Wednesday, November 7, 2007

Start your day with a DOA

Not many calls were interesting yesterday, in fact, most were downright boring. Thankfully a couple were legit. One was a run-of-the-mill CHF call. The monkey-wrench was that the patient was on dialysis, so lasix was out of the question.

We had just gone available from another call when we heard an engine and ambulance dispatched to our local CPR training center for a elderly female who had a witnessed syncopal episode. Knowing the history of how many calls are actually cardiac arrests at the location and our proximity to it, we went en route also. Of course we were the first to arrive. I grabbed both jump bags and the cardiac monitor from my side of the squad while my partner unlocked and grabbed the drug box. We eventually made it down the corridors and elevator to the room.

Drumroll please....

Well whadaya know....she's in full arrest, good thing we brought everything with us. I unloaded the intubation kit while my partner hooked up the pads for the monitor. The Doc and nurses were actually in the room for once and were doing CPR, if you want to call it that. Last time I checked, CPR was more than 15 compressions per minute and is centered over the sternum, not the xyphoid process. While my partner shifts to intubate, I start looking for an IV. I thought I saw a shadow near her hand and went fishing but came up empty. Once she was intubated, we got the IV in her EJ (neck for you non-EMS folks) just as the rest of the cavalry arrived.

Everything sped up at this point. The drug box was unlocked, Epi and Atropine popped and pushed. Still not in a workable rhythm on the monitor. More Epi and Atropine, and a BiCarb. Sugar checked out ok, so we didn't push D50%. Since she didn't have a do not resuscitate order (DNR), we called the local hospital to request orders to terminate CPR.
Airway, IV, 2 rounds of drugs, and still asystolic. We had met protocol so termination orders were granted.
We notified dispatch, disconnected the monitor, stopped the IV, picked up our trash, pulled a sheet over the body, and left.

I know it sounds cold and sometimes it really feels that way, but sometimes there's just nothing more you can do. As a public safety worker, if I were to dwell on every bad call I ran, I wouldn't be able to get anything done. I'm not proud of the amount of death I've seen in my young life, but if I don't do this job, who will?

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