This Stuff Really Works

“She’s not breathing!” screamed the skinny teenage girl, on the edge of hysteria as we came to a stop in front of the apartment building. “Hurry, please, it’s my mother!” Tears streamed down her face.

My partner, Dick, and I were grabbing gear off the ambulance as Engine 7 pulled up behind us. “What do you need, Mike?” the shift captain asked.

“Set up the stretcher at the base of the stairs and bring up a backboard,” I called as I ran around the police cruiser, heading to the back of the building. As I ran up the outside stairs, I thought to myself that nothing ever happens on the first floor, and I’m getting too old to be running up three flights with 60 pounds of gear hanging off my shoulder.

At the top a man with long hair and a bushy mustache was pointing the way. The husband, I suspected. “Through there—the room on the right,” he said. “She’s not breathing—hurry!” We eased our way down the narrow, cluttered hallway to the back of the apartment.

I turned into the room; it looked like it was ready to explode—small, but full of a lifetime of belongings. The bed filled most of it, the patient lying on the only space on the floor. She was wedged between the bed and the dresser. Two police officers who had arrived first had the AED attached to the patient and were performing CPR.

“What do you have, guys?” I asked, kneeling in the doorway by the patient’s head, checking for a pulse.

“She was down on the floor with no pulse,” answered the sergeant. “The AED advised a shock, so we shocked her just before you got here.”

With compressions, she had a good pulse. If they were interrupted, she lost it. I told the cops to continue. Then, “Dick, I need the BVM, then set up for an IV line.” I turned to our paramedic student for the day. “Melanie, what do you want to do?”

“Let’s get our cardiac monitor on her and see what we have for a rhythm,” she answered.

I turned to the police. “Good job, guys, keep doing compressions.” With the ResQPOD in place, I started to assist ventilations with the BVM.

From down the hallway one of the firefighters called out: “We’ve got the stretcher set up at the base of the stairs, and the backboard is in the hallway, Mike.”

“OK. Melanie, what do you have for a rhythm on the monitor?”

“V-fib.”

“OK, what do you want to do for it?”

“Shock it. I need to charge the monitor, 200 joules. Charging, everybody—clear, clear, clear—shocking.” Verumph, the deliberator went off, the patient jerking with the electrical charge as it shot through her body.

“OK, start compressions again, hard, deep and fast. Let’s go, let’s go.”

Out of the corner of my eye, I caught the sergeant grabbing Dick by his jacket. He lifted all five feet of him over the patient and placed him at the foot of the bed.

“Dick, how’s that IV coming?” I asked.

“Jesus, Mikey, I can’t get to her. There’s no room, and we need to get her out of here.”

“All right, get the backboard in here, place the foot of it at her head, and we’ll slide her onto it.”

The crew was getting tense—I needed to calm them down. Beth, one of the firefighters, was struggling to get the backboard placed. She was working in close proximity to my backside. We have worked many tense calls together and have a good relationship and respect for each other.

“Beth,” I told her, “I’m a little gassy today. I don’t think you want to get too close down there.” Silence, then chuckling from the crew. It worked—the tension started to resolve, and people worked harder and faster.

“Geez, Mike, you didn’t have to say that,” said Beth, smiling but understanding what just took place.

The backboard was set. “On my count. Ready, 1-2-3—pull!” Onto the board she went. We now had her in the hallway, with a little more room to work.

“Anyone have any information or history on this lady?”

“IV is in,” reported Dick.

“Give an amp of epi,” I told him, “then get the amiodarone ready.”

“I’m her husband,” the man with long hair and mustache said. “She was in the emergency room yesterday—she wasn’t feeling well. It was busy, so she left without being seen. She didn’t want to wait. Last night she was running through the woods looking for a friend and complaining of her chest hurting. This morning she got up at 5:30 to take her methadone, and when I checked on her later, she was like this, wouldn’t wake up or answer me. I called 9-1-1.”

“Epi in,” Dick said matter-of-factly.

I turned to her husband. “Any heart history on her?”

