Well, if the weekends just don't get more interesting; I was called out on 61 yo/M. having an asthma attack last night. We were seven miles away and made it there in seven minutes. But when we just went into route dispatch called and told us that the caller said that the Pt. (the person having the asthma attack) had stopped breathing. Well, that alerted us that this wasn't an asthma attack. Children are more likely to stopping breathing from asthma but adults rarely.
When we got to the scene the Pt. was laying on the floor face down with an abrasion above his left brow. We turn him over and he had the blue color of someone that had been down for about 10 minutes. Rescue arrived on the scene right behind us and was able to help. My partner hooked the pt. up to the monitor and the pt. was in fine V-Fib w/o a pulse. For those that are not familiar, there are only two shockable rhythms, one is V-Tach, and the other is V-Fib. Hearts that are in asystole are not shocked, (and I'm not getting into the part of pacing here). But my partner called for us to start CPR instead of shocking. We did CPR and the medic off the rescue truck got the lines for us to start pushing drugs. I was in charge of bagging, which is by the use of a BVM, (Bag Valve Mask) we are able to push air into the lungs. Also we can hook up O2 to the BVM and deliver a higher concentration of O2 that the pt. needs. To bag correctly, is to squeeze the bag to force the air into the lungs about once every 6 sec. or 10 times a minute. But it is hard to bag that slowly when that type of excitement, (by excitement, I don't mean something enjoyable) is going on.
My partner was able to place an ET down the Pt. throat so we can deliver the O2 better and also help protect the lungs from stomach contents that may come up, (i.e.: vomit). The pt was starting to show signs of response from the drug therapy with a weak pulse. We still kept the CPR going and his color was improving. By this time we loaded him onto a back board and then onto the stretcher. We then loaded him onto the Ambulance and I made sure that my partner had access to everything he needed and with a fire-fighter to help with CPR, we headed towards the hospital. While in route I heard from the back my partner calling for everyone to clear and a shock was delivered. After the shock more CPR was performed and we made it to the hospital.
As I went around to the back of the ambulance to unload the stretcher, my partner stopped the CPR to check the heart rhythm and the pt was in a shockable one but not long enough to charge up and deliver the shocks. CPR was resumed while we pulled the Pt. into the ER. In the ER when they checked, the Pt. had a viable rhythm and therefore for us, it was consider being a saved.
The ER doctors were able to keep the heart beating and bring the blood pressure up. When the ER placed the Pt. on a 12 lead monitor, they saw that he had an infarct and they got the Cath. Lab called in.
The Cath. Lab was able to clear the blockage that was the cause of all this mess and when my unit left the only question we had left was if there was any brain damage.
Now, I was with an experience medic last night, and I’m glad because if I had been the medic on that scene when I saw that shockable V-fib rhythm at the beginning, I would have shocked as I had been trained to do and would have placed the Pt. into asystole and more then likely not have been able to save that Pt. With V-fib the heart is basically just quivering. With our Pt. his heart was sitting there quivering with old blood in it, (remember I mention that the Pt. was blue when we got there). By doing the CPR we were able to cycle that blood out and move it to the lungs where the CO2 can be exchanged for regular O2. This was a vital factor in bringing the Pt. back.
When we got to the scene the Pt. was laying on the floor face down with an abrasion above his left brow. We turn him over and he had the blue color of someone that had been down for about 10 minutes. Rescue arrived on the scene right behind us and was able to help. My partner hooked the pt. up to the monitor and the pt. was in fine V-Fib w/o a pulse. For those that are not familiar, there are only two shockable rhythms, one is V-Tach, and the other is V-Fib. Hearts that are in asystole are not shocked, (and I'm not getting into the part of pacing here). But my partner called for us to start CPR instead of shocking. We did CPR and the medic off the rescue truck got the lines for us to start pushing drugs. I was in charge of bagging, which is by the use of a BVM, (Bag Valve Mask) we are able to push air into the lungs. Also we can hook up O2 to the BVM and deliver a higher concentration of O2 that the pt. needs. To bag correctly, is to squeeze the bag to force the air into the lungs about once every 6 sec. or 10 times a minute. But it is hard to bag that slowly when that type of excitement, (by excitement, I don't mean something enjoyable) is going on.
My partner was able to place an ET down the Pt. throat so we can deliver the O2 better and also help protect the lungs from stomach contents that may come up, (i.e.: vomit). The pt was starting to show signs of response from the drug therapy with a weak pulse. We still kept the CPR going and his color was improving. By this time we loaded him onto a back board and then onto the stretcher. We then loaded him onto the Ambulance and I made sure that my partner had access to everything he needed and with a fire-fighter to help with CPR, we headed towards the hospital. While in route I heard from the back my partner calling for everyone to clear and a shock was delivered. After the shock more CPR was performed and we made it to the hospital.
As I went around to the back of the ambulance to unload the stretcher, my partner stopped the CPR to check the heart rhythm and the pt was in a shockable one but not long enough to charge up and deliver the shocks. CPR was resumed while we pulled the Pt. into the ER. In the ER when they checked, the Pt. had a viable rhythm and therefore for us, it was consider being a saved.
The ER doctors were able to keep the heart beating and bring the blood pressure up. When the ER placed the Pt. on a 12 lead monitor, they saw that he had an infarct and they got the Cath. Lab called in.
The Cath. Lab was able to clear the blockage that was the cause of all this mess and when my unit left the only question we had left was if there was any brain damage.
Now, I was with an experience medic last night, and I’m glad because if I had been the medic on that scene when I saw that shockable V-fib rhythm at the beginning, I would have shocked as I had been trained to do and would have placed the Pt. into asystole and more then likely not have been able to save that Pt. With V-fib the heart is basically just quivering. With our Pt. his heart was sitting there quivering with old blood in it, (remember I mention that the Pt. was blue when we got there). By doing the CPR we were able to cycle that blood out and move it to the lungs where the CO2 can be exchanged for regular O2. This was a vital factor in bringing the Pt. back.
Also Happy Birthday to Peggy Jean Adams (74)
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