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I started to write this narrative some time ago but never finished it. This is from a call that happened in early December.

Around 10:30, Mrs. Turquoise and I got toned out. The call was for an elderly male down in the shower, unknown breathing, unknown responsiveness. From the lack of detail, I got the impression that this might be a simple trauma. Still, it was ambiguous, so we wasted no time getting in the rig and headed down the street. Two less experienced firefighters were going to follow us in the forestry truck, a large pickup used for utility duties in addition to brush firefighting, in case the call turned out to be serious and we needed help.

We pulled up in front of the house and quickly found the entrance with the help of a bystander. As we wheeled the cot up the sidewalk, Greenie was hopping out of his car at the curb.

Greenie is the department grizzled old-timer. He’s sly as a fox and is a wealth of experience and information. He also has a sixth sense about calls. He had the day off but heard the tone on his pager.

As we came up the steps with a bag and stretcher, the apartment door opened. A man stepped out.

“I think he’s dead.”

We stepped it up. Entering the living room to the apartment, I could see the opened door to the bathroom. A unmoving naked form lay facing away on the linoleum. Several people were standing in the living room in various forms of freaking out.

I went over to the bathroom. Lying on the floor was an elderly man. He was lying on his side on the floor. There was a puddle of a little blood and a lot of clear fluid. The fluid was yellowish and looked viscous.

I stepped into the bathroom, over the puddle. The man’s eyes were open. His face and hands were livid. He looked dead.

Mrs. Turquoise was getting some history from the family. He had gone to take a shower. That was an hour ago. After hearing no noise for some time, they had finally opened the door to reveal the present tableau.

There was a home oxygen setup in the bathroom. The nasal cannula and tubing were on the floor, though not attached to the man.

I yelled at the man.

“Sir? Can you hear me? Sir?”

He didn’t move. His eyes were fixed.

I squatted next to the patient. I felt his neck for a carotid pulse. I couldn’t feel one. I tried several times.

“No pulse!” I yelled.

“No pulse!” Mrs. Turquoise and Greenie yelled together.

Mrs. Turquoise started handing me ECG leads, the wire electrodes that go to the heart monitor. I placed them on his chest, not disturbing his position. Once they were in place, I switched on the monitor. It showed a flat line.

“Asystole!”

“Asystole!”

It was sort of unclear if this would be treated as an untimely death or as an unwitnessed collapse. Greenie was already on the phone with the local hospital. They said to work him.

Greenie went to the first-in bag for a bag-valve mask and oxygen. Mrs. Turquoise pulled out the AED pads for the monitor and attached them. I started CPR.

qrsline_small

Comments

( 14 comments — Leave a comment )
rozebud
Jan. 9th, 2007 12:40 am (UTC)
So, are you going to finish it now? It doesn't sound promising...
bxiie
Jan. 9th, 2007 04:08 pm (UTC)
I don't think so... It didn't get any better.

In short;

The AED said not to shock the patient; asystole (a flat-line) is not a shockable rhythm except on TV. We couldn't get a tube into the guy's airway 'cause of some weird anatomy issue. We threw the guy onto a backboard and picked him up to go just as the AED started to analyze again. The AED thought the motion was a shockable rhythm (ventricular fibrillation) so we set him down and shocked him... Still asystole. So we threw him into the ambulance and raced off to the emergency room, CPR enroute.

At the hospital, they gave him epinephrine and atropine (I am allowed to give these in NH but not VT... In this case, about 300 yards made the difference between early meds and not). These pushed the patient into a 'bradicardic pulseless electrical activity'; a slow but organized heart rhythm that, unfortunately, does not push blood (and is therefore pulseless).

Numerous people rotated through CPR while we waited for the family to arrive; the PA in charge wanted to wait for them before ending the resuscitation attempt (for closure). They never did arrive and so the PA called it after about 30 minutes.

A lot of people thought that we shouldn't have worked this patient at all. Personally, I don't think the patient was at all viable and had we brought him back his quality of life would have been nil (lack of oxygen perfusion to the brain for minutes = major damage). The PA who told us (by phone) to work it later said that one of the big reasons he did so was for the benefit of the family. One positive effect was that many people got to work under the new CPR guidelines and several people who had never done CPR got a chance to do so under controlled circumstances and supervision.

Bloop.
bxiie
Jan. 9th, 2007 04:11 pm (UTC)
Now that I think about it, New Hampshire extends to the high-water mark on the west side of the Connecticut river so this guy was really about 100 yards at most from earlier advanced cardiac life support.

If it were up to me, I'd rather get sick in New Hampshire.
rozebud
Jan. 9th, 2007 06:51 pm (UTC)
Oh, that was me earlier...I forgot to log back in.

If you love New Hampshire so much, why don't you marry it? ;-p
bxiie
Jan. 9th, 2007 08:17 pm (UTC)
Rab' made me move to VT.
(Anonymous)
Jan. 9th, 2007 06:50 pm (UTC)
That was about the ending I expected.

Do you think the earlier meds would have made a difference here? Seems like the guy was gone before you even arrived. The PA's call re: the family sounds like the right one tho...you don't want people thinking you didn't try.
bxiie
Jan. 9th, 2007 08:18 pm (UTC)
I don't think it would have made a difference.
geckospot
Jan. 9th, 2007 05:24 pm (UTC)
no cliffhangers allowed
I kinda saw the end of that story coming but story readers need closure, too. What was the yellow viscous fluid?

Seems odd that the family didn't arrive for so long but I guess it's good that the newbies got some practice in even if it was pretty hopeless. And good for the old guy on not coming back after all that time! No vegetative state for me either please.
bxiie
Jan. 9th, 2007 08:19 pm (UTC)
Re: no cliffhangers allowed
I'm really not sure what the liquid was and I didn't get a chance to taste it.
geckospot
Jan. 10th, 2007 02:41 am (UTC)
Re: no cliffhangers allowed
chicken
bxiie
Jan. 10th, 2007 03:41 am (UTC)
Re: no cliffhangers allowed
Back in the old days (I'm told) they would test for cerebrospinal fluid by tasting it.
peregrin8
Jan. 11th, 2007 05:35 pm (UTC)
Re: no cliffhangers allowed
yes, it probably tasted like chicken
bxiie
Jan. 18th, 2007 04:58 am (UTC)
Re: no cliffhangers allowed
Teriyaki.
(Anonymous)
Mar. 20th, 2011 03:43 am (UTC)
This really solved my problem, thank you!
( 14 comments — Leave a comment )

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Bjamexza Q. Pyndejo / James O. Payne, Jr.
Bxiie Q. Pyndejo

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