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Wednesday, June 23, 2010

Two Out Of Three

Engine 51, you're responding for a 65 year old female with shortness of breath.

On the way to the call my mind started to go over all of the possible causes of breathing difficulties. Even as we walked into the skilled nursing facility, differential diagnosis and treatment options ran through my head. This all changed the instant I walked into my patient's room. I was greeted by the sight of 6 staff members, and a frenzied atmosphere, doing CPR on my patient. So much for shortness of breath.

At this point training and experience took over. I ensured that good CPR was going on (not a given in skilled nursing facilities) and then asked my engineer to work on vascular access. I placed the patient on the heart monitor and noticed that she was in asystole (flat line). As the AMR medic walked in I gave a quick synopsis. She then verbalized what I was thinking, 2 rounds and out. That is to say, based on the clinical presentation, we didn't think that this patient is going to make it. We would try two rounds of medications and then, lacking any improvement with the patient's condition, terminate resuscitation efforts.

After the first round of medications there was no change in the patient. We then waited the correct amount of time, went through our H's and T's, and then administered the second round of Epinephrine and Atropine. Two minutes later I checked the monitor and was astonished to see a heart rhythm. We quickly checked for a pulse. Bingo! We checked her blood pressure and it was 139/88. I was taking a trip to the hospital. By the time that we dropped her off at the hospital the patient still had a nice perfusing blood pressure and had a pulse of 110.

---------------------------------------6 hours later---------------------------------------

Engine 51, you're responding for a 60 year old male not breathing, CPR in progress.

At least this time the dispatch let us know what we were headed into. Not that it makes a whole lot of difference. We walked into the same skilled nursing facility as earlier but this time we went to one of the rooms on the left of the entrance. We were greeted by the same frantic scene. And once again the staff was more than happy to let us in to take control. This time was similar to the last arrest. Since it worked out so well last time we decided to run things the same way. I was running the code while my engineer secured vascular access and administered the medications. This patient was also in asystole at first. When the AMR medic walked in and saw what was going on he started to go down the same thinking as we were guilty of on the previous call. I warned him that we had "saved" the last one that started out just like this one. Sure enough, one round of medications and the patient returned to a sinus rhythm. He was a little tachy at 110 but he had a good BP, 111/79. It was time for me to go to the hospital again.

While at the ER I checked on my last full arrest patient. She was still alive and waiting for a room in the ICU. The staff in the ER were a bit surprised to see us with another "save."

On both patient's a 12 lead EKG was performed after we had a return on spontaneous circulation. Neither one showed signs of an MI.

-----------------------2 hours later, right after dinner-----------------------

Engine 51, you're responding for a possible full arrest. The RP states the victim is cold and blue and refuses to start CPR.

When we arrived on scene we found a 75 year old woman laying on the floor in her kitchen. Her family had run some errands and returned to find her where she lay. Her hands were cool to the touch but her torso was still warm. And although her lips and fingertips were blue she still did not have any lividity. We also checked to see if rigor had set in. Since we found no obvious signs of death we had to work her up. Even though we knew it would be a futile attempt.

I immediately started on compressions. My captain started bagging the patient and my engineer placed the patient on the monitor and, once again, started working on vascular access. As soon as AMR showed up my captain relegated his position at the head so the AMR medic could intubate the patient. My captain would spend the rest of the time with the family starting to console them and prepare them for the bad news.

Twenty minutes or so after we arrived on scene we pronounced the patient dead. We then had the task of cleaning up quietly so as not to disturb the family. SO showed up to take control of the body. We also had to be careful what was said outside at our rigs since there was a small crowd of concerned neighbors. Our nature is to make jokes as a way of dealing with death but that wasn't the time or place.

All things considered it was a good day. Three full arrests with two saves. I have no idea if the patients that made it to the ER survived the night. I just hope, at the very least, that they lived long enough for their families to get there and say goodbye.


Jackie said...

Woah those are two crazy saves! Although I often question the validity of a resucation when the pt is older, (aka why are we pounding on the chest of a 90 year old, breaking her ribs etc. if she does live, it will be in pain and won't have as full of a life as she did before) but that's the cynical nurse in me. 60 &65 is quiet young (Ha!! I remember a time when I thought 30 was old) also young to be in a nursing home... So maybe they'll have longer and healther lives.

Anyway i'm rambling, but crazy how it happens sometimes eh?


melaniek said...

All I can say is thank God for all the people out there like you, who drop everything and run to help a stranger.

Firefighter/Paramedic said...

Jackie- Neither one of the patients that survived had a great quality of life prior to this. I think MD's need to educate their patient and the families about living wills, DNRs and POLSTs.

Melanie- I almost feel guilty getting paid because I love doing this so much.

brian said...

I totally agree about DNR's and POLSTs.

That was some day you had. I'm not sure I've had that many saves in my career! :)

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