Your first cardiac arrest

[SPEARS-101]

Greetings all,

This topic has probably been done to death (excuse the pun) but I was wondering if you could share with us the first time you responded to a patient with cardiac arrest.

I've been on active duty for only three months, and the way the system is set up where I live, I've only just recently been authorized to respond to emergencies. So this is definitely an entirely new kind of experience for me.

I think I handled myself quite well during the emergency and was able to do everything the senior EMTs asked of me. But it hasn't been easy to deal with psychologically.

It seems like as EMTs, we really do see an entirely different face of reality. While most people were sound asleep, one family in one part of the world was watching as they lost their son, brother, uncle, and father.

How do you deal with the death we face in this line of work?

 

[trevor1189]

First one I went on, I was so focused on making sure I was doing CPR right and keeping the airway clear and everything else that goes on in a code than I was really thinking this pt. is dead.

I thought it would be a hard call to take, but it just turned into another call. I felt bad for the family and the children when it was over with, but I did everything I could do and so did the paramedics, so it really didn't bother me personally. I was a little bothered that it didn't really phase me, but I guess that is for the better. Leave what happens on a call on the call...

Sometimes people die despite all our effort to keep them alive.

 

[WolfmanHarris]

My first one was Obviously dead (what we call Code 5)

My second one (same day), was n-stage lung cancer and while not DNR due to late Dx was pronounced on consultation with the family and base hospital physician. Only a couple minutes of CPR and BVM. The thing that surprised the hell out of me as the student was the groan caused by the outrush of air when we sat him up to get him off the bed. I am sure I jumped a few inches.

Third was both Code 5 and DNR.

Fourth was one hell of a learning experience. Was called (still as a student) to a 21y/o M fall from 3rd floor window. Arrived to find pt. on pavement in a VERY dark alley, large head wound attended by a LEO. LEO reported he was breathing. Assessed breathing and while I couldn't hear anything over the multiple diesel engines in close quarters, I could see bubbles in blood at his mouth and nose and I could see his airway was a mess.

My preceptor was really good and at that point was letting me run calls as much as possible. So at my direction we (myself, preceptor, partner and FD) got him boarded and collared and in the back so I could work in a better environment. I hopped on the airway and reassessed. It was then I learned pt was apneic and pulseless. He also had a La forte 3, jaw was totally locked up making airway insertion or suctioning damned near impossible, R orbital Fx'ed and eye closed right up OH and gray matter coming out both narea that I confused with coagulated blood and mud in the dark. Pt. pronounced under obvious death directive.

That presented the problem of having a dead body in the back of the truck. The Ambulance Act in Ontario forbids transport of dead bodies unless necessitated due to public location or at the direction of the Coroner (or designate). Took quite a while to sort out, but that's a different story that reads like Kafka.

Next VSA was also Code 5.

Didn't have a workable VSA until just a few weeks ago, after 2 years as a student and six months on the road. My white cloud continues.

 

[Shishkabob]

~300 hours between EMT and Medical clinicals... not a single cardiac arrest.

Only dead person so far is the one I 'helped' kill in an organ harvest.

 

[mikeN]

I'm a black cloud. My first one we got pulses back, but the guy died in the ED hours later. It was at a dialysis clinic. We were waiting to pick up another patient when the nurse called us over for some help with an unresponsive person.

 

[Mountain Res-Q]

First Code? Details are sketchy in my brain after all these years ... but...

Years ago riding with my FTO on ALS 911 Ambulance when we got a call for seizures. 2 minute code 3 response; 30 seconds out we get informed that the patient isn't breathing. Although rare, we were on scene before Fire First Response, which almost never happened. Two young adults and a very elderly man were outside the double wide hysterical. Inside we found a 70+ y/o woman lying on the carpet. She was watching TV with her family and arrested. Family called it in as seizures.

