The shift began just like any other day. My partner Gary was anal as hell about the checking off all of the equipment. There was no way the shift was going to start until he touched every inch of the ambulance. You know the ones I am talking about. There can be three people shot and they will tell the supervisor, my truck is not ready to go code eight. Gary drove me nuts with his crazy little habits and hang-ups.
Finally, my partner is in the driver’s seat and ready to go. The first order of the day is to eat, and anyone in public service can tell you that eating is the one thing we value most. We were at our favorite barbecue restaurant when the call from came in.
Unit 15, respond to a person down not breathing, CPR in progress. Gary fired up the ambulance as I looked up the call. This location is close to those new doctor’s offices over by interstate 85. The dispatcher comes back over the radio and advises the patient is down in the cardiologist waiting room. I look at Gary and I told him to lets get the patient and run because there will be too many chiefs on scene.
As we pulled up, you could see the commotion from afar. The first in fire engine was taking a long back board to the patient. Gary and I loaded up the stretcher with our cardiac monitor, jump bag, oxygen, and drug box. As we were pushing the stretcher, I was fumbling with my gloves. Guess what? I got a size to small. Yep, my hands would be numb in a matter of no time.
I could see CPR in progress as we came into the lobby area. There was a sea of white lab coats. How many docs can you get into one room? There must have been at least eight cardiologists there helping with the code. Engine 8 was on scene with three EMTs and there were at least five nurses as well. It was way too many people for one small waiting room.
I ask who is in charge. No one replied. Gary asked, can anyone tell me what has been done prior to our arrival. The senior cardiologist said she is in V-Fib but we can’t get the monitor to defibrillator. She needs intubation but we cannot get our light to work on our mac four blade. He said we are having a lot of equipment failure unfortunately.
I was ridding seat and it was my shift to tech. This means I am in charge of all patient care. I ask the M.D. if he wanted me to take over the code or follow his orders. He replied, “How may we assist you?”
Please clear out some people so we have some room to work with. Gary placed defibrillation pads onto the patient’s chest as CPR continued. I told a firefighter to get a glucose reading. The nurse was doing a great job of ventilating the patient with an oral airway and bag valve mask. My partner said, “Stop CPR, check for a pulse.” No pulse replied the nurse. What rhythm is on the cardiac monitor? Gary said, “She is in V-Fib.” I delegated to my partner to defibrillator at 200 joules and continue CPR there after.
I am clear, you clear, were all clear, and the patient’s body jerked with the shock being delivered. Someone cried out, “Is she dead?” “Please don’t let my mom die.” I now have this young lady who is about eighteen years of age holding me by my arm begging us to save her mother. I told her she could help me by holding the IV bag so I could give her mom some medicine. She stopped crying immediately and held the IV bag tightly. The EMT on engine 8 had got an eighteen gauge left ante cubical. He attached the IV to the catheter and one milligram of epinephrine 1:10,000 was pushed.
After the five cycles of CPR, Gary checked the rhythm and shocked the patient at 360 joules. The patient’s body jerked again with a violent motion. Continue CPR Gary exclaimed! I ask the EMT if he had got me a glucose reading. John said, “It is going to be low Jeff.” How low I replied? Her sugar is 26 and I have checked it twice. I told Gary to administer 100 mg of Thiamine and an amp of D-50.
The doctors and nurses were all watching us run the code and waiting with anticipation of the patient’s outcome. You could tell they were impressed with our skill level and our ability to remain calm and focused. I think on that day some of those doctors and nurses gained a whole new respect for firefighters and EMTs.
Gary said, “Medications are on board.” We stopped CPR after five cycles and the patient had a pulse. Not just a weak carotid, but a strong radial. Her rhythm was sinus tachycardia with premature ventricular contractions. I asked Gary to give the patient a 100 mg of lidocaine and start her on a 2 mg a minute drip.
The nurse who was ventilating the patient looked at me and said, “She is breathing on her own.” Sure enough, she was breathing 18 times a minute with excellent tidal volume. Her oxygen saturation was reading 96%. We placed her on a non re-breather mask with oxygen at 15 liters per minute. She was beginning to turn the corner.
Gary had the lidocaine drip going and he was preparing the patient for transport. The EMTs helped him place the patient on a long spine board and onto the stretcher. The daughter was still holding the IV that was delivering medication to her mom. I asked for a repeat glucose check and her sugar was 180. The patient was almost ready for transport.
I was getting the patient’s medical record from the head cardiologist who was repeatedly apologizing for there inability to resuscitate the patient. I told him that it was OK, and we would be glad in the near future to help him and his staff work on running a code. I gave him our EMS card but we never heard from him again.
Gary and I rode in the back of the ambulance with the patient. John from engine 8 drove us to the local emergency room. The patient never regained consciousness while en-route to the hospital. She died in the ICU three weeks later due to end organ failure. The ICU M.D. said the patient had a large myocardial infarction prior to her arrest at the cardiologist office.
This may not seem like a success story, but the family had time to say there good byes and spend time with the patient prior to her death. Studies have shown that families who get a chance to say their good byes have a better recovery. The family came by the station after the patient’s death and thanked us all for all our efforts to save their love one. We all feel that the patient was given the best pre-hospital care possible. Unfortunately, not everyone lives to tell the tale.
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