It’s 1:30am, and I just got home from a long evening shift. But I need to decompress.
Fella was out shopping with his wife at the mall. They were laughing and talking when he suddenly collapsed and fell to the ground. By the time the paramedics got to him, he was pulseless and blue. After multiple shocks and a bunch of rounds of drugs, he was still pulseless when they pulled up to the ambulance bay in the ER. They rolled in with a sweaty fireman up on the stretcher doing chest compressions, and a handful of medics escorting him into the trauma bay.
Down time: 30 minutes.
At this point in the game, my job is usually to settle everyone down and confirm that he’s pulseless and has no treatable rhythm. After that, it’s a formality to unceremoniously announce the time of death and make it official. I’ll usually take off my gloves, thank everyone in the room, and then go look for family members to have the worst introductory piece of conversation you can imagine. “Hi, I’m Jeff, I’m the ER doc. I’m really sorry, but . . . . “
So 30 minutes is a long resuscitation, and flogging the poor guy anymore would be cruel and a waste of resources, even if it does add some drama to an otherwise mundane shift. Chances of survival if you’ve been worked for that long are virtually nil.
But this guy had other plans.
He rolled in with V-fib, which is a shockable rhythm. So we shocked him. He went into V-tach, which is another shockable rhythm. So we shocked him. Then he went into a sinus rhythm, which is a . . . normal rhythm. His rhythm wouldn’t stay there. He died a few more times, and I just kept calling out for more shocks and more drugs. Epinepherine, Amiodarone, Bicarbonate, Calcium Gluconate, Atropine, Dopamine drip. “What the hell am I doing?” is really all I could ask myself. This guy has died multiple deaths in the last half an hour, and I’m only prolonging the agony. Right? But now the guy has a normal rhythm and a decent blood pressure.
The conversation with his wife was somewhat more palatable than having to tell her I couldn’t save her husband. But I wasn’t sure that he was going to stay alive (or more importantly, ever walk out of the hospital), so I tried to temper any enthusiasm with a “but we aren’t out of the woods yet.” tone. In the ER, you see the best and the worst of people. His wife was remarkably calm. I’d be a wreck. Somehow, she kept it together.
We managed to get him to the ICU. But a couple hours later the overhead pager went off, “Code Blue . . . I-C-U . . . room 234″. Of course, it was our guy. He was in V-tach, which prompted me to say out loud, “Oh good. This we can treat.” Having a pulseless, lethal rhythm is generally not so desirable, but everything is relative. Asystole, or lack of any rhythm, really sucks. So hey, V-tach is pretty sweet if you consider the alternative. We got him back to a normal rhythm again, and I went back to the ER thinking I’d be back in the ICU again. But I didn’t get called back. The fella actually opened his eyes and started moving around before I left. We’ll see. Time will tell how things turn out.
I have an idea for a future ad too. Will post next time to get some feedback.
Getting geared up for Outdoor Retailer and Interbike. I’m going to send Claire to work her southern charm on the buyers and get networking. I haven’t decided if I’m going to attend. Maybe I’ll pack up the whole fam for Interbike. It’s in Vegas, so it could be kinda fun.