It's That Time Again
I'm about due for a cardiac arrest.
I know that seems sick/twisted/strange depending on your perspective, but it's just one of the weird facts of my life. I seem to be on a rotating schedule where someone will die on me about once every 4-6 months, and it's been about 4 since I last worked a code. I did have two people die on me in one day this one time, but that was just strange, and entirely their fault.
If the only place you've ever seen a code run is on TV then you'd probably be really surprised to see what goes on in the real world. I've heard jokes cracked, people laugh, dinner plans discussed, and I've been grossed out when someone sat in pee, all while CPR was in progress.
I think the sad fact is, once you've seen one dead old dude, you've seen 'em all.
Obviously it's a different situation with younger people, (or God forbid, kids) but eventually the suprprise and shock of old people dying goes away. Honestly with the conditions in some of the nursing homes I've been in, I almost feel bad trying to resuscitate them, but that's another day's post.
It does give me a nice segue into an important point though. When you're old, and nearly dead, and pretty much done with this world, get a DNR. Seriously. Save your family, and EMS, and the ER, and everyone else the money and trouble of keeping you alive for a few days with expensive tubes and machines. Who wants to kick the bucket with all their ribs broken anyway? CPR has to hurt like a bitch.
I digress though. The truth is, a code (For the uninitiated a "code" refers to all of the resuscitative measures undertaken to restart someone's heart. Comes from Code Blue, and is often referred to as "working a code") is one of the easiest things we have to do. There's no piddling around, asking questions and playing detective trying to figure out what's going on. The problem is obvious, and our treatments are automatic.
A well run code is really a thing of beauty. Take the last code I was involved in. It ended poorly for the gentleman who died, but other than that, we did a great job. Sick humor I know, but if you can't laugh you'll cry.
Anyway, I was working in Cary, and we were dispatched to a respiratory difficulty call. I was on the truck with my paramedic partner, and we had an EMT student with us that day who may have been the biggest dumbass I've ever met in my whole life. His first words that morning had been "So do ya'll think it'd hurt much if I shocked myself with that 'fibalator thing-a-ma-jig?" It didn't help that he smelled like rancid dog vomit.
This is the day of the annual Cary EMS christmas party, and I'm working the day shift, which usually ends at 6pm. I've arranged for coverage to come in at 4, giving me time to shower, change, drive to Chapel Hill to pick up my date, drive back to Cary, and make it to the party.
At 3:45 we're sent to this call. I had done something to piss off the EMS gods.
We're pulling up to the house, and the FD had beaten us to the call by about a minute. Tops. As I'm stepping out of the truck I hear:
"Rescue 2 to Medic one"
My partner responds- "One, go ahead."
Rescue 2- "Be advised, this is gonna be a working code."
Maybe after you've been doing this for a long time, you can prevent that little dump of adrenalin that turns your gut cold and heightens all your senses, but for now even with all my bluster, I'm still new enough that I get really excited at the thought of doing something potentially life-saving. Can't help it.
We grab all our equipment, and head inside. By all our equipment I mean:
-The stretcher
-A backboard
-A cervical collar
-Backboard straps
-The monitor/ecg
-The airway box
-The med bag
-Suction
-An oxygen cylinder
In short, just about everything on the truck. As we make our way into the house, our Chief pulls up onscene, having checked in to help out when he heard it was a code. We're called into the back bedroom by the fire department.
As we walk in, it's apparent that this is not going to be a fun code. People die in the most inconvenient places, and there was just no room anywhere in this guy's house to work. The FD had pulled him out of his bed and laid him on the floor, but there was very little room around him. Typical.
According to the FD, they walked into the bedroom, and watched the guy take his last breaths. Gasp. Gasp. Nothing. They laid him on the floor, attached their AED (Automated External Defibrillator. If you don't know what it is, find out, learn how to use it, and learn CPR while you're at it.) and were promptly told they couldn't shock him. They started CPR, and we walked in 30 seconds later.
This illustrates perfectly the great thing about first responders. If we didn't have the FD with us on this call, we would've walked into a full cardiac arrest without many of the supplies we need to effectively work a code. They were there quickly, and were able to provide definitive care (defibrillation) almost immediately. If you don't thank firefighters when you see them out and about, you should. Leave EMS alone though, we bite.
Content to let the firefighter continue to ventilate the patient and thus absorb all risk of getting puked on, I set about getting the equipment ready for intubation while my partner attached our monitor to their pads. Sure enough, this old dude was in good ol' asystole; the flat line that is the calling card of none other than Death.
Contrary to what you may have seen in movies and/or TV, asystole is not something that can be "shocked" back to life. If you want to know why research defibrillation on the internet. What we could do was try to pace him (as in pacemaker) but that never works, and sure enough, it didn't work this time either.
