As any paramedic or EMT will tell you, the opportunities to really make a difference dont come around very often. The times when you can say that you actually did save a life.
There are many times that we can say that we relieve or ease someones suffering, or help them get to the place they need to be, to continue their care. Even just reassure them and let them know that everything is going to be alright.
These are the reasons why we come to work day after day and night after night. Some would argue that it is self indulgent, but the feeling of actually helping someone or even sometimes saving their life is a wonderful one, not generally experienced by the vast majority of the population on a daily basis!
This was one such time…..
Working with my crew mate Tim, we were dispatched to an elderly male collapsed outside of a local cafe. No further information was immediately available, so this could be one of many different scenarios we were travelling to. During the drive, I had the ’spidey sense’ feeling come over me, and looked over to Tim.
M999: “This is going to be an arrest, I can just feel it”
As we arrive on scene, I glance into the door way and see our patient sitting slumped against the door. His head virtually resting on his knees, obviously unconscious. Even from this distance I can see the all too familiar blue/purple/grey tinge to his lips and face.
M999: “Told you….Lets have the stretcher straight off and we will get him into the back”
As Tim lowers the tail lift and gets the stretcher from the back of the ambulance, I grab the first response kit, Oxygen and defibrillator. As I arrive at the patient, a member of staff (who is just standing over him) says
“He is still breathing isnt he?”
M999: “Er….No, no really. Can I get into him please…..Thanks!”
I get behind him and place my arms under his. I pull his dead weight up and around to the side so that I can manoeuvre him away from the door and onto the path,lying him down in the process. As soon as he is down on the ground, on his back, with his head and neck at the proper angle he takes a couple of agonal gasps. For those that dont know, these are like a last ditch attempt by the brain to try and get some oxygen into the brain and heart to maintain life. They are also the reason why recent CPR guidelines have changed from “is the patient breathing?”, to “is the patient breathing normally?”.
A patient’s heart could have stopped and they could still have a few agonal gasps before they stop as well. Many members of the public understandably assume that an agonal gasp means that the patient is breathing and therefore has a heart beat.
(Just as a side note – here is a video clip from you tube of a successful resus which shows a great view of ‘agonal respirations’ at 3:30 in to the clip)
In this case, it just so happened that my patient did actually still have a heart beat, although going a little slow. Cool, we might get this one back!!
Oro pahryngeal airway in, Bag and Mask on, good seal and good ventilation…..Champion.
Tim brings the stretcher along side and we hoist our patient onto it and move him into the back of the ambulance. Now for the choices, how do I maintain his airway?
He is tolerating the OPA, therefore I consider intubation or LMA. In this case, I opt for one of the iGel LMAs that I have been trialling. It goes in easily but my gentleman decides that he doesnt really like having a big piece of plastic/rubber pushed down his throat and his gag reflex starts to kick in (Great!!, these are all good prognostic indicators). As I was getting good air entry from bag valve mask, then it’s a no brainer to just go back to OPA and BVM which he tolerates well. Tim gets the ECG and monitoring attached, then takes over ‘bagging’ our patient whilst I gain some IV access. I then decide to free up one hand by attaching the face mask to our ventilator instead of manually compressing the bag to ‘breathe for the patient’. I set the ventilator to CMV/Demand, which means that the machine will do the breathing for the patient at a set rate, but if it detects that the patient attempts to take a breath for themself, then it will provide support for that intake of breath also (Clever stuff really!)
Once all thats done, it’s just time for a quick pre-alert radio call to the hospital and off we go, lights and sirens up to the hospital.
On the way, as I test for response to verbal stimulus, his eyes flick open for a short split second. I try again and the eye’s spring open once more. 5 minutes down the line and I hear the ventilator change its rate in response to a deep breath taken by our patient. His heart rate is back to normal limits now and things are most certainly looking up.
By the time we transfer him to the waiting team in resus, he is now making regular efforts to breath and open his eyes when you verbally prompt him to.
He isnt out of the woods yet, but is certainly on the right path.
I complete my paperwork then pop back behind the curtains to see how he is doing before I leave. I find out that his name is Richard and according to his records is a 74 yr old COPD sufferer. He is now breathing regularly and doesnt need bagging. The doctor in charge of the team gives us a ‘well done lads’, and off we go with a bit more of a spring in our steps than before.
So did we save a life, that day?
5 hours later, we were taking a routine admission patient into the medical admissions unit of the same hospital. Once we had got that patient moved over onto her bed and handed over, we left the ward, moving past the various patients waiting to be seen and moved onto the ward they will be spending their time in. I passed one man happily tucking into his evening meal (which actually looked rather tasty – or maybe that was just because I was starving) and had to stop and take a second look.
M999: “Tim, look!!…Thats Richard!!!”
I decided not to disturb him, It is highly unlikely that he would remember Tim or I, and to be honest, it was enough to see him sitting up eating his food, not even on any oxygen.
As the title to this post states, ‘Simple Actions Save Lives’
The single most important thing that I did in this case was to move Richard from his position we found him in and open his airway. If that had been done earlier by a member of the public, he would never have been so close to death. What the medical team think happened, was that he had difficulty breathing with an exacerbation of his COPD which ultimately made him lose consciousness. Once this happened his position in the door way resulted in his neck flexing forward to the point that he obstructed his airway and effectively asphyxiated himself.
The action of opening an airway and breathing for him for a while was all that was needed to get him back from the precipice.