But They Are All Firsts

They say you never forget your first, and they’re right. My first cardiac arrest was many years ago. A pair of friends driving south from Maine or someplace, driver stops to get gas and snacks. Returns to the car to notice that her friend is “still sleeping” but decides this is the Last Chance Rest Area – wake up and go pee!

My crew, in which I was a third, immediately began working the code but the consensus was the passenger could have been “down” since three states back. Still, doing CPR in the back of the medic all the way to the hospital felt like a good and helpful thing to do, at the time.

Recently we received a call for difficulty breathing. Our patient was a morbidly obese male approximately 50 years old, sitting on the edge of a bed. A family member sat next to him, supporting him with an arm around the shoulders. The patient seemed to be breathing normally, both speed and depth of respirations, and without difficulty.

“Hi there, what’s going on today?” DTs asks.

“Just give him some oxygen,” said The Supporter. “That’s all he needs is some oxygen.”

“Well, now, lemme just get in there sir, and take a look, okay?” To his crew: “Let’s get a quick dexy here.”

The Supporter slides off the bed. The patient weakly states, “I think I’m going to go out.”

“Sir, what’s happening?” asks DTs. No response, the patient stares straight ahead. DTs shines a quick light into each eye, is puzzled by what he sees. “He doesn’t have glaucoma, does he?” DTs asks the room, but realizes it’s not the haze of glaucoma or cataracts – both eyes are so widely dilated they reflect a dull, green-blue.

Oh shit oh dear, this patient has just entered Seizure Country. Lay him back on the bed, check the radial pulse as I’m doing so – good radial. The bedroom is crowded with furniture and whatnot, a small room. Stays on the bed, then, until we can…

Foam starts pouring from the patient’s nose and mouth, looking exactly like he’d just chewed up a handful of Alka Seltzer tablets. Grab suction, roll the patient on his side.

The medic has arrived, and suddenly we have hands enough – suction, bvm, attach heart monitor cables – asystole. Check cables still attached, still asystole, his bladder’s let go, toss a pillow onto the bed for my knees and begin CPR, more suction, O2, here comes the reeves stretcher. Stop CPR, roll right, slide the stretcher, roll left, straps secured and we gotta GO.

Tough carry down the stairs – well over three hundred pounds, the stairs are narrow, and Airway and Monitor and CPR are trying to walk next to the patient. Into the medic unit, the patient’s bowels let go, try for an IV but the BP is 0/0 and we can’t get a flash. ET tube goes in but we get breath sounds left, right, AND epigastric sounds – can’t be sure, pull out and drop a combitube. CPR shows good on the monitor, generates pulses but the underlying rhythm remains asystole. Meanwhile, the only IV access is EJ but the patient’s rolls of adipose tissue keep creeping up towards the chin and occluding the flow – and finally dislodges it as we arrive at the hospital.

So, a first. Witnessed cardiac arrest. This time DTs was, he hopes, a bit more helpful. Hell, next time we might even get a save – it wouldn’t be my first, though.

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