Electrical options exhausted for now, my partner came back around to the patient's head, and asked me to get him a 7.5 tube, and a Mac 3 on the laryngoscope. I was holding both things in front of his head before he got the words out because I'm a good partner. This got me a head-pat later. I wanted a cookie too, but if wishes were horses, everyone would drive a camaro (El Guapo!), or something like that.
PS- The whole time all of this is happening, one member of the FD crew or another is performing compressions to keep pumping blood around and around. I'm not mentioning it because it's relatively boring, and it starts and stops so often that if I wrote about it everytime, you'd miss the cool stuff.
While my partner is trying to intubate the dead guy, the Chief is down looking at the guy's arms for an IV. IVs are often difficult on old people anyway, and when they're dead, it only makes things harder. The Chief tries once, but isn't able to get anything. Now I'm a little excited, because I know what's coming, and I turn to get it out.
The next step is the EZ-IO. IO standing for intra-osseus, which if you're medically inclined, or know your latin, you'll recognize to mean "within the bone". That's right bitches, we're about to drill into this dude's leg.
Meanwhile, my partner has managed to get the tube in, after suctioning spooge and other secretions from the guy's throat. Ick. 1st round of drugs goes in. 2mg of epinephrine (Adrenalin. Constricts the blood vessels of most of your body, opens up your lungs, and bitch slaps the heart.) and 2mg of atropine (Supposed to speed the heart up.) go down the tube. Some drugs can be delivered through your lungs. Pretty cool huh?
Bone drill is out, and in my hands. This is awesome. Take your leg, and find the top of your tibia, or shin bone. Go down about 2" and then slide your finger to the inside of your leg. We pop a drill bit in there. The reasoning behind this torture device is that the inside of your bones are filled with marrow, and very much vascular and alive. It's essentially an IV that you can't miss, and is very quick. Drill in, hook up the line, and you're set. This process done, our guy gets round 2 of his drugs. 1mg of Epi, and 1mg of atropine. The dose is lowered since we're delivering the drugs more directly to his circulation now.
I manage to get our capnography hooked up to the ET tube, so we can see that our guy is in fact properly intubated, and is breathing off CO2 with each breath the FD gives him, but not much. Things are beginning to look bad for our guy, and after 2 rounds of drugs with CPR, and no rhythm change, bad means pretty much hopeless.
Still, we're EMS, the eternal optimists (HA!) so we go for round 3, and he gets another milligram of Epi and Atropine. 5 minutes of CPR later, no change in the rhythm. This guy is dead. Not Princess Bride "mostly dead", but dead.
According to Wake County protocols, we've exhausted our abilities, and the hospital can't do anything more for him. We terminate our efforts, and my partner goes to inform the gentleman's wife that her husband has in fact, died. We disconnect our equipment, but leave all tubes and lines in place, as the Medical Examiner has to verify their placement to make sure that we didn't kill this guy. Gotta love our litigous society.
I begin carrying our equipment out of the house, feeling a little bad everytime I pass the guy's wife, as it seems so callous to be "done" with her husband, and preparing for the next patient. It's the way things go though.
I'm outside putting stuff back on the truck when this guy walks up in a soccer shirt and cordouroys with a notepad in his hand, and starts asking me what happened. I'm like "Dude, I can't tell you anything about it"
Then he flashes his badge and I feel like an asshole. They have to send a detective to investigate every death that occurs outside of a medical facility, and I missed the fact that our guy had driven up in an unmarked Crown Vic. Whoops.
He's the only guy I've ever seen open a door with his elbow. Makes sense if you're a detective I guess, but it still looks funny when you watch it.
We clear up shortly after he arrives, and tells us to be on our way. It's pretty obvious there's nothing suspicious about this death, and it'll be a quick report for him.
Remember that date I mentioned? Well after running the code, cleaning everything up, waiting for the detective, cleaning more stuff at the station, and writing an earlier report, it's now 6:15. The party starts at 7, I still need a shower, and Chapel Hill is an hour's drive round-trip. This is the reason that my friend Blair will forever be one of the coolest people on Earth. She'd already bailed me out by agreeing to be my date in the first place after my girlfriend broke up with me about 3 weeks before the party, and after hearing about my current dillema, she offered to just drive over, and meet me at the station. Blair is obviously awesome. I felt bad since when I ask someone on a date, even if it's a "friend" date, I like to treat them well, but I wanted to go to the party, and I wanted a date. I'll make it up to her one day.
Anyway, that night at the party I was awarded with a sweatshirt for having a successful resuscitation in the previous year. The irony of the day was not lost upon me.
