21 January 2008


After running two pregnancy calls in two days where it looked very likely that The Asian was going to be cleaning and warming newborns, I was prepared for our truck to be ushering new life into the world. I was not prepared for what we got instead.

Dispatch was for difficulty breathing, elderly female. At 0150, this is usually a serious call because most folks aren't doing anything strenuous at that hour and if a patient still having difficulty breathing, it is bad news. FD meets us out front, directing us to the side door and helping grab the stretcher, indicated we wouldn't need anything else. As I walk in, I see a FF taking a blood pressure who stops when he sees me and shakes his head no. Misinterpreting, I assume this means he wasn't able to get a good reading. And I check for a radial pulse, none. The second FF says, "I didn't get a pulse." So I check a carotid pulse, none. FF again, "I didn't get a carotid pulse either."

At this point, I'm worried about the patient but also substantially confused as to why the FFs are standing there just staring at her. While trying to find pulses, I was watching for breathing and not seeing any. Hmm, no pulse + no breathing = dead, at least the last time I took a class. Second FF pipes up again, "She was moaning and gurgling when we got here, then stopped." Crap. I can hear The Asian in the other room talking to family about medical history and patient's wishes, so I poke my head out to find out if we're going to try CPR and ACLS or if the patient has a DNR at hand. His quick decision is that there isn't enough certainty by family nor documentation to support not resuscitating the patient. He's back to the truck for our gear, I'm back in the room suddenly in charge of a cardiac arrest, an unusual reversal of roles.

I'm trying to get the FFs moving toward CPR and the AED, but (in all seriousness) it is a difficult mental transition from "we're going to put the patient on the stretcher" to "find the BVM, hook up the defib pads". After all, I walked in to find a dead patient, they walked in to find a barely alive one. They don't really get moving until I whip out the shears and cut her nightgown down the middle and start tossing their oxygen bag looking for a BVM. No shock advised by the AED gets us going into compressions, then onto the backboard and out to a bigger room so The Asian can intubate.

After the first round of medications during the less than 1 mile trip to the hospital, she now has a pulse. On her own. She still isn't breathing well, but her heart is up and running again. This is the event I wasn't prepared for. A patient with questionable DNR status actually being resuscitated. And her sister is also a Sister, who is kind and understanding, but pretty intimidating in her head covering in the waiting room of a religious hospital. We didn't bring new life into the world, but somehow we managed to hang on to an older one which may not really want to be here.

No comments: