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Wednesday, January 18, 2012

Downhill Slide

I was tired. We had had a good structure fire earlier in the shift. I always sleep well after one of those. I woke up and noticed the lights were on. My mind went through it's short cycle of confusion, understanding, then action. I slipped on my socks and headed for the apparatus bay.

I listened to the update from dispatch trying to gauge how awake I was going to need to be for this call. If it's a call for a stubbed toe, I can go on auto-pilot. If it's a critical kid, I would need to be fully awake. We were responding for a person having a hard time breathing. I needed to be fairly awake for this one.

We walked into the back bedroom and found our patient, an 82 year old woman, laying on her bed in obvious respiratory distress. To make matters worse, she only spoke Mandarin. Fortunately her son was there to translate for me.

We sat the patient up in bed and my engineer started getting vitals. I asked and found out that my patient had started feeling a little short of breath early last night and that it had simply worsened until they had to call 911. The old woman was a diabetic with a history of high blood pressure but no breathing problems. She was a non smoker and had had no cough or recent illness. She also had no chest pain.

Just as we got the vitals AMR showed up. The patient had a BP of 110/68, a pulse of 145 and was breathing way too fast. Her pulse ox was 87%. We decided to pick her up and carry her (we didn't want to put any more strain on her) to the gurney rather than do anything else on scene. While the AMR medic and his partner placed her on an oxygen mask I grabbed our equipment. As they loaded the patient into the back of the ambulance the medic asked for a rider and our Lucas device. The patient was obviously starting a very bad downhill slide.

In the back of the bus it only took one look at the patient to know why the medic had asked for a rider. She had the look of someone circling the drain. The AMR medic grabbed his CPAP and started setting it up. I grabbed the monitor and started connecting her to it (BP cuff, pulse ox probe, electrodes and then defibrillation pads). I then rolled up her right pant leg so I would have access if I needed to do an IO.

It was about that time that we noticed she was no longer breathing. I checked for a quick pulse while the other medic grabbed a BLS airway and the BVM. Not finding a pulse I did a quick look at the monitor to see if it was something I could shock. She was in an ideoventricular PEA at a rate of about 20. Thankfully the Lucas device had been requested and we put it to good use. With the thumper going  was now free to do other things. Unfortunately I hadn't taken a seat at the patient's head when I got in the ambulance. That meant that I had to try to find everything (the AMR medic was bagging the patient) in an unfamiliar environment. It was kind of like trying to cook in a meal, with severe time restraints, in a kitchen that you've never been in before....where are the @!#$@# frying pans?!?!! Thankfully, like in a kitchen, most things were where you would intuitively look for them.

I started an IO and checked the rhythm on more time. No change. The AMR medic tried to intubate but found that the patient was a difficult tube. At that point we were about 30 seconds out from the ER.

Inside the ER I helped out the staff work on the patient for another 30 minutes. They really liked our automated chest compression device. We followed the ACLS protocol without success. The patient went from a ventricular PEA into asystole. After 30 minutes resuscitation efforts were terminated.

90 minutes after the tones went I found myself back in bed, slowly drifting back to sleep....but not before turning off my alarm.
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