Thursday, 30 October 2008


'111, we have a cardiac arrest for you, you're being backed up by a Paramedic Practitioner.'

'Roger, book us mobile.'

We were 'green' at the hospital when the job came through.

'I know that address, it's only round the corner.' I said to my crew mate. We turned up 60 seconds the wrong address. I had to recheck the road name and sure enough I got it wrong. The actual address was the other side of the hospital about a mile away so we made our way there. Still got there in under 8 minutes though. The problem was that both road names were very similar and I cocked it up, after all I am human.

I took in the response bag and my airway kit while my crew mate followed with the drugs and suction. As we climbed the stairs we could see a lady attempting CPR while still on the phone to one of our call takers.

The patient was a 70+ year old male whose health had been steadily going downhill for a couple of weeks since changing some medication. The Dr said that there was no link and that it was a coincidence. Any way the gent was in the bathroom, had a episode of diarrhoea and was trying to get in to the shower when he collapsed in front of his wife.

We started CPR and attached the defibrillator, flat line! It's a witnessed arrest which had only happened moments earlier, we had to give him a chance so we pressed on. A few moments later a Paramedic Practitioner (PP) arrived to help. He was on the airway, my crew mate carrying out chest compressions and I was trying to get IV access. As I inserted the cannula I got a flash back but it wouldn't advance so I tried to reposition but to no avail. I could of had another go or tried the external jugular, with the PP at the head end and me at the lower half of the patient I opted for the Intraosseous route (see the picture above). Out came the small battery operated drill, I placed an adult needle on the end and drilled into the patients tibia. Once it was in I flushed it with saline and started to administer adrenaline and atropine. With every adrenaline the ecg rhythm would throw out a few complexes, something which is all too common after adrenaline administration. The problem with resuscitation drugs is that there is no real evidence that they actually work and the key components of a successful resus is good quality CPR and defibrillation. This was not a shockable rhythm so defibrillation was out straight away. All we could do is CPR and use drugs. After about 30 minutes of full Advanced Life Support (ALS) it was agreed to terminate resuscitation. If we weren't going to get him back there then there was probably no chance of getting him back in hospital besides he remained in Asystole throughout. The PP went down stairs and spoke to the patients wife and told her that her husband had passed away, he also explained what would happen next. Once death is confirmed then we contact the police and they attend. They will act on behalf of HM coroner and offer help and support to the relatives. If something is suspicious then they will deal with that as well.
One thing with this job is that out of all the cardiac arrests we attend most will die. It has nothing to do with us, sometimes it is just their time or no one will have been doing any CPR before we get there. I do get frustrated with just 'going through the motions' time and time again only to prolong a death and not save a life! It would be nice to get someone back from time to time but it's beyond our control. May be next time.


Michael Morse said...

I'm 0-50. Every now and then we get one to the ER with a heartbeat but they never make it through the night. At least we give them a chance, I guess.

Pace said...

I'm a new EMT. I like your blog; the posts read like case studies with style.

mac said...

Thanks for that, I just write it as I think about it. I wish I had more of a writing style similar to Michael Morse and Peter Canning but hey ho.

Anonymous said...

My first two codes I ran the same night. The first guy we got back, and the next shift I actually talked with him in his hospital bed.

The second guy that night was DRT.

Every code since has been unsuccessful, as well.

Just remember that we medics are there in case the Big Electron decides to change his mind. We control nothing.