A Flute

Did a code at a nursing home this morning. Patient, last seen allegedly an hour earlier, found apneic and pulseless in bed. She was asystole with cool, cyanotic skin. No shock advised on the first responders' defibrillator. I intubated her, did a round of epi down the tube, then got an IV and did 25 minutes of ACLS, including 25 grams of Dextrose because her sugar was less than 20, but got nothing back, and so I presumed her. It wasn't until I came back to the base and was writing up the presumption that I recognized the medical history as someone who I had transported on Wednesday for a broken knee. Dead people really have nothing in their faces because I had not a clue that I had actually been talking to this person a few days ago.

When I did the tube, I didn't initially see the chords, but with my right hand, I applied crick pressure for myself, using my fingers like the fingers on a flute to find the right spot -- a modification of a technique I learned in a half-day airway class at the JEMS conference in Phillidelphia three years ago. When I pressed down with my middle finger tip the chords dropped right down into view. I said to my partner. "See where I am pressing with my finger. Put your fingertip right there." She put it right in the right spot, and I easily slipped the tube in. I have had a number of tubes in recent weeks, and am feeling much more comfortable again.

The code was the third in three weeks for our service's newest EMT -- a young high school junior, who has made great strides over the last year. He has gone from someone who shyly stood back and watched to an active participate in care. We are kidding him, however, that he is becoming a black cloud.

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Also did calls for a seizure, a dehydration, and a medical alarm.

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Last call was for hypertension at a nursing home. One of our EMT students took a blood pressure -- for the first time -- and said she was sure her reading couldn't be right. She said she got 80/60. The nursing home had said the patient, who had a fever had a BP of 176/120. I took the BP then myself and sure enough it was 80/60. A good lesson for her -- don't trust the nursing home. A lesson for me -- another student with real potential.