I call her Blackcloud...

worked a little overtime on Friday (5/14) and got to work with Angel (AA). every time i get to work with her we run the crap out of some calls. and this day was no different. we had 10 calls in 12 hours with one cardiac arrest, a code medical and a dislocated hip. the cardiac arrest came out as a 33D, cardiac/respiratory arrest at a facility with health care providers on scene. we pulled up to a well known local doctor's office and went in to find this tiny African man (Dr. O) doing chest compressions on a tiny older lady on the floor. there was about 2 gallons of coffee ground emesis on the floor and coming out of her. there was a poorly educated "home health provider" that had brought the pt in and she told the doc that the pt was vomiting blood last night. i asked the person for the pt's history and she stated she did not know. i asked her how old the pt was and, again, she did not know. i then asked her to leave the room and she did without hesitation. AA and i worked her well, very difficult airway (very anterior) and after numerous suctioning our QRV lead medic arrived and was able to intubate her. a firefighter and i lifted her arms straight up which lifts the shoulders and hyperextendeds the neck (this was done after ruling out a fall) and has worked wonders in the past. unfortunately she was in asystole the entire time and was pronounced at the hospital. we then got a call for a 30B2, traumatic injury, where a lady had recent hip replacement and was getting out of her car and twisted wrong and it popped out as she sat into her wheelchair. we arrived to find her in her wheelchair in the heat. she did not fall so we ALSed her there, gave her fentanyl, used a KED inverted to stabilized the hip and took her to the hospital. later in the day we went to a 6D2, breathing problems, and found an elderly man with shortness of breath (SOB) and an impending sense of doom (not good, ever). did a 12-Lead in the house showing his pacemaker was firing but not producing a profusing beat. his heart rate was in the low 40s and his b/p was 80/P. placed the pacer pads on his and got him to the stretcher using a stairchair. we were only a mile away from the hospital and i told the guy that if he relaxes and stops responding to me i was going to have to "light him up" (i know, i know...but it worked. i don't like to shock or pace someone who is talking and fully awake. don't get me wrong, if his b/p was a couple ticks lower i wouldn't think twice about pacing and sedation) which worked. called a code medical and had to take him to the blue zone due to the fact that our recess room was completely full. it was like back in the old ED when we would bring a code medical or code trauma just straight past everyone and into any number of regular rooms to be worked. old school style.

...and I drove too fast.

this is part two of the last post. when last you read us CC and i just had our first cardiac arrest together and CC got his intubation. well, the next day was a busy day and by the end of it we came to the conclusion that we were douches. we were supposed to be done at 7 pm. around 1700 we got a 27D, GSW. some crack head/heroin addict was walking down the street and some peeps drove by and shot her in the ass and back of the legs with a shotgun. it was my call and we got her fat ass off the scene and to the hospital in nice time. we were on top of our game that day, after having such a good day the day before. so we check out of the hospital and right at 1825 we get another call. ok, no big deal i guess. yeah, it sucks but what can we do. so we go and pick up this old guy and take him to the hospital on base (he's retired military and gets a choice between the two in our county). we check out of that hospital at 1945 (45 minutes over our scheduled time) and now we get to go back to base with no chance of getting another call. unless, of course, a bad call comes out and we are the closest. BAM! 9E1, cardiac arrest comes out. we are kinda far from it but when we hear the only truck available for it is coming from base we have a choice to make. i look at CC and he goes "ok, let's do this" and i get on the radio and tell the other truck, medic 13, to keep going and we'll MEET them there. fully thinking (wishing) they will get there a couple minutes before us and CC will get another tube and then we can just help out until they take off for the hospital. but what does my dumb ass do? i drive to fucking fast and smoke the other ambulance. now WE are the first on scene and this is now our call. i couldn't believe it when i came around the corner in the neighborhood and saw just a fire truck. and on top of it all the firefighters placed a BIAD/King airway! so we load the guy up because he was outside in his car at the time. the fire dept had him on the ground and it was cold out so, without thinking, we put him in our ambulance. WRONG. he was in asystole at our first contact and according to our protocols we can work him for another 30 or so minutes (with numerous other caveats on top) and call it there on the scene if he doesn't improve (even getting him into a VTach/VFib i consider an "improvement"). but now we have him in the truck and we aren't just going to stop and take him back out after 30 minutes and lay him in the grass in front of the neighbors. so we take off for the hospital (after setting him up) and en route the King airway is sliding around in the guys mouth due to all the puke. CC notices the SPO2 dropping and d/c's the King and intubates the guy. so it all worked out in the end. at least until it was 2245 and we were still at base writing up the report into emscharts. we both were so tired and we could only laugh at how stupid we were.