Because we were working basically as a 3 man crew, I started compressions while my FTO took airway and breathing. Medic shocked her, but didn't convert out of V-Fib. Medic intubated and gave epi IT. Firefighters walked in during the intubation and were confused as hell; they were also dispatched out to seizures and were never updated on the code. One firefighter took over ventilations, but I would not give up compressions; something about me not wanting to "turn over my responsibility on my first code" or some other stupid thought process. Medic shocked again... no conversion... threw her on a board, to the gurney, and to the ambo.

FTO drove. Firefighter continued ventilation. I would not give up compressions; and yes, compressions for any length of time takes a toll, but the adrenaline of my first code overruled that... lol. Medic threw in a line and appropriate meds. The one big thing I will never forget was after getting the line, the medic looked up at the monitor and said, “Stop Compressions!” Oops, did I do something wrong? I looked at the monitor too… still V-Fib… “Resume”… We got to the hospital and transferred care… prognosis? “She has a rhythm… but you can’t dance to it!” Direct quote; never did find out the end result. It was then that the Medic explained to me why he told me to stop. He said when he looked up at the monitor he was seeing normal sinus on the monitor… but the second I stopped, back to V-Fib. He told me that it was the best compressions he had seen in 20 years. That, combined with the very high marks the FTO gave me at the end of the shift for the call, made me feel really great and put to rest some concerns I had over how I would react on an emergent call…

Since I left ambulance, no codes (on a human at least… lol). Recently I tend to be on a lot more calls with obvious death (it's a SAR thing, you wouldn't understand... lol)… but we tend not to start resuscitation on people that have been submerged for several days (or weeks) or on folks that walk into the woods to put a shotgun in their mouth just as the sun sets over the evergreen cliffs or on people that were killed several days earlier and buried in a shallow grave…

Dealing with it? The fact that someone coded or died isn't what I find hard to deal with... it is the events surrounding any call and/or who they are... i.e. a child that was abused hits me harder than any code/death I have been on. I have been on several body recoveries for kids, but even though these are sad calls, I have been on other calls that hit me harder just for seeming weird reasons, but from an outside perspective may seem like emotionally easier calls... In the end, you either find a way to deal with those little things that should "kill you", whatever coping mechanisms and support systems you might have in place... or you don't survive long in EMS, either because you get out before it is "too late" or you burnout...

 

[Melclin]

My first cardiac arrest was actually quite rewarding, despite the eventual death. I've never had such a strong sense of purpose and clarity. I loved it.


More than anything, I just enjoyed being involved in something that was important and worthwhile. I enjoyed the fact that we were able to arrive and take the responsibility away from his daughter (the relief was clear on her face). I liked that we showed her that we did everything we could for her father and that we were able to help her with the initial stages of grieving. We helped her say goodbye. How many people get the opportunity to do such wonderful things, to be there for people at such horrible times, and get paid for it?

I think its easy to be too focused on the physiological outcome of our pts. I've talked to a few people who have had friends and relatives die after a resuscitation effort, and they all comment on how much it meant to them that the paramedics were there to help, and to direct them after the death; to sort of guide them through the start of the process (we tend to have them say their good byes, explain to them whats going to happen next, what they need to do, and provide them with information on services like grief counseling etc).

I was a little confused at the time as to why I felt so good despite the outcome of my first arrest, until I remembered a quote I'd read somewhere about Marines by Ronald Regan: "Some people live an entire lifetime and wonder if they have made a difference in the world. Marines don't have that problem".

I think the same can apply to us...whackerisms not withstanding.

 

[MrBrown]

I have a habit of being in the wrong place (where there is no cardiac arrest) at the right time (when there is one, and I'm not there!)

Is it too much to ask to electrocute somebody and give them drugs just once?

.... Brown away, but not to a 9 echo it would seem h34r:

 

[RyanMidd]

I'm an outspoken supporter of CISM and similar practices, whether your recent job activity involved a death or not.

I think that the therapeutic value of speaking with colleagues about what happened, and how you feel about it, can do wonders for easing the burden.

I also remember that I have undergone specialized training in a certain field, and that helps to alleviate the "What ifs" that accumulate in the wake of a traumatic or grim call.