I know that seems sick/twisted/strange depending on your perspective, but it's just one of the weird facts of my life. I seem to be on a rotating schedule where someone will die on me about once every 4-6 months, and it's been about 4 since I last worked a code. I did have two people die on me in one day this one time, but that was just strange, and entirely their fault.
If the only place you've ever seen a code run is on TV then you'd probably be really surprised to see what goes on in the real world. I've heard jokes cracked, people laugh, dinner plans discussed, and I've been grossed out when someone sat in pee, all while CPR was in progress.
I think the sad fact is, once you've seen one dead old dude, you've seen 'em all.
Obviously it's a different situation with younger people, (or God forbid, kids) but eventually the suprprise and shock of old people dying goes away. Honestly with the conditions in some of the nursing homes I've been in, I almost feel bad trying to resuscitate them, but that's another day's post.
It does give me a nice segue into an important point though. When you're old, and nearly dead, and pretty much done with this world, get a DNR. Seriously. Save your family, and EMS, and the ER, and everyone else the money and trouble of keeping you alive for a few days with expensive tubes and machines. Who wants to kick the bucket with all their ribs broken anyway? CPR has to hurt like a bitch.
I digress though. The truth is, a code (For the uninitiated a "code" refers to all of the resuscitative measures undertaken to restart someone's heart. Comes from Code Blue, and is often referred to as "working a code") is one of the easiest things we have to do. There's no piddling around, asking questions and playing detective trying to figure out what's going on. The problem is obvious, and our treatments are automatic.
A well run code is really a thing of beauty. Take the last code I was involved in. It ended poorly for the gentleman who died, but other than that, we did a great job. Sick humor I know, but if you can't laugh you'll cry.
Anyway, I was working in Cary, and we were dispatched to a respiratory difficulty call. I was on the truck with my paramedic partner, and we had an EMT student with us that day who may have been the biggest dumbass I've ever met in my whole life. His first words that morning had been "So do ya'll think it'd hurt much if I shocked myself with that 'fibalator thing-a-ma-jig?" It didn't help that he smelled like rancid dog vomit.
This is the day of the annual Cary EMS christmas party, and I'm working the day shift, which usually ends at 6pm. I've arranged for coverage to come in at 4, giving me time to shower, change, drive to Chapel Hill to pick up my date, drive back to Cary, and make it to the party.
At 3:45 we're sent to this call. I had done something to piss off the EMS gods.
We're pulling up to the house, and the FD had beaten us to the call by about a minute. Tops. As I'm stepping out of the truck I hear:
"Rescue 2 to Medic one"
My partner responds- "One, go ahead."
Rescue 2- "Be advised, this is gonna be a working code."
Maybe after you've been doing this for a long time, you can prevent that little dump of adrenalin that turns your gut cold and heightens all your senses, but for now even with all my bluster, I'm still new enough that I get really excited at the thought of doing something potentially life-saving. Can't help it.
We grab all our equipment, and head inside. By all our equipment I mean:
-The stretcher
-A backboard
-A cervical collar
-Backboard straps
-The monitor/ecg
-The airway box
-The med bag
-Suction
-An oxygen cylinder
In short, just about everything on the truck. As we make our way into the house, our Chief pulls up onscene, having checked in to help out when he heard it was a code. We're called into the back bedroom by the fire department.
As we walk in, it's apparent that this is not going to be a fun code. People die in the most inconvenient places, and there was just no room anywhere in this guy's house to work. The FD had pulled him out of his bed and laid him on the floor, but there was very little room around him. Typical.
According to the FD, they walked into the bedroom, and watched the guy take his last breaths. Gasp. Gasp. Nothing. They laid him on the floor, attached their AED (Automated External Defibrillator. If you don't know what it is, find out, learn how to use it, and learn CPR while you're at it.) and were promptly told they couldn't shock him. They started CPR, and we walked in 30 seconds later.
This illustrates perfectly the great thing about first responders. If we didn't have the FD with us on this call, we would've walked into a full cardiac arrest without many of the supplies we need to effectively work a code. They were there quickly, and were able to provide definitive care (defibrillation) almost immediately. If you don't thank firefighters when you see them out and about, you should. Leave EMS alone though, we bite.
Content to let the firefighter continue to ventilate the patient and thus absorb all risk of getting puked on, I set about getting the equipment ready for intubation while my partner attached our monitor to their pads. Sure enough, this old dude was in good ol' asystole; the flat line that is the calling card of none other than Death.
Contrary to what you may have seen in movies and/or TV, asystole is not something that can be "shocked" back to life. If you want to know why research defibrillation on the internet. What we could do was try to pace him (as in pacemaker) but that never works, and sure enough, it didn't work this time either.
