PNB

[Phridae]

Well I just got back from a long and exhausing code, PNB, whatever you want to call it. We were toned out at 2301. The last time someone had see this person alive was 2200. Police were on scen with their AED at 2306. One of our EMTs was there before the officer and had begun CPR. Mind you, this call came in as difficulty breathing. So the officer gets there, sees the EMT doing CPR, and states we have a code blue. We get on scene at 2308. I go in with the monitor and the med bag. He didnt look like he'd been down that long. He wasnt very pale or anything quite yet. Anyways, we get the monitor on him and it shows asystole. We end up with 3 medics and two EMTS on scene total. Which, for Delavan is surprising. When we have a code, people come out of the woodwork. Well, I'm spiking IV bags and putting the end title CO2 detector on the BVM while one of the medics is going for the tube. Another medic is going for the line. We end up getting 2 lines, and the tube. 3 Epi and 2 Atro are pused while we're still in the house. We get him on a backboard and on the cot, then to the rig. Get him hooked up to our vent. And hey, this guy's got a pulse. And and nice looking rhythm. Tachy at about 120. No radial pulses though. Not with a pressure of 50/30-ish. This guy has a history of drugs and whatnot. The medic who tubed him said that she was confused, because she was looking for the white of his vocal cords, but they werent white. They were more a dark brown color. Anyways. Some BiCard is given, along with 4 of Narcan. Then, we're looking like mad for our narc box. We have things all seperated. The narc box as the morphine, versed, and what not in it. We're looking for this incase this is just an overdose and he does come out of it all mad and thrashing. We thought we left it in the house. The house that smelled of dope. But we found it. Anyways. The narcan does nothing. His pupils are fixed, but not dialated. We get him to the ED without any other delay. This ED we went to is just that. Its just an ED. Its not a hospital. Anyone that needs to be admitted gets shipped out. Its the only ED around her like it. And I love it. Well, this guy is obviously not going to be walking out of this place. So, they get a chest xray, tubes in good position. They start a d-drip. Turns out this guy had a right sided infarction. We end up taking him to a hospital 30 miles away. Gave 40 a vaso on the way there, and just took bp's. I manned the clipboard. He made it there okay. One of the medics who we dropped off at the station on the way to the hopsital was surprised the guy didnt code on us again. His pressue never got about 60 on the way to the hospital. But up in the ICU they said it was 110. Then they put in an art-line. Wish they had done that at the ED. So much easier. They dont think he's going to make it. I dont know. No one knows how long he was down.

But it was fun. (fun? I mean...sad and unfortunate)
Now I'm tired. Time for sleep.

 

[Jon]

Originally posted by Phridae@Feb 2 2005, 05:03 AM
Well I just got back from a long and exhausing code, PNB, whatever you want to call it. We were toned out at 2301. The last time someone had see this person alive was 2200. Police were on scen with their AED at 2306. One of our EMTs was there before the officer and had begun CPR. Mind you, this call came in as difficulty breathing. So the officer gets there, sees the EMT doing CPR, and states we have a code blue. We get on scene at 2308. I go in with the monitor and the med bag. He didnt look like he'd been down that long. He wasnt very pale or anything quite yet. Anyways, we get the monitor on him and it shows asystole. We end up with 3 medics and two EMTS on scene total. Which, for Delavan is surprising. When we have a code, people come out of the woodwork. Well, I'm spiking IV bags and putting the end title CO2 detector on the BVM while one of the medics is going for the tube. Another medic is going for the line. We end up getting 2 lines, and the tube. 3 Epi and 2 Atro are pused while we're still in the house. We get him on a backboard and on the cot, then to the rig. Get him hooked up to our vent. And hey, this guy's got a pulse. And and nice looking rhythm. Tachy at about 120. No radial pulses though. Not with a pressure of 50/30-ish. This guy has a history of drugs and whatnot. The medic who tubed him said that she was confused, because she was looking for the white of his vocal cords, but they werent white. They were more a dark brown color. Anyways. Some BiCard is given, along with 4 of Narcan. Then, we're looking like mad for our narc box. We have things all seperated. The narc box as the morphine, versed, and what not in it. We're looking for this incase this is just an overdose and he does come out of it all mad and thrashing. We thought we left it in the house. The house that smelled of dope. But we found it. Anyways. The narcan does nothing. His pupils are fixed, but not dialated. We get him to the ED without any other delay. This ED we went to is just that. Its just an ED. Its not a hospital. Anyone that needs to be admitted gets shipped out. Its the only ED around her like it. And I love it. Well, this guy is obviously not going to be walking out of this place. So, they get a chest xray, tubes in good position. They start a d-drip. Turns out this guy had a right sided infarction. We end up taking him to a hospital 30 miles away. Gave 40 a vaso on the way there, and just took bp's. I manned the clipboard. He made it there okay. One of the medics who we dropped off at the station on the way to the hopsital was surprised the guy didnt code on us again. His pressue never got about 60 on the way to the hospital. But up in the ICU they said it was 110. Then they put in an art-line. Wish they had done that at the ED. So much easier. They dont think he's going to make it. I dont know. No one knows how long he was down.

