcan to rule out an overdose. And his asking me those questions sort of hit me like a hammer; I was so focused on trying to keep his airway clear and make sure that the other things were getting done that I totally forgot about the "H's and T's", as they are known in ACLS circles. They immediately checked his glucose, which was 186, and gave him 2mg of IM Narcan, which did nothing. I took CPR over for one of the respiratory therapists that came in. In the shuffle, his IV went south, so Marl, one of the nurses (I think she was in charge) and Dr. L got new access, including a cut-down on his femoral vein, which I thought was pretty impressive considering how close I was while I was doing compressions.

They tried another round of drugs, which didn't work and ultimately called it 45 minutes after we got the original dispatch. To my knowledge, the medical examiner was notified, and he was there within 1 hour of being called.

I guess the thing that really just is so frustrating about this call is that it was the second cardiac arrest I'd responded to where the patient was under 36 years of age. It was the third code I went to in as many shifts. And while they say that "bad things come in groups of 3", I won't believe it until I go to work tomorrow and not have to face another person whose family will have lost him to sudden death.

Today, needless to say, was not a good day. I'm getting a little tired of these.

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Anonymous said...

Wow...sounds like a rough week beyond anything I could ever imagine. A rough week for me is a couple of broken computers. Don't forget to spend some time focussing on the have a lot of them in the course of a week.

NH Mind said...

John Q. Public is lucky to have guys like you. They don't know it, but you should. Keep up the great work and get your own meds under control....ol' John Q. needs you! Cheers.