 

[Seaglass]

Another white cloud here. All of my codes have either been obviously dead (we've only had to work one, and then only because our protocols said so... it was pretty obvious), or not so serious. I recently had a great example of the latter. Our patient who'd seemed fine suddenly keeled over, and I left the room to grab the drug bag. Pt apparently went into asystole while I was gone. As I came back into the room, the patient is awake again and telling us about an untreated vasovagal condition. I also had almost the exact same experience a few months before that with another patient. When codes come back to life when you enter the room, I think you're officially a white cloud.

Like MrBrown, I'm also always on duty when cardiac calls come in. And always already handling another call.

 

[mycrofft]

I remember it very well. Not very interesting,

except after we got to the ER and were still compressing, the doc turned to the gaggle and said "Anything else we need to try?".

I don't dwell on emergencies, I'm too busy getting back into service and somehow always expecting another one at once.

 

[lightsandsirens5]

Well, my first call right off the bat was a CPR. I was still in EMT class and it was even my first ride along. I can remember everything in vivd detail too. (My first thought was: Wow! This is nothing like in the dumb little CPR class videos!) Fire was alredy on scene and had pt tubed and hooked to the monitor. My crew pretty much grabbed and went. We met up with the bird at a highschool fooball field about 3 minutes away. I can still remember the filght medic climbing into the back of the rig, doing a quick look over the pt and monitor, and starting to push all his drugs. Within 3 minutes of us showing up, they were getting the pt onto their gurney and leaving. I just remember being so awed by the whole thing. (Never thought I'd see a gal lying in the middle pf the kitchen with no shirt or nuthin', tube sticking out of her mouth, firefighters in the process of bagging, doing compressions, and trying to get a line in, then my crew and several firefighters grabbing the pt by the arms and legs and "throwing" her onto the gurney, before loading her up, and practically shoving her onto another gurney and into a helocoptor. After all, to me CPR always happened right outside the ER, or at the nurses station at a doctors office. What else do you think after seeing the AHA training tapes?) Anyhow, afterwards I remember thinking: "This is awsome. I want to do this. So here I am now, hooked on EMS, never to be free. It is great though.

And all my partners have complained before about me and CPRs. By the time I'd been on as a real crew member for a year, I had gotten like 9 CPRs. (With a service that only runs 1600 calls a year.) Now at almost a year and a half, I am slowing down and am only up to 11. (And still no saves or even a brief ROSC! Blahhhhhhhh.......h34r

The second one I had as a trainee, I don't remember as well. I do, however remember seeing the guy in (very) corse V-Fib and hearing my instructor tell me to charge and shock the guy, then watching his V-Fib go right into asystole after the shock spike. The RRT at the hospital told me later that if they have been down a while, often the shock will just speed up the inevetable......

 

[Akulahawk]

First full arrest call I ever ran was on a BLS bus with Fire on scene, and they'd defib x3 with ROSC. She was tubed and such... the ALS bus showed up just before transport and I rode in with them - they were a different company altogether. We all worked well, the FD, the transport medic, and me... and she survived to the ED, and she was just starting to take breaths of her own on arrival at the ED. I didn't get to do compressions, but I certainly helped keep things going.

My first CPR was a little old lady that was unconscious/unresponsive. EMT-D FD crew was on scene first. In the 2 minutes between their arrival and getting vitals, and our arrival, she lost vitals. AED wouldn't fire. So I started CPR... I distinctly recall her sternum popping with the first 3 compressions. We did a load & go. Total VSA down time to arrival at the ED was about 6 minutes. (Yes, we were THAT close.) IIRC, an ALS bus was still about 15 min away at that point... I don't recall the rhythm, but the AED was a no-go. This was about 11 years ago and the highest level of care on that call available was the EMT-D.

Back then, the system I worked in was horrifically overloaded. It wasn't unusual for BLS to run system calls. It took a couple years for things to improve. Now, that system rarely has BLS taking calls unless it's for 5150 or BLS transport is specifically requested.

The rest of my CPR/Code calls just blur...

 

[R.O.P.]

1st code

I remember the first code I went on... Actually it was a very good experience for me, even though the outcome was sad.

