Thursday, February 11, 2010

My First.

It's a little past 3am when the tones go off. I know its for us, since we're the only crew still at base. It came over as a sick call, priority 1 hot. Off we go. Okay, I can do this. Should be simple enough, right? I hope.

We find the address in the map book, figure out where we're headed, and off we go. Less than a minute goes by when dispatch comes over the radio to tell us that our sick call has turned into a cardiac arrest. What if we have to use the AED? One pad on the upper right chest area... Remember to connect the electrodes... What if the patient has a hairy chest and I have to use that little razor? What does it look like when someone actually gets shocked? Now I'm getting nervous!

We arrive in less than 4 minutes. Fire is already on scene. (Can I just ask... how in the world does fire always beat us to the scene?!?) I grab the AED, jump kit, suction and oxygen bag as my partner gets the stretcher. I finally look up at the house to notice there are about 8 steps leading to the front door. Okay, stretcher is staying outside. At least it's not raining.

As soon as the door opens I hear... "Analyzing rhythm. Stand clear." Oh dear.

There is a narrow flight of stairs leading to an already over-crowded bedroom. My mind is already trying to figure out how we're going to get this patient out. The fact that there was a stair lift that cut the stairway in half was going to make things harder.

"No shock advised. Begin CPR." Oh dear.

By this time I have made it to the bedroom to find a ghostly pale woman lying in bed. As the nearby firefighter gave his first compression, dark red (almost brown) gritty looking fluid came spewing out of her mouth.

"Let's get her off the bed." My first words! The 2 other fire guys rushed over and helped move her limp body to the floor. (Why is it that dead weight really does feel heavier??)

Out of nowhere a medic showed up. As soon as he got a feel for what was going on, he started calling the shots.

"I need suction. I can't see a thing." The patient had a massive upper GI bleed. I had not experienced the sight or smell of that before. It wasn't pleasant. My partner took over compressions from the firefighter.

We're gonna need a backboard... Got it. As the patient is being loaded onto the board and the medic tries to intubate her, I talk to the husband and get as much information as I can.

I gotta say, whenever fire is on scene there's not much left for us EMS folk to do. It's like they're all so eager to do something, get some hands on, that they jump at the opportunity. Even if its holding c-spine, doing compressions or lifting and carrying. Thank you. :)

The husband of 38 years told me that just ten minutes ago he was talking to his wife. She had been sick all day, vomiting. Vomiting blood. "We thought it was the flu."

The patient had MS for the past 6 years, and rarely got out of the house, let alone her bed. She was all there in her mind, her body just wouldn't cooperate. She loved cats. She had five of them. There were feces and fur caked onto the bed posts.

"I should have called earlier. But we didn't want to be a bother. We just thought it was the flu."

Somehow fire managed to maneuver the patient down the stairs around the corner and out the door. My partner yelled for me to grab our equipment. So I did. I get back and they're in the ambulance. "Suction!" I'm on it.

The stuff coming out of the patient's mouth looked like coffee grounds and blood. The medic still couldn't get anything other than an OPA in. He tried to start a line, but that was unsuccessful as well.

As I head up front I find the husband sitting in the passengers seat. The window is down and there is a firefighter standing beside the door. Both are silent. As I get in I can feel the ambulance rock ever so slightly with each compression. I almost feel bad breaking the silence to talk to dispatch and let them know where we're headed.

After what seemed like eternity of me sitting in the drivers seat, just itching to be in the back doing compressions and suctioning, the medic finally says that he's ready to go.

"Get me there yesterday and go easy on the bumps." I had yet to drive lights and sirens with a patient in the back. I know every bump we feel up front is exagerated many times over in the back, so I'm not quite sure how to drive fast and yet make it a "smooth" ride. (My driver training consisted of parallel parking a 12 passenger van, driving it around some cones, and backing it into a parking space... haha)

I thought about trying to make conversation with the husband, but nothing seemed important enough to talk about at that point.

At the hospital fire practically had the doors open and the patient out before I even put the ambulance in park. I asked my partner if she needed me to take over compressions but she declined as she hopped onto the side rail of the stretcher and rode it in. Hmm, that looks fun. Though knowing me I'd hurt myself. ;)

I gave my report to the doctor as fire moved the patient onto the bed. Four minutes later he called it. Everyone stopped what they were doing. The husband was just standing by the door. No expression on his face.

As I was walking back to the rig the lady's husband came up to me.

"I should have called earlier. I was just talking with her ten minutes before you showed up... We thought it was the flu. We didn't want to be a bother."

2 comments:

danaelliottMD said...

We will like to share with your readers on what First Aid Corps trying to improve survival rates from sudden cardiac arrests.

In our efforts to locate automated external defibrillators (AEDs) locations, we have collaborated with a volunteer organization The Extraordinaries (www.beextra.org) to get iPhone users to locate AEDs worldwide. You can view some of the AEDs that were located by iPhone users at www.firstaidcorps.org. For the public to participate, they just need to follow our org "First Aid Corps" in that app to get access to our missions.

How the world society benefits is that we have an iPhone app to locate AED locations throughout the world. It is called AED Nearby. You can view the screenshots and a video on it at www.firstaidcorps.org. You can download it for free from the app store.

Dave Hayes said...

The first of many to come. Sounds like you guys did the best you could with what you had. IV access is usually difficult with anyone who goes into cardiac arrest from a bleed. Not much blood in the veins to make them stand up and they aren't usually accessible.

Airways are always a problem when puke is involved - blood makes it about 10 times worse. No fun.

Dealing with family members is perhaps the most challenging issue. The husband felt guilty for not calling. GI bleeds like this have an extremely high mortality even in - hospital. If he'd called earlier and she'd gotten to surgery, she might have survived. But I'm guessing the odds were against her.

I'm not sure if conveying that to him would be appropriate. Sometimes It helps. Depends on the situation.

Keep writing. We're rooting for you!