Sudden death MI

This happened when I was a Medic intern.
We get toned-out for a chest pain early on a weekend morning. Just by the time of day, it is statistically likely it will be the real thing. In the bizarre Murphy's Law of EMS, the condo is several flights up, stairs only. This also greatly increases the risk of the patient being very ill. Sure enough, my precepter and I get to the top, go all the way back in the bedroom (more bad signs), and there's this really grey man lying there. His BP is 60 and his HR is 40. We're batting 1000.
I start an IV immediately, and my precepter does a 12-lead EKG. We see what we expect-an AMI. I immediately call Med Control for Dopamine orders, which they immediately deny. F-ers.
We proceed to load the guy up on a Reeves' stretcher for ease of transport down all those stairs. I had everyone carry him down head first to try and boost his BP. It worked-he got up to a whopping 80 by the time we made it to the ER.
We hauled ass, not being able to do a whole lot besides ASA and O2. I held the man's hand all the way to the ER. It started out as keeping his arm straight for the IV to run in (I started an AC), but it ended up being emotional support. He was visibly scared. In the end, I was quite glad I did, because he was dead an hour later.
Turns out, this guy was a close friend of my Sgt.'s (who was on the call). Also turns out, he waited most of the night to call us, because he didn't want to leave his wife home alone-she was suffering from CA. Oh, the irony.

For Zhane

I'm starting with the most gruesome, anger-inspiring and gut-wrenching call I've ever run. I want to get this one out, and out of the way. Zhane was the name of my patient.
It was a cool night, late in winter, and we were toned-out for a possible structure fire. During our frenzied response, reports kept coming over the radio that there were injuries, and possibly a CPR, and possibly a real fire. The radio traffic from Comm was confusing and busy. I knew something bad was happening.
I was a BLS AIC at the time. John and I were the first EMS unit on scene, following PD and multiple fire apparatus. As we're pulling onto the street where the call originated, I notice a police officer and a fire fighter performing CPR on a small child, on the sidewalk. I mark up on scene, and notify Comm that we have CPR in progress.
The fire fighter performing CPR (Joe) is a really calm guy. I am completely alarmed when he sees us, picks up the child, and runs toward me at top speed, yelling "Open the door! Open the door [to the ambulance]!" I did so, and we very quickly had the child on our stretcher.
The child was indeed pulseless and apneic. I was at the head to bag the patient.
Here is where I will try to describe her. She was a beautiful, 15 month-old little girl. From the front, she looked almost like a doll. We thought she had a chance, from that view. But then, as I tried to open her airway, my hand slipped behind her head and I realized why this little girl was clinically dead. Her entire back side, and when I say back side, I mean the back hemisphere of her entire body, had the consistency and appearance of charcoal. At that point, I was screaming at the top of my lungs inside my head. It still elicits a sense of alarm inside me when I think about it, and this was about 7 years ago.
I'm sure I uttered something like "Oh my God" out loud. But, no screaming on the outside. That would not accomplish anything.
Another thing I discovered upon trying to open her airway was that she was stiff. She was warm, though. I figured that her muscles had stiffened from her burns. But, when I tried to insert an OP airway, her mouth wouldn't open. This made me wonder if she also was in rigor mortis, in retrospect. More on that later.
I bagged her as best I could, then Lori, the Medic on duty arrived. She couldn't intubate the baby, because of the stiffness. We do not carry paralytics, so there was nothing she could do but allow us to continue w/the best BLS airway we could.
Then, Lori tried to obtain an I/O, but she was unable to do that, either. We continued CPR and made our way to the LZ. I'm positive the only reason that Zhane got a helicopter was her age and her burns-helos don't fly CPRs.
We got to the LZ and the flight crew got her intubated w/a great deal of drugs. She was that stiff. They whisked her away to Children's Hospital where she was pronounced dead.
We all made our way to the local hospital to clean our rig. It had that charcoal-like stuff all over it. We were all pretty freaked-out.
Lori got a call from the MD up at Children's stating that there was really nothing more we could have done for Zhane. It was very kind of him to make that call trying to reassure us. Usually, we never get any feedback, especially from hospitals other than our own.
After we cleaned up, we went back to the station closest to the hospital and had a Debriefing.

I later found out some details about the call that made me feel worse. The fire had originated in Zhane's crib. Fire fighters from my crew who were in the house described her room to me. The fire was started w/a table lamp. There was no table within reach of her crib. Her mother wasn't home, but her father was downstairs (this was a TH) at the time the fire started (supposedly). The parents claim that her big brother, who was quite young himself, knew she liked the lamp and put it in her crib for her. According to the police officers I spoke with, and the fire crew, her parents had totally inappropriate reactions to the situation. The whole thing was fishy.
One thing I noticed, being on airway, was that she had no soot in her airway. If she had died of smoke inhalation, a possible reason that she didn't cry when she was being burned, than it would have shown up that way. The MD at Children's also said that her lungs were wet.
The conclusion that most of us who were there came to was that she must have been dead before the fire. However, the ME didn't agree. The parents were not found to be responsible, instead, they blamed it on her brother and the lamp. You draw your own conclusion.

The next day, I went in to work late. We were up til about 4am w/the debriefing. My boss was totally understanding. John faxed me the article that showed up in the paper about it, which is how I learned of her name and actual age. We will never forget her.

Greetings!

I've been sucked in to creating a blog by my pals MedicChris and MedicCat. OK, it's not really their fault... I was just inspired by their blog, Night Runs.
As stated in my profile, I work in an ER and I also run as a Medic for a local VFD. I'm a glutton for punishment.
Most frequently, my husband John is my driver. We've been running together the entire 10 years I've been in EMS. The VFD is where we met. The rest is history, as they say.
Abandon all hope, ye who enter here!