Thursday, April 10, 2008

You Know It's Gonna Be A Bad Day When.....

You start the shift with a cardiac arrest. At 5:07PM, 7 minutes into the tour. A 76 year-old male, witnessed arrest - his wife was giving him a sponge bath when he went down. She started CPR before Fire arrived. We got there and they were doing their thing. Put him on our monitor - asystole with an occasional funky complex. I attempted to intubate him, and I got a face full of vomit for my trouble. I wasn't happy. So he got a combi-tube. We still had junk coming up through port 1 (or 2 - I can never get them straight), so he got almost continuous suction. Two IV's, both 18's, 3 rounds of Epi and 2 of Atropine. Got pulses back after the second Atropine. We had him on the truck by this time, and with the pulses he got 150 of Amiodarone to try to ease the heart muscle that has been so aggravated by Epinephrine and Atropine. Probably 3 minutes later we lost pulses, so we had to start CPR again. By this time we were at the hospital, and we were maybe 40 minutes into the resuscitation. Got him into the Trauma bay as it was the only one available. They worked him some more - the doc got a 7.5 tube into him. That pissed me off; it's nice that they have the controlled environment that they can do their job in. Maybe one of them should come on scene with me when we're working someone in a 10X12 room and I'm on my belly trying like hell to get the breathing tube where it belongs.

Anyway, they called it maybe 20 minutes after we brought him in. Truthfully, I wasn't surprised; he had a huge medical history, and I think his wife was expecting it to happen. She was awfully calm when we'd gotten there, so she must have had an inkling.

Later on (9:00 or so) we got a call for a public assist - 73 year-old female who'd fallen, needs help getting up, no injury. A priority 2, or an "alpha" response. We get on scene, and the woman's husband is waiting for us at the front door, on the phone with 911. We find the woman, on the bathroom floor on her back with a couple of pillows behind her head. She was in severe respiratory distress and she told us that her lungs hurt. I could hear gurgling when she would breathe, she was on home O2, and she had a history of COPD - she's in the end-stage. We tried to get her up and out of the bathroom, but she was of no help and she was like jelly. So we called for an engine company. They arrived, and what we ended up doing, mainly because of the space constraints we had to work with, was to get a backboard under her bottom and slide her out of the bathroom. We couldn't lay her flat - that started her trouble in the first place - so we had her sit, and we pulled her out. Got her onto our stair chair and extricated her from the house. I listened to her breathing before we left the house, and she was moving no air, plus I could hear the gurgles - she had a pretty good amount of fluid in her lungs at that point, plus she had a systolic blood pressure of 190. Right heart failure, anyone?

Immediately she was put on CPAP - I didn't wait to do that. On the way to the hospital she got 0.4 mg of sub-lingual nitro and 80 mg of Lasix. I'm guessing that it didn't do that much good initially, but at least it was a start to try to get some of the fluid off of her lungs. Within 7-10 minutes of us bringing her into the ED, she was intubated. I'm guessing that the doc didn't believe it was doing a lot of good to have the CPAP on her, so he made the decision to put her down and tube her.

I can respect that - the doc, Dr. "Stecks", is one I have a lot of regard for as he knows what he's doing. I also got the respiratory therapist who made it to the ED the information on settings that I had for the CPAP device. He appreciated the information.

It is nearly 2:00 AM, and I am sitting up writing. The shift is not over, and I can hardly wait to see what else happens.


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