Post-partum (Respiratory) Depression

This is a call I just went on yesterday.
I was running w/MedicChris and his driver, Wayne for a few hours yesterday. The day was mostly laid-back, spent mostly shooting the breeze and telling stories. Right after the start of the Daytona 500 (as Chris calls it, "the roundy-round"), we got called for seizures.
We head out to the call with the Tower behind us. Most of the rest of the North Side of the County was already headed to a townhouse fire in the same box.
En-route to the call, we get additional info that the patient is 40, had a baby last week, had a headache yesterday and took Tylenol, and has been seizing for 5 minutes. Don't know what to do w/all that info. The gal in the back and I are bouncing around ideas and I decide to guess Amniotic Embolus just b/c it is the least possible thing.
We get to the scene and are met at the front door by a woman wearing one of our Dept.'s BINGO t-shirts. A customer! She tells us the patient is upstairs.
We start up the stairs and when I get to the top I look over into a bedroom on my right, and I know I've come to the correct one. Inside is a young pre-teen or -tween boy, kneeling on the bed, sobbing hysterically into the phone while rubbing the back of our patient. For about 5 seconds, I think the patient is rolling around the bed in pain, but once I get closer, I realize this lady is in big trouble with a capital T.
She's rolling back & forth on the bed, working incredibly hard to breathe, and she's not responsive other than to swat at us when we touch her or try and move her in any way. She's also somewhat blue, her pupils are hugely dilated, and her skin feels hot. Groovy... not.
Chris and Wayne had already coordinated getting the Tower to bring our Reeves stretcher and gotten the O2 I'd asked for. She didn't like that mask on her face, seeing as she was suffocating, but she damn well needed it.
We barely got the LifePak hooked up with all her flailing. She's extremely tachycardic. Eventually we manage to get the SPO2 probe to stay on her finger long enough to tell us it's 92%-on a non-rebreather. Yikes. We also checked her blood sugar, since we found out she had Gestational Diabetes, but is was 200, so that wasn't her problem.
So, why she had Respiratory Distress, I don't know, but it was bad. I noticed her belly was mottled in addition to the bluish hue the rest of her had. I pushed on it with my finger and noticed her capillary refill was also slow. I said "Chris, look!" and did it for him. He's like, "What do you think that means?" and I said "It's BAD!". Later on he told me that he didn't realize why I was poking her in the belly like she was the Pillsbury Dough Girl. We had a good laugh over that one!
Meanwhile, the Tower crew had gotten the Reeves up there like we'd asked, and we were ready to get the heck outta Dodge. It took some doing to get her wrapped up in it and down the stairs, but we got it done. As we got her outside, she was getting more tired of breathing on her own. I silently prayed that she wouldn't stop breathing, as I'd already assessed that she'd be a difficult intubation. I also silently cursed the fact that we couldn't just RSI her.
We all climb in the back to hold her down so I can try and get an IV and we can try to get a BP. Wayne helps me hold her arm down and I get an 18g in her hand. Unfortunately, it infiltrates while we're trying to get it taped down. Tess (the other girl with us) tried 2x on the other hand with no luck. We really need to hit the road and not screw around with access anymore. Her BP once we finally got it was too low for Lasix... by this time we'd ascertained that she had Pulmonary Edema but we still didn't know why or how.
We started for the hospital, Wayne at the helm, the rest of us in WWF mode in the back. I'd told them I'd get another line en-route, so I had to pony up on that. Thankfully, I did. I ended up getting a 20g in her inner wrist and just wrapping the roll of tape around her wrist till it ran out. I wasn't losing access again!
Chris at some point had called the ER and told them we were coming, but I already have forgotten when in the sequence of events that happened. It was a tad on the hectic side!
We turn onto the main drag where the hospital is located, and lo and behold, that's when she decides to become responsive. She wants to sit up, and she's needing suctioning. Well, Reeves stretchers don't bend so well. I offered to sit behind her to hold her up, but Tess ended up doing that. Probably a good thing, this lady weighed about 250lbs. and we didn't need to see how much the cot could hold *ahem*...
I said out loud at some point that the hospital wasn't going to believe us about how combative she was now that she was waking up and had completely calmed down. Amazing how much good high-flow O2 alone can do. Chris joked it was that magic 10 drops of NS we infused...
We roll into the ER, disheveled, with one of our personnel behind the patient on the stretcher like it was a sled. I looked at one of the RNs and said "Don't ask!"
We roll in and manage to get her transferred over. She was still sick enough that they all realized we were not shitting them. It wasn't until we'd gotten her on their stretcher and hooked up to their monitor that I realized my hands were shaking.
Later on, before we left the hospital, I went back in to see if they'd shot her Chest X-Ray yet. The RN I'd spoken to before pointed out to me that the patient had petechii all around her eyes. Sure enough, I got up close, and it was there-in an oddly-shaped pattern similar to a raccoon, or maybe The Lone Ranger. I'll be damned, first time I'd seen it in real life.
Today, boy are my arms tired (and I didn't just fly in).