But it was fun. (fun? I mean...sad and unfortunate)
Now I'm tired. Time for sleep.

all of my codes involved patients who, upon arrivial to ED were VERY STABLE (Read aysystolic in 3 leads). I've never had a "save" either in clinical or on the street. Kinda depressing - at least you guys did EVERYTHING YOU COULD and got the Pt. to the ED fast, with a pulse and rythym (both are VERY GOOD THINGS - DUH!)

you win some, you lose some..


Jon

 

[Chimpie]

Good job. Whether or not he makes it, good job. It sounds like you all worked together doing the best you could for him.

 

[ffemt8978]

At least you gave the guy's family a chance to say goodbye to him at the hospital.

Sometimes, you just gotta take your victories where ever you can find them.

I've personally done CPR over a dozen times, and have never had a patient live longer than 24 hours afterwards.

 

[Phridae]

Originally posted by ffemt8978@Feb 2 2005, 01:50 PM
At least you gave the guy's family a chance to say goodbye to him at the hospital.

Sometimes, you just gotta take your victories where ever you can find them.

I've personally done CPR over a dozen times, and have never had a patient live longer than 24 hours afterwards.

I've done CPR once. On my chiefs mother in law. :blink:

We had another code about a month ago. Maybe longer. I wasnt on it. But it was some guy who was driving his car or something. (what I know is sketchy, sorry) But someone saw this guy slumped over in his car and got out to see if he was okay. Apparently this somebody was a medic. Some other people stopped to. They pulled this guy to the ground and performed CPR in the middle of Hwy 50. Right in fron of McDonalds. Another EMT who was there said by the time they were putting the cot in the back, the guy was asking if he could sit up. Crazy.

 

[Phridae]

Originally posted by Chimpie@Feb 2 2005, 11:52 AM
Good job. Whether or not he makes it, good job. It sounds like you all worked together doing the best you could for him.

We all did work together nicely. I was surprised. Usually we have so many people on these calls that 10 people are doing the same thing it seems. This time it was just 5 of us. There was no frantic looking for anything, no running back to the rig because something important was forgotten. We got everything done in a nice order. I have to say this was the best code we've ran in a long time. Considering we have a code about once every 2 months or something.

 

[rescuecpt]

In response to Jon's post about bringing in stable patients (asystole) - I actually had one recently that started as asystole, we got him into a perfusing rhythm (but not breathing on his own), and the ED staff made him stable again (asystole). Man was I pissed. :angry:

 

[Phridae]

I also forgot to mention that when we got to the ED, the whole garage smelled of burning breaks. Why? Because the driver drove with the parking break on the entire time. It was a nice laugh.

 

[PArescueEMT]

Originally posted by Phridae@Feb 3 2005, 01:23 AM
I also forgot to mention that when we got to the ED, the whole garage smelled of burning breaks. Why? Because the driver drove with the parking break on the entire time. It was a nice laugh.

OOPS... i've never done that one

 

[PArescueEMT]

Originally posted by rescuecpt@Feb 2 2005, 10:30 PM
In response to Jon's post about bringing in stable patients (asystole) - I actually had one recently that started as asystole, we got him into a perfusing rhythm (but not breathing on his own), and the ED staff made him stable again (asystole). Man was I pissed. :angry:

Would that DWEDA??

 

[rescuecpt]

Originally posted by PArescueEMT+Feb 5 2005, 03:01 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (PArescueEMT @ Feb 5 2005, 03:01 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt@Feb 2 2005, 10:30 PM
In response to Jon's post about bringing in stable patients (asystole) - I actually had one recently that started as asystole, we got him into a perfusing rhythm (but not breathing on his own), and the ED staff made him stable again (asystole). Man was I pissed. :angry:

Would that DWEDA?? [/b][/quote]
huh?

