Archive

Archive for September, 2009

Arrest Numero Dos

September 30, 2009 Leave a comment

The day began more slowly than any other weekday shift I’ve been on. I was driving for a medic and dispatch sent us to post up at nursing home close to the base (typically in case we need to transport a “vent” (patient on a ventilator). The first hour-and-a-half went by fast enough, but then boredom rapidly set in. To pass the time, the medic (a very laid back ex-army guy from “Care-oh-line-uh”) decided to take me through every last item in his medic bag (drugs, intubation kit, IV supplies), the cabinets on the bus, as well as explain how to control the LifePack, portable ventilator, and IV pump. As if it wasn’t obvious before, medics can do a lot of interventions we can’t.

This took nearly two hours, and as we finishing packing away the last items the radio comes to life, “7-Adam, could you head upstairs for a low pulse ox? Sounds like they’re having trouble.” So, in what must be one of the fastest response times ever, we simply stepped out and rolled the stretcher to the front doors.

Upstairs, we found several concerned-looking staff members standing around a very elderly patient that wasn’t moving, but had an oxygen mask on her face and a pulse oximeter on her finger not showing a reading.

“We don’t think she is breathing,” the nurse says.

Okayyy, you’re a nurse, the word “think” shouldn’t be in that sentence. My partner and I walk over to her and check for ourselves, no lung sounds, no chest rise. Yep, not breathing. Neither of us finds a pulse, but she’s still warm and there’s no rigor.

“She has a DNR.”

Great, so our perfect response time is meaningless. The medic has me setup a quick 4-lead EKG anyways. There’s a clear rhythm on the monitor. Crap, did we miss something? That’s about the time we realize she has a pacemaker, obediently putting out a perfect sinus rhythm… electrically at least. At that point there was nothing we could do, no CPR, no ventilations, no drugs.

One of the nurses wanted to leave the oxygen on her, not that it would help someone that has no heart beat and isn’t breathing.

On a more positive note, we took out the mod that day (modular ambulance, the ones that are box-shaped, think FDNY), which is a joy to drive compared to the old junky ones we use on the weekends. That is once you get comfortable knowing that if the mirrors clear then the rear will clear (the rear compartment is wider than the cab) it’s pretty comfortable. Before that, it feels like you’re driving a tank down the street and you get the tendency to drive in the middle to avoid hitting anything. Not the most relaxing thing to do in NYC.

Advertisements
Categories: EMT

Lines

September 21, 2009 Leave a comment

You can judge the quality of the local populace by how well they adhere to lines. I can tell you that the lines at McDonalds in Harlem are decidedly low class.

Categories: New York

Arrest

September 9, 2009 2 comments

“7 Charley, code 1, coney island, patient unresponsive”
“7 Charley, 10-4, 63 to coney, patient unresponsive”

“Probably just abdominal pain”, my partner commented. I replied with “let’s pretend it’s real this time.” So, we went over protocol on the way, the same one all EMTs and (for that matter, all health professionals have drilled into their head: ABC’s – can the patient maintain their own airway? No? Insert OPA if unconcious. Breathing? No, give 2 breaths. Pulse? No? Start CPR. Apply AED pads, analyze the rhythm, and so on.

Seven minutes later we walked into the quiet, small apartment with 2 family members and a nurses aid standing outside a room. Inside, a very frail old man with his eyes glazed and mouth open, not moving, not at all. Something just clicked for my partner and I, and thankfully our training came back to us immediately. I checked for responsiveness (none) then airway/breathing (none), and told my partner to give me the BVM (bag-valve mask) and gave two breaths. Chest rise, good. Checked for a pulse, nothing, we began CPR and called dispatch to bring medics (already on the way). As we pushed hard onto his sternum, all of his frail lower ribs gave way. I briefly took over compressions so my partner could apply the deilfribillation pads and turn on the AED. Soon, it was analyzing his heart and we stopped CPR — “No shock advised” — Ok, resume CPR. “When will medics get here,” I wondered aloud.

