You know those days where everything goes wrong? You know, sleep through your alarm, flat tire on your way to work, get set to give a power point presentation at work only to realize that the computers are down, forget that it's your anniversary? Yeah, me neither.
But we recently had one of those calls where everything just went sideways. Fortunately we didn't kill the patient, although her being dead already probably had something to do with that.
Station 58 was out on training so we covered half of their district while engine 57 covered the other half. Just before noon we were toned out for a man down, possibly not breathing. Dispatch came back to us while we were responding. They said that our patient was, according to the RP, over 300 pounds and they wanted to know if we wanted engine 57 to respond as well.
While we were closer to the call Engine 57 had a straighter shot at it so we arrived at almost the same time. We were met by PD and the sister and brother in law. We were led down the hall to the rear bedroom while the police officer explained that the patient had been found face down in his own vomit but the family members had flipped him over.
While walking through the house we looked for a place to work up a full arrest. It can be very difficult in cramped quarters so we try to move to a place where we can work a little better. Unfortunately the house was full of.....stuff.
As I entered the room I looked at the body down at my feet. The man's face was blue but and he was a little cool to the touch. I immediately checked for a pulse and to see if he was breathing (I've heard of too many horror stories where the medic never checked and just assumed that someone was dead only to have the coroner correct their mistake). Once I determined that he was indeed pulseless and apneic I checked for any obvious signs of death. Finding none, we started to work up our patient.
My captain had the great idea to just flip the queen size bed on it's side. Together we created the work space that we needed. My engineer and the firefighter from the other engine put the patient on the Autopulse. I placed him on the monitor and confirmed my suspicions, he was in asystole....flat line.
Up to this point things had gone relatively smoothly. I then tried to get an IO on the patient. It wouldn't flow. Two other medics tried to get IV's, they failed. Finally the ambulance medic got an IO in the other leg. There were problems trying to intubate the guy as well. It seemed like everything we were trying wasn't working for a little bit. Finally we had a secure airway and good vascular access. We continued to work on him for 15 minutes administering medications and checking heart rhythms and then terminated resuscitation efforts.
Thankfully we had BLS care ongoing throughout the entire call. The Autopulse provides for great chest compressions and we had an adequate airway with just an OPA. We also had him on the monitor quickly. And, according to the data that the AHA is putting out now those are the most important things. High quality CPR and early defibrillation if needed.