Chuck got his tube...

i have been training CC since 12/23 and we have seen just about everything in the entire protocol book (CPAP, SVT, Afib w/ RVR, STEMI, etc.) but we couldn't buy him an intubation. we would try and jump cardiac arrests and someone would be closer or we would get there and the dude would be dead for days. we tried switching up stupid things, trying to drum up a cardiac arrest. and finally on 2/17 CC finally got one. we were at base and a 6D, respiratory distress, came out for medic 10 and the dispatcher stated possible cardiac arrest. CC and i were very close so we advised dispatch we were going to it too. we figured that we would pull up a minute after medic 10 and CC could still intubate (and we would just steal the call from them and run it in). the two units met at an intersection and CC was on the phone with medic 10. we were at the exact same intersection near the call and they stopped their lights and siren and gave it to us. we rolled up on scene and the fire dept. was already there (it happened to be one of the guys mother-in-law). she was on the floor with CPR going and we took over. she was in asystole on the monitor and after the next rhythm check she was still in asystole. we had IV access and intubated her and cardiac drugs on board. our QRV was there, as well, and had pulled the family into the kitchen and explained that we were going to work her for another 25 minutes and if she didn't get out of asystole we were going to call it here in the house. the family was ok with that and were very understanding. the pt just was released from the hospital with pneumonia and when we tubed her thick, white phlegm was all in the tube. she was altered and short of breath (SOB) for most of the day and she just collapsed on the floor. 24 and a half minutes into it she gets a strong femoral pulse and we scooped her up and took off to the hosptial. 24 1/2 minutes exactly. asystole to pulse. strange, very strange. she stayed alive for most of the day and CC went into the room to see the family (they had already signed a DNR for her and were sitting by the bedside all day) and CC literally saw her go into PEA and he called for the doc to come in to the room. CC brought her back and was there the second she died, again. strange day. the next day was even stranger....

I must be dreaming...

this was a couple years back. i was working a shift with SA and we were in line to get breakfast at Bojangles and a 10D, chest pain, came out and we both got out of line and set off to it. usually when interrupted from breakfast a crew may make snarky remarks about the pt we are going to (of course, once on scene that all goes away) but this time i remember we didn't say anything we just took off. we got on scene and the first responders were already there with the pt. this was in a bad area of town on one of our worst streets for drugs and violence. we walked into the house and the pt was a black male about 42 years old, he looked younger. he was wild eyed and clutching frequently at his chest. right away we could tell there was something going on and we placed him on the stretcher. as we were pulling the stretcher out of his house, he was only 2-3 minutes from the hospital and we decided to do everything in the truck, he said something about "spiders". his house was dirty and i started to look at my shoulders and arms and get that feeling like stuff was crawling all over me. as we loaded him into the ambulance he said it again "is it the spider?" and i crawled into the truck looking at my clothes for spiders. SA placed him on the monitor and right away, i think without even a 12-Lead she just said "let's go, i'll do everything en route". the pt was very anxious and had that text book "impending sense of doom" going on, looking back in hindsight. i took off for the hospital and i could hear him asking SA "is it the spider" and finally she asked him what he was meaning. he started to say he was watching a hospital-type show the other night and heard about a spider. SA asked him "you mean a widow maker?" and he goes "yeah, that. is it that?" and i just mashed the pedal a little further into the floor. as i pulled up on the ramp of the old ED i could see SA in the rear view mirror start yelling at the guy and she pulled the head of the stretcher down, moving him from sitting to supine. i ran around to the back and pulled open the doors and jumped up and the pt looked to be having a seizure. SA was at the monitor and she had placed the pads on him earlier and the monitor was showing V-tach. but the pt was shaking so violently i told her to hold on and i checked for a pulse quickly and after 5-10 seconds of not finding one she gave him a nice shock at 200J. as i was pulling him out someone came out and i yelled to them to tell the ED our pt coded on the ramp. we ran him in and i was doing CPR and SA was pushing the stretcher and we got him into the old orange zone and the nurses and MD were there and i moved around to lower the head of the stretcher and the doc yelled out shock him again. the monitor was in between the pt's legs and the doc could see the V-tach plain as day once i stopped doing compressions. BAM! we hit him again and began to move him to the bed. within a minute of his first shock on the ramp the pt was shocked a second time and he was on the hospital bed, biting a female ED tech in the hand and screaming "i'm dreaming!!! i'm dreaming!!!". hell yeah he was dreaming. and sure enough he WAS having a widow maker. we later found out he had an extensive cardiac history from abusing cocaine and had had a mild MI in the past. "i'm dreaming!!! i'm dreaming!!!" crazy town.