An exercise in futility

This is a call I ran on the Medic unit one weekend morning some years ago.
We were dispatched to a CPR in progress at one of our sister stations. This was first thing in the morning, hadn't even had coffee yet. Didn't need any until the adrenaline wore off, then.
The basic unit did a scoop & swoop with the baby, and radioed me to meet them en route. We met up about halfway between our two stations and the hospital. Our prospective drivers stopped right in the middle of the road. I wasn't going to yell about it right then. Fortunately, we had PD with us to add to the light bar display.
I jumped up in the back and my Lt. at the time, plus her driver were doing CPR on an infant. The mother was sitting in back with them, on the bench seat.
I look down and see a bluish, mottled body. I touch the baby, and she is cold. I told the crew to continue BLS measures (by protocol we cannot stop), and then I spoke to the mother. I told her that there probably wasn't anything we could do. She was crying, but quiet-far from hysterical. That would have just made things worse.
I then made my call to the hospital. While dialing I note that the baby has bruising and/or mottling on the tip of her tongue and in the center of both lips. She also has dried, bloody mucus in one of her nares.
The MD answers and I tell her that I have a 2 month-old infant, found down, having been that way for an indeterminate period of time. I relay my physical findings and say that I'd like to terminate resuscitation efforts. She tells me to try and intubate the baby and get an IV or IO. I'm shocked and appalled. I told the mother that I'd try some other interventions while we continued to the hospital, but that the situation was still grim (I wasn't going to say pointless no matter how true-it was too trite).
I went into my ET kit and picked out a 3.0mm tube and a 1 blade. I had the crew stop CPR so I could attempt intubation. Even with the stylet, that 3.0 tube was like a wet noodle in that baby's mouth. There was no way I could pass it. She was far enough into rigor mortis that the majority of her neck and head was already affected (the first regions of the body to become rigid).
In retrospect, I was glad to have my first opportunity to attempt intubation on a baby in a less-pressured situation. I am also glad that I was at least able to visualize her airway, so I knew what a real one looked like for future reference.
I abandoned my intubation effort and never had the opportunity to try a line because by then, we were already at the hospital. I was grateful, not wanting to continue the charade with the mother as a spectator.
Once in the ER, they continued to attempt resuscitation. The anesthesiologist was actually able to tube the baby, and I was in awe of that. Pretty soon, though, they quit trying. They then did a "Kiddie-gram", what we in-hospital folks call a head-to-toe x-ray of a small child-all part of the post-mortem in an unwitnessed death and/or ME's case.
I went on my way to write my report. I was also really, really glad to have a laptop at the time, on which I wrote the longest, most detailed summary I've ever written. 1.5 typed, single-spaced pages.
There were mitigating factors that I found out about after the fact, but none of them will bring the baby back. The death was suspicious, but apparently not enough that it didn't get pinned on SIDS in the end.
A few things happened afterward (still in the ER) that I was grateful for. My Chief at the time, MedicJon, brought me coffee from Wawa as a way to show his support for me. One of my favorite cops was there as part of the investigation, and I was glad to have him to talk to. Lastly, one of my co-workers was there on duty as an RN, and I was able to get a hug from her. It's really, really nice to have such a good support system when something that tragic comes your way--and it will.