“No, but her two sisters have had heart attacks, and her father died from one,” he answered.

Strong family history, I thought to myself. Or is it an overdose?

“Rhythm check: still v-fib. Shocking again at 200 joules. Clear, clear, clear—shocking.” Melanie was doing a fine job of running the call. Verumph, the monitor discharged again. “Continue compressions!” Melanie was really getting into giving orders.

“OK, Dick, push the amiodarone. Let’s get another epi ready. She had her methadone, let’s give a trial of Narcan.”

“Here are the epi and amiodarone,” Dick said, handing the medications to me. “I’m getting the Narcan.”

I pushed the drugs. “Let’s get her, the monitor and the oxygen tank strapped onto the backboard. We need to start getting out of here."

“Rhythm check!” shouted Melanie. “I have sinus rhythm on the monitor.”

“Is there a pulse?” I quickly asked.

In a surprised voice she answered, “I have a pulse! I have a pulse—oh, my God!”

“Check for a blood pressure. Put on the pulse oximeter probe!” I told  her as I snapped the last strap in place. “She’s trying to breathe on her own. Melanie, keep assisting with her ventilations.”

“Mike, blood pressure is 164/101,” Dick said. “Great,” I answered.

“She’s really breathing well on her own now,” Melanie shouted. “O₂ sat 100%.”

“Change her over to a non-rebreather, then we’re out of here. I need a blanket to cover her.” We had exposed her chest for compressions and attaching the defibrillator pads.

I pointed to two firefighters. “You two grab that end of the board,” I said, then turned to the officer beside me. “You grab that corner, and Beth, back us down the stairs.”

We proceeded out the apartment and down the steps. For the officer and me, it was a backward process—and when we got to the last flight, it stopped. The oxygen tank was slipping out from under the strap and started to fall off. I grabbed it. Holding my corner of the board with one hand and the oxygen tank in the other, I called, “Beth, can you get hold of the tank and pass it down to Dick?”

“No problem, let me just reach through here…” she answered. But we had a little problem: She was reaching between my legs and couldn’t quite reach the tank.

“If you keep reaching and fooling around there, I’m going to need a cigarette,” I told her. At that point everyone lost it and starting laughing. We all managed to hold on to the backboard and not drop our patient. “Geez, Mike, not again,” said Beth, giggling.

With one final stretch Beth reached out, grabbed the tank and was able to pass it over the railing to Dick. We proceeded the rest of the way down the steps, then got our patient secured to the stretcher and into the ambulance. I had been keeping watch on the monitor. The rhythm was good, and her blood pressure was maintaining. She was still breathing well on her own, maintaining her own airway. 

Code 3 to the hospital; we reassessed our patient, going through the differential diagnosis that could have caused this lady’s arrest.

“Pupils are reactive to light.” Melanie said. “Lung sounds are a little coarse; she may have aspirated at some point. Do you want to intubate her?”

“We have good oxygen saturation, and she’s maintaining her airway and has a gag reflex,” I answered. “We’re less than 60 seconds to the ER. I think we’ll wait until we get there.”

On arrival we turned our patient over to the staff and gave our report. They intubated her and continued care, and our patient continued to improve. The attending doctor wanted to rule out a head bleed, so he ordered a CAT scan; it came back negative. My report written and attached to the patient’s chart, I went home, wondering if she would survive the night and, if she did, how well she’d recover.

But I also had another thought: When everything falls into place from the hours of training we all do, the AED and police arriving first, EMS and fire coming in and everyone working as team, good things can happen. I thought to myself, This stuff really works.

Epilogue

Four days later I returned to work, checked the hospital census and found my patient was still in the ICU. I went over to check on her. She was sitting up in bed, extubated, eating and drinking, family in the room, neurologically intact. I spoke with the husband; he said she was being transferred to a cardiac center for further testing and treatment. The cardiologist had told him it was a long QT segment that caused the v-fib. He didn’t quite understand about that, so I explained to him the best I could.

Two weeks later our patient returned to her home, her family and her life.