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Friday, January 15, 2010

Who Dies At 0300?

Guess what I was doing at 0306? Sleeping in my bed at the station, very comfortably I might add. Guess what I was doing 90 seconds later? Responding with lights and sirens to attempt to save someones life. While sitting in the back of the engine I couldn't help but think who notices that someone is dead at three in the morning?!

We arrived on scene just after PD. The wife was opening the front door for the officers just as I walked up. I then had to walk behind the cops up the stairs to the master bedroom. Now I am grateful for the officers especially for all they do to help us. But when there's a dead person upstairs and there's a medic behind you trying to get to the person and save them, either move faster or get out of the way!

Once in the bedroom I found my patient. I noticed immediately that the 51 year old man was over weight and appeared very dead. He in fact was just "mostly dead" (bonus points for the movie reference). I checked for breathing and a pulse. There was nothing. But he was warm to the touch and didn't have lividity or rigor. We quickly moved him to the ground and started CPR. I started on chest compressions while my engineer worked on the airway. As my captain came in with our autopulse we place the patient on the machine. This freed me up to start some ALS treatment. The AMR crew walked in just as I placed the defibrillation pads on the patient. I asked the medic to get vascular access. After establishing a secure airway my engineer had an EMT take over breathing for the patient. He then connected to patient up to capnography.

As I turned on the monitor and checked the rhythm I noticed that the patient was in V-fib. This is a good thing (relatively). It means that the heart is still alive enough to have electrical activity. We just have to get it to be a little more organized. I charged the monitor and made sure that everyone was clear. I then shocked the patient with 200 joules of electricity. I love Edison Medicine. As soon as the shock was delivered, CPR was resumed. The AMR medic did a great job getting the IV in the left arm and was administering Epinephrine. After two minutes went by I checked the heart again. He was in asystole. Not so good. We continued CPR and the AMR medic pushed some atropine. After two more minutes of CPR I checked the heart again. I saw something I didn't expect, a normal sinus rhythm. So I checked a pulse...BINGO! We got him ba....uh oh....he's in V-tach....check a pulse, no pulse, now in V-fib....continued CPR while I charged the monitor. That's just about how long his pulse lasted. But it was a good sign. I shocked him one more time and sent him back into asystole.

This went on for a few more cycles with the patient's heart rhythm going all over the place. We decided it was time to get to the hospital. Loading up a 300 pound man onto a backboard with the 30 pound AutoPulse and then trying to get him down a narrow stair case while continuing CPR and not tripping on wires and IV and oxygen lines is quite the exercise. Since this was my patient, once we had the him in the ambulance I hopped in. I took over bagging the patient and the AMR medic continued to administer meds and check the heart rhythm.

Once at the hospital we transferred the patient to the ER bed. In the move, the AutoPulse became miss aligned and stopped working. I continued on the BVM while two RN's tried to fumble with my machine. Meanwhile, the patient didn't have compressions going. I finally pushed (gently) the nurses out of the way, and started chest compressions manually. After a couple of minutes an ER tech came over and relieved me. After the call I gathered my equipment and restock from the ambulance and waited for my ride (another firefighter had to come and pick me up). Before we left, the patient regained a pulse. I hope he makes it.

So how did we get this call at 0300 instead of at 0700 when the alarm went off? The wife woke up to her husband snoring loudly. When she tried to wake him she couldn't. This prompted the 911 call. Then, while on the phone with the call taker, the patient stopped snoring....of course that's because he stopped breathing all together. If he lives I think his wife will lose the right to complain about his snoring.
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