Driving into work I had my portable on. The medic I switch with at the beginning of the week always comes in a little early in the evening so I don't get slammed with a last minute call so I try to return the favor for him. I'm crossing the town line when I hear them paged out for a mother who's son is cold. Okay, I'm thinking code, but I'm also thinking presumption. I start that way -- it is on the other side of town. They get updated that CPR is in progress. They are already out when I arrive. I find them in the bedroom doing CPR on a middle-aged man. He is in asystole. The night medic is going for the line while the cops do CPR, compressions and bagging. I go to the head and put in the tube. His jaw is not limber -- there is a slight amount of stiffness there, but I am able to get the tube in. We work him for twenty minutes, and then call the hospital to gert permission to presume. We don't have to call, but since he is in his forties, we do. The night medic tells the mother that her soon is gone, and she starts crying, and comes over to the body and gets down on her knees and throws her arms over him and starts crying out to Jesus. (Often I give the family a chance to say good bye before we stop CPR, telling them that while we are breathing for them and pumping their heart, they might be able to carry their family's voices off with them when we let them go. I didn't even think of it this morning. Maybe because I wasn't the one running the code or maybe it was still so early in the morning. I wish that I had.) It was a very emotional scene. The night medic's partner was in tears. It was sad, but it was also one of those times when you feel good about the world because you see so clearly the love that people have for each other. The guy died young, but he was surely loved by his mother.
Later in the day we were sent for a seizure possibly not breathing. It was out a house I hadn't been too for several years, but I remembered as a psych's place. We found a semi-naked fourty year old woman in the back seizing, well, she was shaking. I wasn't convinced it was a seizure. She was hot and diaphoretic. I put her on the capnography and saw she was breathing fine and had good cardiac out. In the ambulance she admitted she had been drinking and hadn't had a drink for three years. Then she started shaking again, her whole body. On the capnography she was apneic while she shook, but it never lasted more than thirty seconds. I thought maybe she was holding her breath. My preceptee tried to line and she jerked it out. When she stopped seizing, we tried a sternal rub, but she didn't respond, but then she was awake with no postictal period. The ride in was a bit of a fiasco with us yelling at her to knock it off, her alternately seizing and swearing at us. When I told her I had to stick her to get a line, she said it had hurt the last time. My preceptee had stuck her when she was suppossedly unresponsive. We ended up giving her 1 mg of Ativan just to chill her out some. At the hospital she did her seizure routine for them, and ended up getting strapped down after she started screaming she wanted oxycodone.
Then we got sent priority one for a "severe hemmorage" at the diaylsis center on a commercial pass -- it turned out to be guy walking around with a clamp on his arm. The place was closing and after two hours he still hadn't stopped bleeding whenever they removed the clamp, so because they had to go they couldn't observe him anymore so we had to take him to the hospital.