Code Blue

Well. Last post up until now, the volunteer ambulance service I ride with fielded fairly routine calls, more medical cases than anything. Nothing really exciting or crazy.

I was waiting for a chance to...do something crazy. Save someone's life. Work a code.

Earlier this morning, I got my wish. Damn it...I wish it never happened.

It was actually a light Friday night, with several refusals and nothing close to my usual weekend crap-fest of calls slammed right after each other. I had dinner with the rest of the firemen, and relaxed while the others moved the ambulance and fire engine out into the street in order to play street hockey in the bay.

A nice normal night.

At 0145, we had a call for respiratory distress. Again, still normal considering the change in humidity and weather lately. Wooweewoowee bright flashing lights, zooming down the narrow road dodging idiot drivers.

We get on scene to find a gentleman with a mouth and tongue swollen up to Jabba-the-Hut size. He could still talk, with a odd high pitched tone. None of the firemen or us EMT's did anything on scene; instead, we walked him over to the ambulance.

Mr W, my paramedic supervisor asked me if I could handle this call. (Usually the supervisor can jet in their Crown-Vic responder cars, in order to be ready for the next call if he felt the two EMT's could transport a non-emergent patient without any complication.) I thought about it for a second. For the last couple of shifts I had always asked the paramedic to ride in since I am normally very over caution about everything. I looked at the pt, who was settling into the stretcher, who didn't look too agitated. Maybe I can finally just own up and take care of patients myself instead of defaulting to a superior. Maybe I could grow some balls.

"I've got this one, W. Don't worry about it." Mr. W looked at me, then back to patient. Our student was hooking the gentleman up to reserve oxygen, while my partner jumped into the driver's seat.

"I don't know. He is having a bit of respiratory trouble. I'll ride in," Mr W decided. I hook our pt onto the cardiac monitor, and tried to help Mr W start a IV.



Everything started to go downhill.

Mr W. couldn't get a line going. Our gentleman started to flail about. It took me absolutely too long to realize what was going on.

I looked at the monitor to see our pt's oxygen saturation drop. Drop. Drop. 95-100% is great. 90-95% Means something is seriously wrong. Any thing less means I get to shove a tube down your throat to force air into you. Your fickle body will probably be unconscious as well.

82%

63%

Our patient was flailing because his throat had swelled shut with his tongue so huge it was choking him.


We didn't have a line in. No IV benadryl or epi to slow down the reaction. I threw a dose of benadryl to Mr W, who stabbed the patient with a IM needle to deliver the drug into the muscles in his shoulder. Piss poor absorption. This man is going to die soon if we didn't do anything.

Our patient went limp. Blood oxygen saturation at 20%. His heart threw in the towel and the monitor flatlined.


Our student looked at me, then at Mr. W, unsure of what to do.

"START CPR NOW. FORGET THE DIVERSION, MR G YOU ARE TURNING THIS AMBULANCE AROUND NOW." Instead of heading to a hospital across town because they had our patient's records, we now were ripping down a sleepy road to the nearest hospital that was already on diversion for critical ER saturation. Our patient's life was literally draining out of our hands with every second we wasted on the road and NOT in a ER.

I frantically tore open compartments, looking for a bag to force air into my patient's lungs. WHY WAS EVERY BAG-VALVE-MASK PEDIATRIC SIZED?!?! The flustered student was pumping down on the patient's chest entirely too fast and too shallow, while I finally slapped together an adult BVM. I threw an Epi-Pen at MR W, who struggled to cut open the pt's pants, then stabbed the Pen in.

My God.

Thank goodness we were only several minutes away from the closest hospital. Those minutes were the most agonizing of my entire life. I tried so hard to bag our patient with one hand, but the whole endeavor was like trying to drive 80 mph down a freeway with one foot on the pedal and the attached knee steering. I am not joking. You need at least four hands to successfully bag a patient, I only had myself.

I felt like an utter failure.

We flew into the ambulance bay, and of course, the stretcher just HAD TO RUN OUT OF POWER as we tried to unload the patient. God damn battery powered stretcher. It saves us from breaking our backs trying to carry a 600 pound patient, but tonight my student STOPPED CPR in order to unjam the stretcher. ARGHHHHH NOOOOOOOOOOOO.


We finally wheeled our patient into the hands of a waiting ER team, and the began to do real CPR and pump the gentleman full of drugs. Maxed out on Epi. Threw in bicarb and D50.

During the entire scene described above, I was not scared nor freaked out. A weird detached calm blanketed me, my body was in automatic mode. Well, at least until I saw the patient's brother, sitting in a chair around the corner. Scared, uncertain eyes locked mine, until I forced my self to look away. Suddenly a flood of emotion rocked my body, all the way through my sweat-filled gloves. If the ER doc running the code didn't succeed, this man was going to lose a family member.

With the ER team in controlled chaos trying to save the gentleman's life, we EMT's were suddenly useless, so I waited outside while Mr W transferred the last of our patient data to the scribe. I stood outside with Mr G (my partner and driver for this night) and our student. After a minute I couldn't take it, and peeked back into the room. Seconds later, the nurse pounding the CPR stopped, and everyone relaxed a notch. Spontaneous heartbeat. Soon the gentleman was breathing on his own again.

Everyone involved was credited with a CPR save. "We" all worked together to save his life.

I don't know any more.