Electrical options exhausted for now, my partner came back around to the patient's head, and asked me to get him a 7.5 tube, and a Mac 3 on the laryngoscope. I was holding both things in front of his head before he got the words out because I'm a good partner. This got me a head-pat later. I wanted a cookie too, but if wishes were horses, everyone would drive a camaro (El Guapo!), or something like that.
PS- The whole time all of this is happening, one member of the FD crew or another is performing compressions to keep pumping blood around and around. I'm not mentioning it because it's relatively boring, and it starts and stops so often that if I wrote about it everytime, you'd miss the cool stuff.
While my partner is trying to intubate the dead guy, the Chief is down looking at the guy's arms for an IV. IVs are often difficult on old people anyway, and when they're dead, it only makes things harder. The Chief tries once, but isn't able to get anything. Now I'm a little excited, because I know what's coming, and I turn to get it out.
The next step is the EZ-IO. IO standing for intra-osseus, which if you're medically inclined, or know your latin, you'll recognize to mean "within the bone". That's right bitches, we're about to drill into this dude's leg.
Meanwhile, my partner has managed to get the tube in, after suctioning spooge and other secretions from the guy's throat. Ick. 1st round of drugs goes in. 2mg of epinephrine (Adrenalin. Constricts the blood vessels of most of your body, opens up your lungs, and bitch slaps the heart.) and 2mg of atropine (Supposed to speed the heart up.) go down the tube. Some drugs can be delivered through your lungs. Pretty cool huh?
Bone drill is out, and in my hands. This is awesome. Take your leg, and find the top of your tibia, or shin bone. Go down about 2" and then slide your finger to the inside of your leg. We pop a drill bit in there. The reasoning behind this torture device is that the inside of your bones are filled with marrow, and very much vascular and alive. It's essentially an IV that you can't miss, and is very quick. Drill in, hook up the line, and you're set. This process done, our guy gets round 2 of his drugs. 1mg of Epi, and 1mg of atropine. The dose is lowered since we're delivering the drugs more directly to his circulation now.
I manage to get our capnography hooked up to the ET tube, so we can see that our guy is in fact properly intubated, and is breathing off CO2 with each breath the FD gives him, but not much. Things are beginning to look bad for our guy, and after 2 rounds of drugs with CPR, and no rhythm change, bad means pretty much hopeless.
Still, we're EMS, the eternal optimists (HA!) so we go for round 3, and he gets another milligram of Epi and Atropine. 5 minutes of CPR later, no change in the rhythm. This guy is dead. Not Princess Bride "mostly dead", but dead.
According to Wake County protocols, we've exhausted our abilities, and the hospital can't do anything more for him. We terminate our efforts, and my partner goes to inform the gentleman's wife that her husband has in fact, died. We disconnect our equipment, but leave all tubes and lines in place, as the Medical Examiner has to verify their placement to make sure that we didn't kill this guy. Gotta love our litigous society.
I begin carrying our equipment out of the house, feeling a little bad everytime I pass the guy's wife, as it seems so callous to be "done" with her husband, and preparing for the next patient. It's the way things go though.
I'm outside putting stuff back on the truck when this guy walks up in a soccer shirt and cordouroys with a notepad in his hand, and starts asking me what happened. I'm like "Dude, I can't tell you anything about it"
Then he flashes his badge and I feel like an asshole. They have to send a detective to investigate every death that occurs outside of a medical facility, and I missed the fact that our guy had driven up in an unmarked Crown Vic. Whoops.
He's the only guy I've ever seen open a door with his elbow. Makes sense if you're a detective I guess, but it still looks funny when you watch it.
We clear up shortly after he arrives, and tells us to be on our way. It's pretty obvious there's nothing suspicious about this death, and it'll be a quick report for him.
Remember that date I mentioned? Well after running the code, cleaning everything up, waiting for the detective, cleaning more stuff at the station, and writing an earlier report, it's now 6:15. The party starts at 7, I still need a shower, and Chapel Hill is an hour's drive round-trip. This is the reason that my friend Blair will forever be one of the coolest people on Earth. She'd already bailed me out by agreeing to be my date in the first place after my girlfriend broke up with me about 3 weeks before the party, and after hearing about my current dillema, she offered to just drive over, and meet me at the station. Blair is obviously awesome. I felt bad since when I ask someone on a date, even if it's a "friend" date, I like to treat them well, but I wanted to go to the party, and I wanted a date. I'll make it up to her one day.
Anyway, that night at the party I was awarded with a sweatshirt for having a successful resuscitation in the previous year. The irony of the day was not lost upon me.
posted by C at 3:36 AM
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