4 Medics=1 guaranteed code

This past Saturday, I had the pleasure and good fortune of running w/3 other Medics. Of course, as one of them (MedicJon) put it, we were doomed to run a code.
Right when we sat down to eat lunch (another damning scenario in EMS), we got toned-out for an "Unconscious".
We get there and pull in front of the Engine Co., who were already on scene. We walked up to the wrong house, me being in the lead and looking like the Head Moron. Seems the Engine Co., who really had their shit together, pulled so far past the actual address that they were in front of the next house up. They were, of course, trying to leave us room to pull right up front. Doh!
We then proceeded to the correct address. I should have been clued in that this wasn't just an "Unconscious" when I saw the Cops, but it didn't dawn on me.
We go through the door. A woman in the living room has the telephone up to her ear, speaking to someone on the other end through sobs. The Engine Co. directs us downstairs.
We head downstairs to an incredibly cluttered basement. This is the first time we know that we actually have a CPR In Progress on our hands. I get to the bottom of the stairs and look to my right where the Engine Co. is crowded around our patient. On top of the unbelievable amount of stuff in the basement, there is absolutely no room to get an airway or IV on the patient where he is lying. I say "Oh shit." when I realize this.
Our patient is a Katrina evacuee who had turned 63 just the day before. He was quite large, I'd guess 160kg. Yes, that's kgs. Thankfully, he was lying on a sheet that we ended up using to drag him out of his room and into the common area where there was slightly more (read: any) room to work.
I set up to intubate while one of the other Medics was in the room verifying that the patient was Asystolic. She had the other guy with her, and MedicJon was with me, documenting everything. The two of us went through the "pile o' meds" on the table while we were waiting for them to drag him out.
Out came the patient, and it was showtime. I noticed he was not only a big guy, but he had acumulated a fair amount of his fat in the head and neck. Great.
I went in for a look-see, and not only couldn't I see his trachea, I couldn't even see his esophagus. Second look, same result. I passed the torch to MedicJon, who has far more experience than I. I figured I was just rusty. Not so, apparently. This man had so many jowls that we almost needed another pair of hands to pull all of it out of the way. Jon was able to visualize, but not pass the tube. We ended up admitting defeat and putting in a CombiTube. I never thought I'd have to do that. I know, "never say never".
Well, to Jon's credit, he intubated the trachea with the CombiTube! WOW
While we were working on a definitive airway, the other female Medic had gotten a line and the first two rounds of drugs on board. No change.
It was time to get the patient out of the house. This in itself was a challenge. The Engine Co. had to cut the lock on the gate to the backyard, because that was the only way we were getting him out of the house.
We got him out to the unit, when I noticed that his IV had backed up. Now, normally, that's just a few inches of blood in the tubing. Not so with this guy. The drip chamber was full of blood. We had to change out the tubing completely before we gave the third round of drugs.
We got a 4th Epi on board before arriving at the ER. The ER pronounced him almost immediately after our arrival.
I saw one of my co-workers there that day. When I saw her today, we were chatting about the patient. She tells me that the guy's wife was so upset, they had to give her Ativan. Seems they had just lost a son, in addition to their home. Eesh.

Famous last words

Another one from the ER.
Medics called in report on an AMI (Acute Myocardial Infarction, AKA "The Big One"). We got ready for them.
Upon their arrival, most of the staff was waiting for them in the room, including the MD. We got him on our stretcher and I started to do a 12-lead EKG. I'm in the middle of hooking up the leads when he goes into VFib (Ventricular Fibrillation). Well, we weren't prepared for that. While waiting for the LifePak (defibrillator) to be hooked up, I asked the MD if he wanted me to "thump" the patient. He said "Sure."
"Thump" is what we call a "Precordial Thump", where you pound on someone's chest in absence of a defibrillator. It actually works. I don't know why we don't do this in the field anymore. I can tell you that if someone went into VF in the back of my unit, and I didn't have the pads on him, I'd do it.
I thumped the guy, but immiediately realised I'd not done it hard enough. He was a large man, about 275lbs I'd guess. So, I slammed my fist back down on his sternum, and lo and behold, he came out of it.
He was obviously a bit shaken but speaking coherently. We tried to calm him down and re-assure him. I attempted to finish the 12-lead EKG while one of the RNs placed the defib pads on him. The man then looks up and distinctly says, "Oh shit, I think I shit myself." He had. He then proceeded to go back into VFib. We shocked him into Asystole, where he stayed, despite CPR and drugs.
I'll always feel sorry for him having uttered those last words. on what would be his deathbed, in front of so many witnesses. Fortunately for him, we all knew that the occurrence was perfectly natural.

"Captain Cachectic"

This is the nickname I've given a patient I helped care for here in the ER yesterday.
This is also my first post about working in the ER, as opposed to the field. I will try to explain things that I think may be outside of the realm of a fellow Medic (stuff we don't need to know pre-hospital).
The first explanation I'll make is for the word cachectic. I never heard it myself before working here. It basically means a frail, old, pathetic and beyond-emaciated person. And that, he was.
He comes in looking whiter than the MD's lab coat and panting for breath. He's also not making a whole lot of sense. He's so dry his skin is flaking off. His feet are being eroded by decubitus ulcers. He's got a G-tube (into the stomach feeding tube) and has an indwelling Foley catheter (tube that goes up the urethra into the bladder). He's also wearing a diaper.
This guy was septic. More times over than someone healthy could probably handle. Yet, he was still alive, although for how long, I couldn't say. I thought he was gonna die right in front of me.
He had a whole host of problems. The first was his sepsis, which I mentioned. He also was in A-Fib w/RVR (Rapid A-Fib as we sometimes call it). He was hypotensive, requiring Dopamine, and we kept having to turn it up. We switched to Levophed ("Leave 'em Dead", or Norepinepherine) later. He was in Respiratory (and probably Metabolic) Acidosis (HC03 of 13 on the ABG, for those who care). He was dehydrated (as established earlier) and Hyperkalemic. He also "ruled-in" for an MI via lab results. The question became, what wasn't wrong with him.
The causes of his sepsis were many. He had multiple pneumonias and a UTI (Urinary Tract Infection). He also had a case of Cellulitis (bad skin infection that can sometimes be "flesh eating") brewing on one arm. Who knows what else was going on.
So, the story of how he got this way goes sorta like this: he fell five months ago and broke a hip. He was in hospital for some weeks, and then a Nursing Home for rehab after that. In the hospital they placed the urinary catheter. Well, turns out it had never been changed. Geez, no wonder he had an infection! (They shouldn't be left in more than a week or two.)
He lived at home, with a reported elderly wife. Said wife shows up here shortly after he arrives via Medic. To look at her, she doesn't seem like she's too incapable of taking care of the guy. Plus, his brother or uncle is with her, and tells me he has a Home Health Nurse. Hmmmm. OK, so the "Nurse" is obviously an idiot. Wifey, upon first impression, smells like she's been drinking. The picture becomes clearer and more maddening.
This man had languished, unnoticed to everyone around him. Poor guy. Seems despite their lack of effort and caring, he had hung on.
The pneumonias probably developed from him not ambulating enough after surgery, and thus the decubitus ulcers also formed. He probably had the heart attack from any number of causes. We're lucky he didn't go into a Ventricular Dysrythmia, too, with the K+ problem.
We did what we could for the guy. Intubated him, put in a central line, gave him drugs for his pressure and antibiotics for his multiple infections, yadda, yadda, then shipped him off to the ICU. I hope someone in the ICU decides to help him with his social situation, if he lives. Which I doubt.
I really like old people. I really hate people who don't take care of old people.