Code

6:03. Person not breathing. The night medic hasn't left yet so he offers to come along. I'm thinking its going to be a stiff. We get updated. "The person has a pulse, we're about to use the AED." Okay. We enter the house walk through a narrow hallway,and then down a narrow staircase, and then around some big furniture to a basement bedroom where they are doing CPR.

We enter the room at 6:10. Man in his late fifties with a diaylsis port hanging out of his chest. He's warm. Family says he was talking to them shortly beforehand. A witnessed address. He's asystole now. I intubate him. End Tidal CO2 shows a good wave form with a reading between 17 and 23. We work him hard. Doing the new CPR. I get an EJ and in go the drugs. Epi and Atropine. (Later the night medic asked me why I didn't use Vasopressin. Vasopressin! Do'oh. I never remember we carry it now. It is zipped up in a small pouch. Over a decade of this, I am programmed -- epi, atropine. I give him some Calcium. Next thing I know the ET CO2 is up to 35. We stop compressions. He's got an organized rythmn and a pulse. BP is 124/80. It is now 6:30 -- a half hour into the call. We have to package him. Fortunately we can go out through a backdoor, but there will be a hill to push him up. As soon as we get him outside, the capnography drops down to 18. Back to CPR. More epi/atropine. Capnography gets him back up. We lose him again as we push up the hill, but regain ROSC as we near the hospital at 7:00.

Going down the hall, he starts to fade out again, and even though his ETCO2 is 32, we start CPR. The rythmn looks idioventricular. They work him awhile longer at the hospital, but he doesn't make it.

The capnography was very instructive. It did the following:

1) Confirmed placement of the tube.
2) Alerted us to ROSC three times.
3) Whenever we were doing CPR and the number started to fall, we switched compressors and the number came back up. At one point, I told my partner if he could get the ETCO2 up from 16 to 20, I'd buy at Dunk'n Doughnuts. He started pounding the CPR and the number slowly climbed all the way up to 28. Stopped compressions, the number fell off the cliff almost right away.
4) Confirmed continuously placement of tube. Pulling him out of the ambulance, the wheels didn't drop properly and we almost lost him. There was a lot of jarring, but when I looked at the monitor, the wave form was textbook. Tube still in place.

Here's the capnography trend summary showing Return of Spontaneous Circulation (ROSC).

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Just when I start to feel like a paramedic again, my next two calls are for blood oozing from a catheter in a nursing home patient and a direct admit from an endoscopy center, both of whom called 911 instead of the commercial ambulance.

Later I did a dsypnea/chest pain with an MI/COPD history that felt better with a breathing treatment and two nitro.