The Chain of Survival
After finishing my paperwork I come out of the ER and sit in the front seat of the ambulance. My partner, who is in the back putting linen away, says, “About five minutes ago they sent an ambulance up to Pilson Way for a call where they are doing CPR.”
“We should probably clear,” I say. “No telling where they are coming from, plus at any rate they’ll need backup.”
We clear with our dispatch and they put us on the call. Pilson Way is a hike. The Med radio updates us that it is a sixty year old woman who is not breathing. She was breathing when her husband called in, but has stopped and they gave the husband CPR instructions. The police are on scene now.
It takes us about eight minutes to get there. Ahead we see two police cruisers and a commercial ambulance. I ask an officer standing in the driveway what is going on, and he says they shocked her once and she started breathing. I start in through the open garage door, but he says no, they are already in the back of the ambulance.
I open the side door and ask what I can do to help. The medic is one of our town medics who works the night shift at the end of the week. Like me, he works a lot of city overtime for the commercial service. “I’m just putting on the capnography,” he says. “Wilson here shocked her and got her back.”
I look at the cop. Bob Wilson sits there squeezing the ambu-bag. “Wilson, I say, you are amazing. “ I can’t count the number of saves I have had where Officer Wilson was there first to either shock or do CPR. “Than man with the magic hands.”
“Just doing my job,” he says.
I take over the airway and ride in with the medic. I get the story along the way. The woman just came home with her husband. He went in the house and noticed she didn’t follow. He found her beside the car. She was breathing funny and not responding, he called 911. Officer Wilson got there and shocked her once, and then immediately started CPR. The medic got there moments later. The woman appeared to be in PEA, but then she started breathing as he intubated her. Her pressure now is 74/40Her ETCO2 is 51, but with measured assisted breathing we get it down to 35. 300 cc of saline and her pressure is much better. Her color is good. Pupils sluggish but reacting. She’s in an a-fib in the 120-130 range. Her sugar is fine. We even do a 12-lead. Pressure on arrival at the hospital is 140/80. SAT is 100%. The doctor says, “Fine job.”
Wilson calls me later to find out how she did.
“Great,” I say, and tell him what I know. “You are the man!” I say.
“Just doing my job,” he says.
***
Futility
That afternoon we get called for unconscious, not breathing at the nursing home. 94-year-old terminal cancer patient with a lengthy list of other medical problems. I walk in the room and see the officers doing CPR. His body is misshapen. He has a huge distended abdomen, which the nurse says has been normal for him of late. He has kifosis of the neck, so his head is about nine inches off the bed. The defibrillator was no shock advised. He is asystole. The nursing home confirms he is a full code. I get the tube easy enough. His initial ETCO2 is 14, but within a few ventilations it is down in the 5-8 range. I have a hell of a time getting an IV. I finally get it in of all places the AC. I dump in epi and atropine, but he is still asystole. I call it after a half an hour. We pick up all our medical trash – IV wrappers, stylet, defib pads, empty epi vials, syringes, two by twos. Two nurses’ aides put him in a fresh gown, and then pull the sheet up over him. We push our stretcher back down the hall, carrying all our equipment and the long board. On the way, we pass a nurse leading a stunned woman, who says to the nurse, “What do you mean, My Daddy’s dead?”
