Monday, August 27, 2007

The Storm...

A few posts back, I spoke of The Calm. A commenter warned me of the storm that always follows it. I should have listened...

On the way to work yesterday morning, I was wondering who I would be working with and if
last shift was just a fluke. I speculated on the possibilities of working with the same New Partner (NP) again, or someone else. When I pulled up, her car was there and my suspicions were put to rest. She had made a point to get there before I did and was half-way through checking off the truck by the time I pulled in. With a big smile on her face she said hey and asked if I'd slept late. Smartass..Hmmm...I think this partnership will work out just fine.

Everything went as usual for an hour or two, then all hell broke loose. The entire county exploded and all 5 trucks got a call in less than 15 minutes. Ours was a routine transfer from a nursing home to Big City Hospital for a "routine medical", whatever that means.

Well it turned out to be not-so-routine. Out patient was an elderly lady with decreased level of consciousness (LOC) and no blood pressure to boot. We got underway and amazingly I got an 20 gauge IV in her arm. After a bucket-load of fluid, her pressure hadn't changed and her LOC hadn't improved. I couldn't find anything else wrong with her, 12-lead was good, her Foley catheter had urine in it and it was clear of junk, she wasn't running a fever, lungs were clear, pupils were reactive but sluggish. I was thinking maybe stroke, maybe an MI without ECG changes, hell I was grasping at straws by this point. I even gave some Narcan in case it was Opioid, even though her pupils weren't pinpoint.

No matter what was causing this, I knew I had to get her pressure up. So I started a dopamine drip and it worked! This action might seem very mundane to a lot of my readers and colleagues, but this was the first time I had done it, ever. Even in all the clinical's, I had never even seen one started. Needless to say I was nervous, but I couldn't help grinning as I watched her pressure rise to 96 by palpation and I stopped increasing the drip and it held. She even started moaning a little by the time we got her to the ED.

The next call was an allergic reaction, another bee sting. This time it was a 19 year old and she was having a full anaphalactic reaction. Luckily her parents knew all about it and stuck the patient with her Epi-Pen and it slowed the reaction till we could get there. But it wasn't enough. NP gave her another shot of Epi under the skin, and some Benadryl and Solu-Medrol through the IV I had started. She was still wheezing, so a couple of nebulized Albuterol treatments cleared her up on the way to the hospital.

We slowed down a bit after that, did another routine call for a guy with the flu and a three year old who had fallen off the back porch of his grandparents house. A few bumps and bruises, but otherwise he was OK.

We had just finished eating dinner and the tones went off. A possible Code Blue (Cardiac Arrest) at an assisted living facility. NP was almost jumping out of her skin with excitement. We get there and she practically drags me down the hall from the front of the stretcher. We see our patient, elderly male, laying on his back and he is purple from the nipple line up. Not a good sign.

The staff have no idea how long he has been down, the last time anyone has seen him alive was approximately 30 minutes before we got there. He is a full code, no DNR. I drag him to the floor, start bagging him and doing chest compressions while New Partner got the monitor out and attached the pads. Asystole, shit. The first responders show up and together we get him on a board and then to the cot. Once we get to the truck, NP goes for a line while I get out my intubation stuff and the squad members set up the IV lines and do CPR.

NP wasn't successful at the IV's so I told her to get the BIG gun out. It's a special device that puts a needle directly into the bone, that way we can give fluids and medications to the patient directly into the marrow and then it gets to the blood stream quickly. I dropped the tube on my first attempt and checked for breath sounds. I'm in! I look up and see NP grinning like a fool. She nailed the BIG gun on her first try as well.

The patient was still flat-line on the monitor and we started pushing the drugs and I told the squad to jump out and but I would need a driver. Me and NP worked the rest of the code by ourselves for the 15 minute ride to the local ED.

We didn't get him back, didn't even get any Epi-blips on the monitor. But I felt like we had gave it our all and done everything we could. Our supervisor was there when we arrived and he had heard everything on the radio. He was grinning from ear to ear. Later he took me aside and said that he was proud of me and that I was defiantly on my way. I imagine I turned about 8 different shades of red from this compliment. I thanked him and went to clean my truck. Running a code is a messy business, there were wrappers and equipment all over the place. About 45 minutes and 2 trash bags later we were all cleaned up and I checked us back in service.

That was the last call of the day, we actually got to sleep all night. Before I went off to bed, the phone rang at the station. It was my Training Officer. He was calling to tell me he had heard the call and had heard that we did exceptionally well. This man is the only one that could really intimidate me. I'm not sure exactly why, but he does. So a comment from him was a great thing to hear at the end of the day.


Shannon said...

I'm enjoying reading about your experiences so much! Thank you for taking the time to share them.

I hope to one day follow in your footsteps, but honestly, it's a pipe dream at this point. Making a difference in the lives of others - helping your must be a really special feeling.

I look forward to reading more!

Epijunky said...

Congrats! Wow... what a day, huh?

Medic 61 said...

That's great to hear, BRM! That must have been such a crazy day, but it's awesome that you did so well!

Medicmarch. said...

I had my first good call the other day. We had a guy with a rate of thirty and the whole time I was working on him I had "welcome to the jungle" playing in my head.

Isn't playing paramedic fun!?

Loving Annie said...

Nice ending to a massively busy day for you, Blue Ridge !

NYC EMS said...

Was this NP first death?

Loving Annie said...

Hope you are having a good Labor Day weekend, Blue Ridge -- be it calm or stormy :)

Anonymous said...

You've won an award! You can pick it up here -


~Sandy G.

PDXEMT said...

Wow, a busy day indeed! Well done.

Two quick questions:

Do you have to call in for dopamine?

Under what circumstances can you call a code in the field? In my area we'd never transport anyone in asystole with no response to meds, advanced airway, etc.

Blue Ridge Medic said...

Thanks to all who have left comments, I appreciate them.

nyc ems- yes it was her first code, ever. She took it well.

pdxemt- No, we don't have to get orders for dopamine. As far as calling a death in the field, it's pretty much up to the Medic on scene. This guy was in asystole, but he was still warm with no rigor or lividity, so I decided to go ahead and work him.


Detail Medic said...

Soooo jealous about the IO gun. Our Medical Director doesn't allow us to use them...but we're working on him.

Good work guys!