I was a volunteer at a rural dept, there were 3 of us responding in the Rescue that day, first unit in. "Unresponsive pt."-it was our neighbor's house that had called. We entered thru the garage entrance, and without even speaking to each other, we each fanned out to clear a different room. We were just working along calling out "Hello-911?" We had made it about halfway through the house when the wife of the pt screeched out this horrible scream- I will never forget that noise- and we found them both in the bathroom, pt. collapsed in the shower, wife sobbing on top of him. Without the 3 of us saying a single word to each other, one opened the door to the adjacent deck, the other got behind the pt. and the third got in position to move the pt outside. As soon as he was out, one of us dropped an OPA and started CPR, the other got the defib up and running, and the third began consoling the wife and getting her to a different spot so we could work. All this without a single phrase between us. It seemed like we almost read each others mind... total synergy. This lasted for about 15 minutes until ALS showed up.

Unfortunately, the pt died. But we nailed that call! So the satisfaction, or the condolences if you will, lay in the fact that we did everything we could, as efficiently as possible for the pt.

I wish the other codes I've been on went as smoothly as that 1st one did...

 

[fast65]

My first code was on my very first EMT-B ride-a-long. We hadn't received but one call all day and finally we got dispatched out as an Echo response to an unresponsive elderly male. We arrived on scene after the Engine and LE, we walked in as the medic on the engine was intubating him (having a tough time I might add) and I took over compressions from the officer. We worked the code for another 15 minutes probably, they called medical direction and then called it on scene. As we were walking out the officers were telling the wife that her husband didn't make it and she just kinda said "well, I figured he'd be going pretty soon anyways", which shocked me a little bit.

Anyways, I really can't describe what I was feeling after it, I mean was upset, grossed out, sad, or anything like that...it just felt kind of weird walking away from someone who I had been doing CPR on just a few minutes earlier. Overall, I thought my first code was a really interesting and neat experience that really got me hooked into EMS.

 

[Medic744]

~300 hours between EMT and Medical clinicals... not a single cardiac arrest.

Only dead person so far is the one I 'helped' kill in an organ harvest.

Almost 700 hrs of clinicals and the only CPR we stopped 2 min in as the wife produced the valid DNR signed 12 hrs prior. Other than that I have had my first "real" one as a result of him causing a MVC right after the massive MI. One round of Epi and pulses were back. The hospital took him of LS a week later. The only other one was an 18 wheeler driver that was kind enough to pull his rig to the side of a major highway facing on coming traffic but not in their way and have his MI. By the time someone driving by figured out the "whats wrong with this picture" and called us we worked him for 30 min, got him to the hospital, put him on their stretcher, and they called TOD.

 

[AZFF/EMT]

First CPR was during clinicals in EMT class. Dont really remember just hearing the code page go out at the hospital and hopping up and doing some compressions. 1st as a FF/EMT was a single vehicle rollover 2 adults and 1 small child ejected. Mom was a trauma code, got a ROSC, then it went away and never returned. Still remember her face and the scene.

The calls dont bother me at all, sometimes the circumstances surrounding them are pretty sad but as long as I do my job and give it my best I have no issues, death is part of life.

1st shift back on the engine as a newly carded medic and worked a trauma code (guy working on a car without cribbing itand it crushed him) and a 39 y/o male naked on the toilet who turned out to die of a massive PE. Tubed both Pt's, did cpr on both as well.

 

[Lifeguards For Life]

i had a cardiac arrest on black friday

 

[redcrossemt]

My first arrest was cool from a learning perspective. We were about to call the code after working it on-scene for about 20 minutes. My paramedic preceptor asked me if there was anything else we should try... I suggested sodium bicarb and calcium due to renal failure, acidosis, hyperkalemia... Gave the bicarb and after a couple more minutes of CPR got ROSC. Ended up starting a dopamine drip for the first time. The patient made it to the hospital in a nice sinus rhythm with a systolic pressure of 100. Unfortunately, as with many arrests, the patient did not survive to discharge.

 

[wyoskibum]

i had a cardiac arrest on black friday

Glad you are well enough to post today! ;-D