Epi-do
I see dead people
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So, I get into the firehouse today to start my 24, and the first thing out of the outgoing medic's mouth is "The truck needs fuel." I couldn't help it, the first thing out of my mouth was, "Again, really?" You see, this was the fourth shift out of the last 6 that the truck was left needing fueled. I listened to the rest of his report and then went about checking the rest of the truck. After stewing over it for a few minutes, I went up to him and asked what the deal was. After he gave me some lame excuse about how sometimes they just aren't able to get fuel, I told him that it was becoming a habit, it was getting really old, and it needed to stop so he had better figure out what needed to be done to change things. The only time we truly can't get fuel is between 2359-0400 on Sunday nights/Monday mornings. So, that accounts for today's incident, but doesn't explain the other 3 out of 5 shifts.
Then we started running. In the first 7 hours of our shift, we had 5 runs. The first couple were run-of-the-mill, no big deal, types of runs. On the third run, we had a very grumpy old man that had flu-like symptoms, refused to put a mask on, and was insistent on going to one of our heart hospitals rather than the "regular" ER.
Run 4 was an unresponsive person at this huge retirement compound and all the nurse could tell dispatch was we needed to go to "door 10." Each wing/building has a name and we know the facility by building names, not door numbers. It took us a few extra minutes to finally figure out where we needed to be, and that was after asking a few different employees who called/where door 10 was and no one could tell us. We finally get to the patient and she takes one last aginal breath and then stops breathing. She is also pulseless. She has a valid DNR, so I hook the monitor up to get my strip of asystole to include with the report & DNR, and she is in PEA. Yes, she is pulseless, but technically, her heart hasn't stopped beating yet, so now what the heck do I do? Since she has the DNR do I just stand there and do nothing until she is finally in asystole? Well, since I wasn't sure, and there wasn't another medic on scene with me, I opted to get the patient moved and to transport. Just as we were getting ready to move her, she converted to asystole. We double checked all of the leads to make sure none of them were pulled off (they weren't). I printed my strip, took the paperwork that I needed from the ECF, and we went on our way.
Run 5 was an unresponsive person at the Jr. high school. While we are enroute to the school, dispatch advises us that our patient is a 13yo special needs child who has stopped breathing, and CPR is now in progress. The engine arrives first, and takes over CPR until the pt has ROSC. When we get there, he is not letting them bag him any longer, and while he is pale, he is no longer cyanotic, like he was when the engine first got there. He is fighting having a NRB on his face, but needs the oxygen, so we use kerlex to restrain his hands at the side of the cot. He is breathing well on his own and is interacting with us at this point. We head downtown to the children's hospital, about 15 minutes away. About half-way there, he begins breathing inadequately again and we begin to bag him again. He eventually stops breathing again, and goes from sinus brady to PEA. I only had one other person in the back with me, so we start CPR and take him in with only an OP, BVM & chest compressions. He was ventilating well with the OP, so I didn't attempt to intubate. I also was unable to get a line or push drugs since CPR was taking precidence. The ER was able to get him back, but I am not sure what sort of quality of life he will have if he even survives.
So, that was the first 7 hours of my 24 hour shift. We haven't done anything else (yet), but we still have until 0800. (I swear if I get a third arrest this shift I am going home and will be done for the shift.)
Then we started running. In the first 7 hours of our shift, we had 5 runs. The first couple were run-of-the-mill, no big deal, types of runs. On the third run, we had a very grumpy old man that had flu-like symptoms, refused to put a mask on, and was insistent on going to one of our heart hospitals rather than the "regular" ER.
Run 4 was an unresponsive person at this huge retirement compound and all the nurse could tell dispatch was we needed to go to "door 10." Each wing/building has a name and we know the facility by building names, not door numbers. It took us a few extra minutes to finally figure out where we needed to be, and that was after asking a few different employees who called/where door 10 was and no one could tell us. We finally get to the patient and she takes one last aginal breath and then stops breathing. She is also pulseless. She has a valid DNR, so I hook the monitor up to get my strip of asystole to include with the report & DNR, and she is in PEA. Yes, she is pulseless, but technically, her heart hasn't stopped beating yet, so now what the heck do I do? Since she has the DNR do I just stand there and do nothing until she is finally in asystole? Well, since I wasn't sure, and there wasn't another medic on scene with me, I opted to get the patient moved and to transport. Just as we were getting ready to move her, she converted to asystole. We double checked all of the leads to make sure none of them were pulled off (they weren't). I printed my strip, took the paperwork that I needed from the ECF, and we went on our way.
Run 5 was an unresponsive person at the Jr. high school. While we are enroute to the school, dispatch advises us that our patient is a 13yo special needs child who has stopped breathing, and CPR is now in progress. The engine arrives first, and takes over CPR until the pt has ROSC. When we get there, he is not letting them bag him any longer, and while he is pale, he is no longer cyanotic, like he was when the engine first got there. He is fighting having a NRB on his face, but needs the oxygen, so we use kerlex to restrain his hands at the side of the cot. He is breathing well on his own and is interacting with us at this point. We head downtown to the children's hospital, about 15 minutes away. About half-way there, he begins breathing inadequately again and we begin to bag him again. He eventually stops breathing again, and goes from sinus brady to PEA. I only had one other person in the back with me, so we start CPR and take him in with only an OP, BVM & chest compressions. He was ventilating well with the OP, so I didn't attempt to intubate. I also was unable to get a line or push drugs since CPR was taking precidence. The ER was able to get him back, but I am not sure what sort of quality of life he will have if he even survives.
So, that was the first 7 hours of my 24 hour shift. We haven't done anything else (yet), but we still have until 0800. (I swear if I get a third arrest this shift I am going home and will be done for the shift.)