V-tach with a pulse...upstairs, of course.

this call happened in the early morning hours of 8/17/09. i was working that night on medic 14 stationed out of city #7 with another paramedic RVC. call came out and it was just around the corner from the station and we beat the first responders there. the call came out a 10C (chest pains, hot call), we arrived and the wife escorted us to the second floor of a very nice, well kept home. the pt was a 54 y/o male who was laying supine in bed and c/o chest discomfort, pt had a strong radial pulse that was irregular with gaps noted by me upon palpation, i just assumed we would see some PVCs on the monitor and the pt's b/p was good and he was talking to us fine and not in distress. the fire fighters arrived and slogged up the stairs rubbing the sleep from their eyes and i turned and told them we were good and that we would just use the stairchair to get the pt down to the stretcher (we recently got new stairchairs that work wonderfully). they left as my RVC was placing the electrodes on the pt. i was kneeling next to the bed writing down the pt's hx, we were going to do a 12-lead in the house and give some ASA and then move the pt, when i heard my partner ask the pt "do you have a pacemaker" and it immediately said "oh, shit". and there it was, v-tach with a pulse on the monitor. my partner placed the 12-lead cables on the pt while i ran down and stopped the FD from leaving and asked them to grab our stairchair. i came back up as the ECG was printing and it was upright in V6 to confirm, without a doubt, v-tach. again the pt was c/a/o x4 and was hemodynamically stable, if had not been it would have been some cardioversion. an IV was established and amiodorone was mixed in D5W with a 60 gtt. set and administered. we kept the pt and his wife fully aware of what was going on. after the 10 minutes the pt converted into a NSR with occasional runs of PVCs/V-tach but the pt stated he was feeling much better and stated something like he wanted to run down the stairs, but of course he was helped to the stairchair and brought down the stairs still attached to the monitor. the compartment the stairchair is in is very cluttered and i just had the FD place it in the passengers seat. so our new stairchair rode shotgun as my partner ran us emergency traffic to the hosptial. below is our activity log and after is the narrative found on our run chart.

08/17/09 02:30

226

140 / 90

107

97

16

Wide Complex Tachycardia (IRR)

4/5/6

WCT - S

4

Manual Cuff

Normal

08/17/09 02:34

Cardiac

v-tach with pulse12-Lead EKG performed by RVC. was successful.

08/17/09 02:35

159

132 / 90

104

99

16

Wide Complex Tachycardia (REG)

4/5/6

WCT - S

4

Auto. Cuff

Normal

Initiate IV

Peripheral IV initiated by RVC with 18 ga. at Left Antecubital. Attempts: 1 successful

08/17/09 02:37

Medication

Amiodarone,150 MG via IV - PUSH given by ParamedicX mixed in 100 cc D5W flow with 60 gtt set ran over 10 minutes

08/17/09 02:42

122

126 / 84

98

100

16

Wide Complex Tachycardia (IRR)

4/5/6

WCT - S

0

Auto. Cuff

Normal

Cardiac

runs of v-tach, irregular, perfusing on normal beats with strong radial pulse, non-perfusing during v-tach runs12-Lead EKG performed by PX. was successful.

08/17/09 02:50

118

130 / 84

99

100

16

Wide Complex Tachycardia (IRR)

4/5/6

0

Auto. Cuff

Normal

pt moved by stairchair and stretcher to ambulance, pt on monitor at all times, paddles attached to pt since before medication admin

08/17/09 02:55

100

110 / 70

83

100

16

Wide Complex Tachycardia (IRR)

4/5/6

WCT - S

0

Auto. Cuff

Normal

Medication

Normal Saline,150 MG via IV - PUSH given by PX fluids given enroute

08/17/09 03:00

106

136 / 68

91

100

16

Wide Complex Tachycardia (IRR)

4/5/6

117

0

Auto. Cuff

Normal

bsl checked at this time

08/17/09 03:05

98

140 / 66

91

100

16

Wide Complex Tachycardia (IRR)

4/5/6

WCT - S

0

Auto. Cuff

Normal

54 y/o male woke from sleeping with heart palpitations and slight chest discomfort and called 911. pt laying in bed at first EMS contact, FD arrived at same time as EMS, pt c/a/o x4 and talking well without resp distress, pt radial pulse irregular but strong with gaps of non-perfusion, pt placed on monitor showing v-tach with a pulse, pt hemodynamically stable and on second floor of home and decided by EMS on scene to treat on scene. pt given 12-Lead, confirming, and IV est. pt given 150 mg amiodarone via 100 cc D5W over 10 minutes with 60 gtt set. pt converted out of constant v-tach on the monitor to runs of v-tach and pt stated he was feeling much better and that the discomfort in his chest was gone and when pt was moved to stairchair pt stated he would be able to "run down the stairs" if we wanted him to. pt moved by stairchair and stretcher to ambulance with constant monitoring. pt with rare skin disease and prolonged admin of prednisone and lasix with constant fluid retention in lower legs and periodically into abd. pt legs wrapped in bandages due to pressure ulcers in lower legs. pt in good spirits during entire EMS contact and pt transported emergency traffic to CFV and taken to the recess room upon arrival where ED staff and ED MD were waiting.