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gold patch....

Posted Jan 27 2009 8:26pm
Decent shift, not too many calls. First was a little old lady that couldn't breath. She was discharged from the hospital for the same thing the day before. Personally I think she just liked the food there, or the staff waiting on her hand and foot, or something. Then ran another gentleman with the same thing. He was a little more serious. Got to the house and he was laying in a hospital-type bed in obvious distress. He had a chest tube coming from the left side of his chest that was attached to a vacuum pump. His son was slightly frantic running from one side of the bed to another, clearly not knowing what else to do for his father after he had increased his oxygen from 2 liters to 4 by cannula. The man had a whole list of medical problems and medications. We got him loaded up and headed down to the big hospital. My partner looked at me and said, "You OK with this?", well I could tell that he would rather drive, so against my better judgement I said yes. I put him on a mask and increased his liter flow, took vitals and got him on the monitor and started an IV en route. Everything was checking out pretty good, O2 sat was down a little, but given his history I figured that was probably normal. His lungs were slightly diminished, but no rales, rhonchi, wheezing or stridor. But he kept complaining that he couldn't breath. While I was looking at him, fidgeting around trying to make him comfortable, something just didn't click, felt like I was missing something or there was something else going on with this guy. Well, we were about 15 minutes from the ED and I remembered capnography. I got it out, unraveled it and hooked it up to the monitor. When I turned back around to put it on him, he was all clenched up in a seizure. Shit. I hollered to my partner who was oblivious to the goings-on in the box, content to drive and listen to his music, to step it up, he was seizing. OK, what do I do now? Valium, yea! Shit, I can't! I'm not a damn Medic yet!!! I looked out the window, we were about 8 minutes out as the sirens started blaring. Looked back at the patient and he stopped seizing. Sigh of relief, now re-assess. That's when I noticed he's not breathing, no pulse, but the monitor was showing a nice sinus rhythm. PEA!Fuck me! Shit on a stick! Damn it! I layed him back real quick-like and checked for pulses one more time just to make sure. Nope, nothing. Dead. I grabbed an oral airway and threw it in and bagged him a couple times and started compressions, hollering at him to wake the fuck up! I reached over and flipped open the jump bag and grabbed an epi which I ripped open with my teeth. Then I slammed it in with one hand and went back to pumping on his chest. My partner took this moment to ask what the hell was going on? In the 2 seconds before the words came out of my mouth, I called him everything but a son of God, then answered him in as calm a voice as I could manage that the patient was in PEA. A few minutes later we got to the ED and roll in with me doing CPR. The charge nurse looked completely dumbfounded, "I thought you guys had a difficulty breathing?" she says to me as we roll past her to the room. I give report while they scramble up the people to continue the code. I can't really blame them, the report I gave was completely different than what we came in with. After a few minutes a tech takes over for me as I wipe the sweat from my brow and strip my gloves off. My partner is just looking at me, I say nothing as I walk back outside. He comes out as I am smoking and putting the cot back together and has the nerve to look at me, laugh and say, "I guess I should have taken that one". Needless to say, I was a little hot under the collar. I've ran codes before, this wasn't my first rodeo. This was just the first one that I did on my own, granted that it was only for 10 minutes, but I've not even graduated yet. I tried to take it in stride, chalk it up to a learning experience. "What doesn't kill you makes you stronger" and all that. Now I sit back and try to take stock of what I learned about myself. I learned that I could have delt with it a little better, I don't think yelling at the dead man on my stretcher helped anyone. It's a good thing a family member wasn't riding with us. I learned that in the midst of the shit, I did remember how to read the monitor and what to do, even though it was just CPR. Hopefully next time I will do it a little better. Hopefully next time won't be until I have that gold patch on my arm.
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