A minute later they showed up.
“Take off your pads and slap on ours!” Done.
“Stop CPR,” as the medic watched the monitor in search for something he could shock (as the saying goes, medics only want to be called if they can “poke ’em, tube ’em, or shock ’em”). There was nothing, so we continued.

Quickly two IV lines were started and the first round of epi and atropine were pushed (they stimulate the heart to contract harder and faster). Then, in order to better maintain the airway, the medic intubated him (first try, good) and got a postive reading on his CO2 meter (a process called capnography, which makes sure we inflate his lungs, not his stomach). I attached the BVM to the tube and now gave breaths and compressions simultaneously (normally, CPR is performed interposed: 30 compressions, then 2 breaths).

“You can stop.” I turned around, it was his daughter.
“Does he have a DNR?”, the medic asked.
“No.”
“Then, I’m sorry, we can’t stop.”

So we kept going, two more rounds of drugs were pushed, the monitor never showed electrical activity, compressions were now like pushing hard down into a pillow (essentially pushing directly on his heart with no resistance from bone since by this point his sternum was broken as well), and after 30 minutes of CPR, medical control was contacted and time of death was called on the scene. The family was ready, but even though all of us were exhausted and pouring sweat, I think all 4 of us felt weird stopping.

According to the medic there, who has run dozens of arrests, the code went very smoothly. And, on a technical level it did. We assessed the patient quickly, did the steps in order, had good chest rise and good compressions. And, technically very few arrests end with a living patient (after-all, they were dead when we got there). But, I’m looking forward to the code where the patient comes back.

We got back to base, and before we had replaced our supplies, the call came over: “code 1, abdominal pain, 2647….”, and we were on our way.

Categories: EMT

Interesting Partners

September 4, 2009 Leave a comment

Soon after starting work as an EMT you realize you will be forced to interact with a wide variety of people (both partners and patients). While the patients are usually the salient feature of the shift, sometimes it’s your partner, as was the case yesterday.

“R” is either one of the most interesting partners I’ve worked with so far, or biggest pathalogical liar, maybe both. Within 30 minutes of the shift starting I had learned she was an accomplished pianist by 13 and had maybe $500K for a concert at that age, and now plays for the likes of Beyonce and Jay-Z for “no less” than $50K per gig. Here some other “facts” I was given over the next 7.5 hours.

Her dad is the chief of police for NYC
She has had 3 NYPD officers fired via her dad
She owns 8 guns, and has a concealed carry license (courtesy of her dad)
Two of her brothers are “OG” bloodz members
Rivals of her brothers attempted to kill her but she was “packing” and emptied her clip and she wasn’t hurt
One of her brothers beat her with a bat and left her in a coma for a month, she retained full neurological and motor function afterwards
In return, she staked out his house with another brother and either she or the brother with her shot the brother that beat her in the arm and leg and he now walks with a limp
The brother she shot deposits $25K/month in a bank account for her son.
Another brother is a doctor, one is a nurse, her uncle is a neurosurgeon, her aunt is an ObGyn, her grandma is a famous gospel singer
Her 7 y/o son is an excellent drummer and drums on 4 of Kanye West’s new songs
Kanye got a tattoo of “ye-ye” because her son couldn’t say “Kanye” but could say “ye-ye”
She played piano at Beyonce’s wedding

That’s all I can remember for now. Now, I’m not trying to make fun of her, but this is a difficult story to swallow coming from someone that works at a private ambulance company. I did a couple quick google searches and came up empty for both her and her chief of police dad, but maybe I wasn’t looking deeply enough.

On another note, we had to take a woman that fell while dancing (possible hip fracture) all the way from the middle of Brooklyn to the Upper East Side of Manhattan because she requested. She asked if we were going to go lights and sirens to the hospital and I just wanted to say “no mamn, if you can wait long enough to go to Manhattan, then we don’t need to risk our safety by going lights and sirens”. I was kinder than that, but we still drove there nice and slow.

Categories: EMT