06 December 2006

Witnessed arrest

FD Dispatch: "Truck A, Ambulance X respond to [address] for a fall. Caller was hysterical and hung up on 911."

That's gotta be some fall for someone to be that hysterical. Enroute I hear the truck and ambulance sign out on scene with no further update. Scene was less than 3 minutes from the station, but more like 8-9 from my house.

Arriving on scene, I walk in to the kitchen to find a average-sized middle-age woman on the floor, shirt cut off, one medic intubating, one FF doing chest compressions, and the other medic adjusting leads and preparing to defibrillate again, calling out meds and rhythms for the other medic to discuss. I wait for an opportune moment to see what I can do because everything looks like it is being done, and get assigned to bring in the drug box, then the backboard (already in the house) and prep the stretcher outside. On my return, I find her boyfriend standing very close to everyone, crying and freaking out (understandably). I gently move him away a bit and start pumping him for information on the patient, name, DOB, meds, allergies, history.

After he's able to calm down a little because he's got something to help with, he fills me in, 43 years old, negative history, negative meds, just engaged 2 months ago, they were working on the garage and she went into the house to get something they forgot. Patient was in the house with her daughter, reported feeling dizzy and went down like a ton of bricks. Bystander CPR started before FD arrival. At this point, he is crying again and asks me if she's alive, does she have a pulse? I take a quick look over and see active chest compressions, electrical activity on the heart monitor (when they stop compressions), and see the seriousness with which they are continuing to work and not prepping to leave and tell him that she does not currently have a pulse but they are still aggressively working and we'll do everything we can for her.

The medic decides he's ready to roll, so out we go, compressions in progress, into the ambulance and the additional meds. They keep working on her in the truck, including starting her second IV in the external jugular (a great big neck vein). I'm sent back in to clean up the mess - wrappers, paper, saline, plastic, all the debris of a working code. I finish up quickly and find the ambulance still outside, so I'm back in, and get handed the BVM to maintain ventilations. Second medic is out and we're off.

I'm ventilating, chest compressions are going every time we can't find a pulse because she's back and forth as to whether her heart is beating hard enough to create a pulse, and drugs are going through the IV or on a drip. The medic exhausts the supply of 2 of the 3 drugs he's been pushing and eventually there's nothing left to do but keep ventilating, watching the monitor, and checking for a pulse. We see a little V-tach, some V-fib, something nobody recognizes, and even a few sinus beats from time to time. Patch to the hospital goes by phone instead of radio to prepare them for what we're rolling in with, but there's no way to summarize the massive amount of work that has gone on, so the medic hits the highlights - her current state, the meds in and the shocks delivered. Another ambulance at the hospital sends out crew to help us get inside with the assortment of attachments and the doctor starts checking for the all-important pulse. He gets no radial pulse. Possible faint but intermittent carotid pulse, he isn't convinced. He listens to her heart - and hears it, we haven't lost her yet.

I don't know right now how she fared. I wasn't feeling optimistic when we left the hospital because they had the lights off in her room and were looking for her finacee. I may find out tomorrow because that crew is on duty again. This was the first working cardiac arrest I've ever been a part of, and I have to say that it was pretty near how I imagined it. Heart-wrenching to interact with the family, but otherwise too busy to have emotion in the way of getting the job done. The ambulance was on scene for half an hour, which was much longer than I would've expected. My role was minor, and I expect the scene would've affected me a lot more if I'd been ultimately responsible for her care rather than following the medic's lead.

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