 

[ffemt8978]

DWEDA = Dead With Emergency Department Assistance

 

[Jon]

Originally posted by PArescueEMT+Feb 5 2005, 03:00 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (PArescueEMT @ Feb 5 2005, 03:00 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-Phridae@Feb 3 2005, 01:23 AM
I also forgot to mention that when we got to the ED, the whole garage smelled of burning breaks. Why? Because the driver drove with the parking break on the entire time. It was a nice laugh.

OOPS... i've never done that oneC [/b][/quote]
yeah...then again, one of our trucks had no brake....

and it wasn't just once................ :lol:

Jon

 

[Jon]

Originally posted by rescuecpt+Feb 5 2005, 08:44 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (rescuecpt @ Feb 5 2005, 08:44 AM)</td></tr><tr><td id='QUOTE'>

Originally posted by PArescueEMT@Feb 5 2005, 03:01 AM
<!--QuoteBegin-rescuecpt

@Feb 2 2005, 10:30 PM
In response to Jon's post about bringing in stable patients (asystole) - I actually had one recently that started as asystole, we got him into a perfusing rhythm (but not breathing on his own), and the ED staff made him stable again (asystole).  Man was I pissed.  :angry:

Would that DWEDA??

huh? [/b][/quote]
The Great Goddess Does not know about Dying with ED asstiance????


OMG

What to do, what to do......

I guess she can no longer be RescueCapt....


Now must be FNG, or PHDNA (person who don't know abbreaviatons, DUH!)


Jon

 

[SafetyPro2]

I went to bed last night with a premonition that I'd be doing CPR before the sun came up. Sure enough, at 0530 the tones go off for a "Person Not Breathing" about a block from my house (and yes, I had the ambulance). One of the other guys lives in the same are and had the Utility last night, so we both got on-scene at the same time. Grab our gear and go in, and PDs in there talking to the wife (first red flag...they're usually doing CPR). PD Sgt. says "He's down the hall." As we head down, overhear wife saying "I don't need an ambulance" in a resigned voice (second red flag). We go down and have to step over the O2 lines running out of the closet (third red flag). PT is lying on his back in bed with an NC on and obviously in full arrest. Pale, but not overly cyanotic. PD Sgt. comes in and says "He's dead." We begin to realize this is a terminal PT, so we do a quick check. Trunk is warm to touch. I ask PD if we know the down time and get a negative. I ask if we have a DNR...again negative. We roll the PT and check for signs of post-mortem lividity on the back...none. Move the limbs...no sign of rigor. Again, do we have a DNR? Nope. Third FF/EMT arrives at that time, and we look at each other and all say "We gotta work him".

As BLS, we're only allowed to "determine" death based on a few obvious factors, including PM lividity and rigor, and he didn't have any of the criteria. And barring any legal DNR/Advanced Medical Directive, we can't NOT start resuscitative efforts. So, we start CPR and hook up the AED. AED shows asystole. We continue with another cycle and again, asystole, so we package and go. Get him to the ER and they work him for a couple minutes before calling him.

Turns out he's an old family friend of one of our FFs, who got on scene and then followed us down to the ER. Terminal with pulmonary fibrosis, and was supposed to sign his DNR today.

And to top it all off, both PD and the ER staff got pissed at us for following the County protocol. PD expected us to come in and make a field determination for them, but he didn't meet any of the signs. ER staff got pissed because we brought in an unsavable PT (one doc kept asking us if the wife told us to not resuscitate...doesn't matter if she did, we can only follow a written order). At least during our crew meeting this morning, everyone (including the Captains and BC) reiterated that we did exactly what we should have, and the Chief will be having a conversation with the PD Chief over his Sgt's behavior on-scene (apparently some inappropriate comments about our personnel were made in front of the PT's family.)

So, that's how my day's been going.

 

[Wingnut]

Well I'm sorry you got such a negative response, but you did the right thing. And consequently covered your ***...I've heard too many horror stories about EMS personnel doing exactly what that Sgt & Dr wanted you to do and it rarely ends well.



*Golf clap for SafteyPro*

 

[PArescueEMT]

See Below

 

[PArescueEMT]

For Safety Pro:


.......A
....E....P
..S........P
....U....L
.......A

 

[ffemt8978]

Originally posted by PArescueEMT@Feb 5 2005, 07:47 PM
See Below

That's a cheap way to increase your post count!

 

[PArescueEMT]

it was an accidental double post. I had to change 1 of them. Would you rather have a "see above"?