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Thursday, October 22, 2009


We were recently toned out at 0520 for a person with heart problems. We were met by the fire of the patient at the front door. We followed her into the bedroom where she proceeded to shake her husband trying to wake him. One look and we could tell that he was dead. I quickly moved the wife out of the way and checked to see if my patient was breathing or if he had a pulse. Nothing. I then checked to see if rigor mortis or lividity had set in becuase if it has, there is nothing we can do. Not finding any "obvious signs of death" (this part always reminds me of the movie "The Princess Bride" where Miracle Max talks about someone being mostly dead or all dead) we pulled the patient onto the floor and began CPR. I jumped on compressions. For those of you that haven't had the opportunity to do chest compressions on a frail old person the first one or two compression are noisy and strange feeling. I was able to feel all of the ribs on the right side of my patient's chest and most of them on his left break. I quickly asked my Captain to check and see if there was a DNR on this patient. So with just two of us doing CPR we noticed that there was a lot of medical knowlegde between us (we're both experienced medics) that is not doing any good because wer're alone and doing CPR.

Finally the AMR crew shows up with three medics. They have a new guy so he takes the lead. We quickly move the patient to the front entry way where there is more room to work. While the other firefighter and I continue CPR the new medic puts on the defibrillation pads, turns on the heart monitor and says, "SHOCKING!" That got our attention real fast. We moved away from the patient and then looked at the FNG. Fortunately his trainer calmly informed him that there were some issues that needed to be addressed before shocking the patient. First, plug in the pads to the monitor. Second, determine if he has a shockable heart rhythm. Third, charge the defibrillator. Finally, shock the patient after you make sure that everyone else was clear. I hated being the new guy. After that we got the autopulse going, started an IO, got an airway, checked capnography and administered two rounds of meds. We also administered some sugar and sodium chloride. Everything that we did had no effect. Time of death was called at 0553.

After the code we were able to obtain some more information. The deceased had had a heart attack in April and was advised that he needed a pacemaker, but refused. He woke up that morning at 0300 not feeling well. At 0500 his wife woke up and checked on him. She said that he had a very slow pulse. 18 minutes later she called 911. We were able to wait until the coroner was contacted and it was determined that we would be allowed to remove everything that we had done (such as the IO and the airway) and to move the body back into the bed for the wife. All this was not easy to do since there was a major language barrier.

After this call I had some time to reflect upon death and my intimate relationship with it. Recently there was a death in my extended family of a 3 month old baby, an apparent case of SIDS. Given that I deal with people dying on a fairly regular basis I was surprised at how much the death and funeral of this baby affected me. It really put me into a funk for days. I thought that my ability to be emotionally detached would work in this case but I was wrong. So sitting outside the residence of my deceased patient I realized that there were some major differences (other than the fact that it was a family member and a baby) between the patients that die and my family member. After the patient died I was able to go over everything that I did with the other firefighter and critique the situation making sure that we had done everything possible to give this person a chance. It may not seem like much but having the ability to do something and then reflect that you did actually do everything you could is comforting. Talking out and critiqing the call actually helps deal with it.

As soon as we cleared the call we went back to the station, then went home. What a strange job.
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