My first code...
First, I must say I am spoiled working on a double Medic truck. It was just nice to have a partner that also knew the protocols and could handle half the work at the same time.
I do not have any notes in front of me at the moment, so here is the short version of what happened...minus a lot of details.
0130: Call comes in..man witnesses his wife's arrest. Due to an earlier heart attack, a local hospital had given this family an AED as part of a pilot-program. No shock was indicated and the husband initiated CPR. Pt is a 54yo female with unknown history other than the one heart attack.
0139: Fire and EMS arrive on scene. This house is on the far edge of our county and I drove WAY too fast to get there. Getting there at the same time at the fire department is rare, they must have had a hard time waking up. Of course the pt is in an upstairs bedroom down a narrow hallway.
We slide the pt from beside the bed to a spot in the room where we could actually get all around her. The pt's is warm, dry, and blue from the nipples up. We attach our Defib pads. Fire starts CPR. Another firefighter attaches the monitor leads.
Pt is Asystolic. My partner intubates the pt. I apply chricoid pressure while looking for an IV site. Tube goes in fine and I start an 18 guage IV in her right arm. Gave two rounds of Epi & Atropine then gave 50meq of Sodium Bicarb.
Pt now in V-Fib. Shocked the pt three times with persistant V-Fib. Amiodarone 300mg. Shock. Pt now in a very ugly looking V-Tach....with a pulse! Pt even takes a breath. Not breathing fast enough..so Fire is still assisting ventilations. Pt is not so blue at earlier. While hooking up an Amiodarone drip pt goes back into V-Fib. Also got another 18 guage IV in her left arm while setting up drip.
Shock. V-Fib. Amiodarone 150mg. Shock. V-Fib. Sodium Bicarb 25meq. Magnesium Sulfate 2G. Shock. V-Fib. Epi. Shock. Effective CPR to circulate drugs between shocks. After the last shock, the pt's rhythm changes to a very pretty looking Sinus Tachycardia with a pulse of 115bpm. Pt again takes a breath but we still need to assist respirations to keep a good rate. Pt now pink instead of blue.
Move pt to Long Spine Board and verify tube placement. Now the fun of moving down the hallway, down the staircase, out the foyer, over some landscaping bricks by the porch and onto the cot. Verify the tube placement again and pt still has Sinus Tach pulse of 115. Lines all still attached and flowing. Of couse, it now starts to rain. Quickly move into the truck and go en route to the hospital. Pt stays in the same rhythm and rate the rest of the time we are with her.
The Pt's pupils were fixed and dilated the whole time. I am not fooling myself on this. People who we meet in Asystole tend to either never make it to the hospital or if they do, they tend to not live past it. But, by the time we left the ER, the whole family was at her bedside and the doctor was explaining the odds and likelihood of things to come.
My thought on the whole matter is that we at least give the family time to say goodbye, be together a little longer, and maybe even hold onto a little hope that the pt's condition may improve.
It's the least we can do. The whole thing from 911 call to arrival at ER was almost exacly an hour. We cleared the hospital at 0249. We took some vital signs and such along the way through this. The pt had a bp of 100/60 in the ER.
PS- Thank God for a great Fire Engine crew. Between them they did perfect CPR, knew how to spike an IV bag, and understood how to move and ventilate a patient without dislodging an ET Tube.
*******
I'm too tired to proof read this post right now. I've only slept 4 hours today. I'm glad I do not work tonight. Another big thunderstorm, I'm sure we'll have some more anxiety attack patients. I think I got all the major points typed out correctly in the post above, I'll check later. Until then, this is good sleeping weather.
I do not have any notes in front of me at the moment, so here is the short version of what happened...minus a lot of details.
0130: Call comes in..man witnesses his wife's arrest. Due to an earlier heart attack, a local hospital had given this family an AED as part of a pilot-program. No shock was indicated and the husband initiated CPR. Pt is a 54yo female with unknown history other than the one heart attack.
0139: Fire and EMS arrive on scene. This house is on the far edge of our county and I drove WAY too fast to get there. Getting there at the same time at the fire department is rare, they must have had a hard time waking up. Of course the pt is in an upstairs bedroom down a narrow hallway.
We slide the pt from beside the bed to a spot in the room where we could actually get all around her. The pt's is warm, dry, and blue from the nipples up. We attach our Defib pads. Fire starts CPR. Another firefighter attaches the monitor leads.
Pt is Asystolic. My partner intubates the pt. I apply chricoid pressure while looking for an IV site. Tube goes in fine and I start an 18 guage IV in her right arm. Gave two rounds of Epi & Atropine then gave 50meq of Sodium Bicarb.
Pt now in V-Fib. Shocked the pt three times with persistant V-Fib. Amiodarone 300mg. Shock. Pt now in a very ugly looking V-Tach....with a pulse! Pt even takes a breath. Not breathing fast enough..so Fire is still assisting ventilations. Pt is not so blue at earlier. While hooking up an Amiodarone drip pt goes back into V-Fib. Also got another 18 guage IV in her left arm while setting up drip.
Shock. V-Fib. Amiodarone 150mg. Shock. V-Fib. Sodium Bicarb 25meq. Magnesium Sulfate 2G. Shock. V-Fib. Epi. Shock. Effective CPR to circulate drugs between shocks. After the last shock, the pt's rhythm changes to a very pretty looking Sinus Tachycardia with a pulse of 115bpm. Pt again takes a breath but we still need to assist respirations to keep a good rate. Pt now pink instead of blue.
Move pt to Long Spine Board and verify tube placement. Now the fun of moving down the hallway, down the staircase, out the foyer, over some landscaping bricks by the porch and onto the cot. Verify the tube placement again and pt still has Sinus Tach pulse of 115. Lines all still attached and flowing. Of couse, it now starts to rain. Quickly move into the truck and go en route to the hospital. Pt stays in the same rhythm and rate the rest of the time we are with her.
The Pt's pupils were fixed and dilated the whole time. I am not fooling myself on this. People who we meet in Asystole tend to either never make it to the hospital or if they do, they tend to not live past it. But, by the time we left the ER, the whole family was at her bedside and the doctor was explaining the odds and likelihood of things to come.
My thought on the whole matter is that we at least give the family time to say goodbye, be together a little longer, and maybe even hold onto a little hope that the pt's condition may improve.
It's the least we can do. The whole thing from 911 call to arrival at ER was almost exacly an hour. We cleared the hospital at 0249. We took some vital signs and such along the way through this. The pt had a bp of 100/60 in the ER.
PS- Thank God for a great Fire Engine crew. Between them they did perfect CPR, knew how to spike an IV bag, and understood how to move and ventilate a patient without dislodging an ET Tube.
*******
I'm too tired to proof read this post right now. I've only slept 4 hours today. I'm glad I do not work tonight. Another big thunderstorm, I'm sure we'll have some more anxiety attack patients. I think I got all the major points typed out correctly in the post above, I'll check later. Until then, this is good sleeping weather.
posted by MidwestMedic at 21:24
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