Here's a close call for the Dearborn Fire Department while performing vertical ventilation. Too bad we can't see a few minutes before this.
Friday, March 30, 2012
Wednesday, March 28, 2012
Tuesday, March 13, 2012
One Of Those Calls
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.
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.
Wednesday, February 29, 2012
Should Have Called Sooner
Most calls that come in to our 911 system are really non emergent. I'm sure the people calling think that it's an emergency or at least I'd like to think that they do but in all reality, most of our calls are just the adult version of what I do for my 2 year old. A band-aid and a proverbial kiss to make everything better. It's psychological treatment. Every once in a while though we get a call that should have come much sooner.
While preparing lunch the tones went off (you ever notice that a lot of my calls happen at meal time? Maybe it just seems that way). We were responding to a known address. The woman there had breathing problems and called fairly frequently. Enough that I knew the address when I heard it.
This time, as we approached the door, we were greeted by the woman, not her husband. Strange. I asked what was going on and she said she thought her husband was having a stroke.
Going through my assessment I noted that she had first noticed his symptoms (drooling, facial droop and slurred speech) about 8 hours earlier. Her husband had also had a stroke about a year before but on the opposite side. She didn't call earlier because she thought the symptoms would go away after a nap.
Unfortunately for him they had waited too long. There is only a small window of time during which we can administer thrombolytics (clot busting drugs). My patient was now well beyond that. There wouldn't be much that they could do for him at the stroke center. There was even less that we could do. We were reassuring as we could be and transported him to the hospital as soon as we could.
We also spent a little time educating the wife. We stopped short of saying that she should have called sooner but we did encourage her not to wait next time. When it comes to CVA's, waiting can cause permanent disability.
While preparing lunch the tones went off (you ever notice that a lot of my calls happen at meal time? Maybe it just seems that way). We were responding to a known address. The woman there had breathing problems and called fairly frequently. Enough that I knew the address when I heard it.
This time, as we approached the door, we were greeted by the woman, not her husband. Strange. I asked what was going on and she said she thought her husband was having a stroke.
Going through my assessment I noted that she had first noticed his symptoms (drooling, facial droop and slurred speech) about 8 hours earlier. Her husband had also had a stroke about a year before but on the opposite side. She didn't call earlier because she thought the symptoms would go away after a nap.
Unfortunately for him they had waited too long. There is only a small window of time during which we can administer thrombolytics (clot busting drugs). My patient was now well beyond that. There wouldn't be much that they could do for him at the stroke center. There was even less that we could do. We were reassuring as we could be and transported him to the hospital as soon as we could.
We also spent a little time educating the wife. We stopped short of saying that she should have called sooner but we did encourage her not to wait next time. When it comes to CVA's, waiting can cause permanent disability.
Monday, February 20, 2012
Stupid Drivers, A Real Danger
We pulled out of the station with our lights flashing. As the tailboard cleared the apparatus door my engineer hit the remote control closing the door.
This station is in a residential neighborhood. We turned left onto the small street. As we approached the main road through town the growler started to wail. My engineer had to come to a complete stop at the uncontrolled intersection to wait for traffic to stop. The traffic to our left stopped (shocking I know) and we started to pull into the intersection to clear the other side.
It was about then that the woman driving in the #1 lane decided that she no longer wanted to stop for us. She drove across the intersection and were it not for the yells of stop by my captain the old lady would now have a giant imprint of the bumper of our fire engine in the side of it.
Sometimes getting across the street from the station can be the most dangerous part of the job.
This station is in a residential neighborhood. We turned left onto the small street. As we approached the main road through town the growler started to wail. My engineer had to come to a complete stop at the uncontrolled intersection to wait for traffic to stop. The traffic to our left stopped (shocking I know) and we started to pull into the intersection to clear the other side.
It was about then that the woman driving in the #1 lane decided that she no longer wanted to stop for us. She drove across the intersection and were it not for the yells of stop by my captain the old lady would now have a giant imprint of the bumper of our fire engine in the side of it.
Sometimes getting across the street from the station can be the most dangerous part of the job.
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