Sunday, February 25, 2007

Epic

Saturday morning. The whole call is like a movie.

*BEEP* *BEEP* *BEEP* "Engine 401, Squad 402, 4809, Engine 95, Medic 105, an echo response, cardiac arrest, across from Fargone Park, 49600 Wayout Road. Map page 6295-D, working Tac 2, time out eight thirty two."

We're a block from the fire station, going on a non-emergent walk-in sick person. My partner grabs the radio microphone. "Medic 105, we're diverting to the echo response at Fargone Park."

I hit the red EMERG MASTER switch, twist the siren knob to WAIL, and off we go. It takes us about eight or nine minutes to get there, hauling butt, and we beat all the fire responders (volunteers and paid from two rural departments).

About halfway there we get the expected update that CPR is in progress.

It's an area I don't know well at all, but my partner directs me; left turn, right turn. I drive hard -- either the gas or brake is all the way to the floor, the whole time.

We scream across a bridge, and we can see three or four people gathered around a man lying half in a mud puddle, doing CPR.

My partner bails out almost before the car is stopped, shouting to the bystanders, "Don't stop!" He grabs the monitor. I grab the hard plastic medkit and skid it across the pavement towards the patient, then sling the airway bag over my shoulder and run over. My partner drags the patient out of the mud puddle and the bystanders start compressions again.

They're doing good CPR, damn good in fact. They've taken a class recently and know the new standards.

Great. Keep going.

I pop an OPA in and start bagging. My partner gets the patches on -- "Check a pulse! None? Okay, we're in PEA. Continue CPR!" and starts getting stuff ready for a line.

I hear a growler siren and glance over to see the first of the calvary -- the squad and the duty officer -- pulling across the bridge. Brilliant.

A moment later we've got four or five firefighters eager to help. They take over compressions and bagging. My partner has an IV in, and starts pushing drugs. I rip open the airway roll and get my stuff set for a tube.

When I'm ready, I nudge the fireman aside, twisting my baseball cap backwards so the bill is out of the way. Drop to my knees in the mud, wipe rain off my face. Everything tunnels down to the narrow world of laryngoscope and mouth.

Suction.

Slip the blade in.

Look. See the cords. Lose them when I go to pass the tube.

Esophageal. Crap. Out.

Fireman bags. Adjust the tube.

Suction again.

Look again. A hint, a glimpse.

Lift his head all the way off the ground with my other hand. There. Bullseye.

Get a fireman to support the head. Cric pressure from my partner.

Perfect. Pass the tube, pull the stylette, inflate the cuff. Attach the BVM.

I bag as my partner listens. Good tube. My first in the field, after a frustrating series of misses and failures.

And the code goes on. I drop a second line and we start a fluid challenge. The PEA goes to v-fib and we start shocking him. We push the drugs: amiodarone, lidocaine. The v-fib continues. At some point the two engines, from different departments, show up. We keep rotating compressors for good CPR. At some point I run to the car for more epi.

The v-fib keeps going, and we've got to transport. Load him on a board, to the gurney, to the car. I get an escort by the duty officer's SUV out to roads I know. Manage not to throw my partner and the firefighters around too much.

By the time we're at the hospital he's in asystole, and been down over an hour. I code-surf the gurney in to the ED, doing good hard compressions. About eight minutes after we arrive the doc calls it.

My partner, running out immense code summaries, tells me they pushed twelve rounds of epi. We have to go out of service to quarters to get more drugs.

As we're leaving, I note that one of the bystanders seemed very emotional, on scene. "Yeah," my partner says, "it was his brother." They were enjoying some Saturday morning fishing.

I don't know if I could do CPR on my sibling.

And it was good CPR, too.

4 comments:

Anonymous said...

Good entry. Hope that you guys were able to let the brother know that he'd done a good hob with the CPR, and that you would have pushed him out of the way if it was not up to standard. If he doesn't know that, he deserves to. Congratulations on getting the intubation right.

PDXEMT said...

Yes, my partner told the brother that if his brother had any chance at all, it was because of the good CPR he'd done. They (brother and a friend) were doing a great job with compressions and rescue breathing, 30:2, spot on. They did everything right.

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Kari said...

As always, fantastic posting. Can't wait to see it first-hand.