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“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.
“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
  1. CR
    September 10, 2009 at 10:52 pm

    I like your writing style here. Sounds intense.

  2. WKC
    September 14, 2009 at 7:27 pm

    I was surprised that the ribs and sternum were broken during this process. Bottom line is:”when it’s your time, it’s time to go. It sounds like you went through a surreal experience, one of many to come. Keep up the good work!

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