True Life is Stranger than Fiction

True stories from the ER, and the streets of EMS.

Monday, January 30, 2006

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.

2 Comments:

  • At 6:12 PM, Blogger MedicChris said…

    Grin, heard a lot of medics doubt the combitube until the first time they need it. Nice to have I think. Anyway, I was only kidding when I called to remind the four of you that you were there to SAVE lives, grin. Lets face it, with four you are lucky it was only one code.

     
  • At 12:01 PM, Blogger S. said…

    I was kidding when I flipped you off over the phone, too. =)

     

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