WAY TO GO ANTHONY

[AnthonyM83]

Thanks guys.

I never really announced it, but I'm in medic school full-time now. BUT still in didactic (not internship, not clinicals, yet)

I just happened to be shadowing an ER doctor I had met when was in the field. This was unrelated to school. I just wanted to get an idea of how our doctors think and what we can do better in the field to help them. We're going over charts and such, when we get notice of a full arrest en route, no details (guess he coded enroute).

Well, just happens that while we're waiting, my school's paramedic internship coordinator walks in. She's riding along to watch a student being precepted.

(So, see where this is going... student shadowing... full arrest coming in... preceptor coordinator there...this happens to be one of the official hospitals for ER clinicals for my school...and we had already finished airway and cardiac block)

Basically:

-Patient arrives (Enroute went SOB to bradypneic to agonal to arrest, first rhythm asystole...2 rounds epi/atr so far)

-Short, fat neck. They couldn't get ETT, so dropped a Combitube.

-Doctor offers me intubation. I get the go ahead from my teacher/coordinator.

-Standing there looking calm and relaxed amongst the chatter (but really my heart's POUNDING). I pretend it's just another scenario and patient's an actor.

-Game time.

-I try to slip blade in, but he reminds me I have to scissor the mouth open first (hey, the dummies didn't require that!).

-Fat freaking tongue...how the hell do I even get the blade down there to look (I forgot to slide in from right to left...)

-Okay, now I see a lumen, edges look like they're probably cartilage, but can't be sure (can't see ridges...too bloody...I suction...still can't be sure)...no way I'm going in if can't be sure.

-Been ten seconds, so I pull out. RT bags a bit.

-Doc shows shows me how to position blade deeper.

-I go in again...now I see the ridges/bumps of the cartilage. Ah, there are the chords.

-Crap...where'd my ET tube go? Left it right there! . . . Oh, RT is holding it for me smiling... Thanks! (I'm so used to not having assistants in practice).

-Slip it in. Doctor confirms. Tada.

Details on code for those interested (and interesting observations on the nurses):

Now back to CPR. I'm trying to think of H's and T's...but they come sooo slowly (In megacode practice, I rattle them off the fastest with signs and treatments...go faster brain) Anyway...doctor is running the code... next rhythm check, VTach, shock him, next check, a sinus rhythm at 140...pulsecheck...yup! Some Ami...even got a good BP

Does well for awhile, then bradys down and pulses diminish into a PEA. Maxed out atropine, so just epi and bicarb. Get pulses back.

Happens again, epi/bicarb, comes back. So orders a Bicarb drip.

Doctor goes out to chart and arrange CT, ICU, and other stuff. I stay...My first real patient...I'm committed now.

Now it's just me, a nurse on the phone with ICU, RT, and two nurses shuffling in and out. I go back to EMT mode (I'm the ambulance guy, I stand in corner and watch you guys work and try to learn).

BUT see HR dropping very slowly. I call it out, but no one does anything. I go up and take a pulse. Chubby neck..hard to feel through the fat, think I feel weak intermittent ones. I ask others in the room to help me check, they all come over and do so (wow, never told a nurse or any of the staff what to do...) We all wait a little too long saying we can't feel one (I'm not used to feeling femorals...I expect one of them to call out "no pulse, it's a code"...but instead they just keep looking and remarking they can't really find one).

Alright Anthony, what more do you need, he just met the indications. "So, he's in PEA, let's start CPR". The nurse starts compressions.

(Wait, WTF, you told hospital staff to do something?...and they didn't hesitate to do it. Why the hell is my word any good.... maybe cause I'm dressed up like the doc and not in my little EMT uniform? they KNOW me, though...i'm ambulance guy)

Anyway, shake that off. What's next? Uhh...no one's doing anything. They keep yelling to hallway to get the doctor to see if he wants to give the same drugs as last time to see if it'll work...but can't find him. Time ticking away.

Screw this. Why are we getting caught up in this? We're all ACLS certed, right? He's in PEA, we should give Epi...that's a standard...why do we need the doctor? Do a quick legalities check in my head (preceptor approval (though she left already)...official contract with ER and my school so insurance stuff is good...nurse usually precepts a medic, so don't need the doc...so I can act like a medic right?

"Okay, guys, this is a PEA. PEA gets Epi, so I'm just going to push it, okay?" (I get an okay) Then I push Bicarb... we end up with pulses again.

Basically, the point of all the above is It was really a mind trip to realize how nothing was being done if the doctor wasn't there and even more that they looked to me for our next move, our next drug, whether we start CPR. Nothing against nurses. And I know most of the ones here are Type A personalities...but I forget how many Type B's there are. They need someone to decide...and as soon as they do they do their jobs great (they were helping me out with technical stuff the whole time like reminding me to pinch the line). Maybe it was cause they knew me from the EMT days, but it was weird how easily they took me as the leader and even kept checking in with me. I still have a confused look on my face as I type this. That guy would have gotten nothing more than CPR until they found a doctor....

Anyway, end of story, is he stablized. The rest of it was just me, 2 techs, 2 RNs, and RT. Took him up to a floor and transferred him. But even for that, I had to tell them to stock up on more Epi and drugs. Then someone said "you're staying with us!" I don't know if I just seemed like I knew what I was doing? Or dressed like I was? Or they associated me with the doc cause we were side by side the previous 8 hours? I don't know. I just know they've been on SO many more full arrests than I have. And it feels weird leading someone of a higher authority than me. Leading other EMTs on-scene, I'm great. I run scenarios with students all the time. I'm an FTO. But THIS...was like your teacher in high school coming to you for advice or something...just seemed off.

Oh, and at the end, the doctor thanked me in front of everyone for being able to "show up" my experienced peers who couldn't get the tube and on my time. That was probably the best part of the day. I thanked everyone for letting me be a part of their team and left to celebrate.

Edited April 13, 2009 by AnthonyM83

[celticcare]

Congrats Anthony, You have lost your pvc virginity and succeeded.

Proud of ya mate, may many more tubes come your way with ease and care and the aid of lubricant.

but good on you mate

Scotty

[CBEMT]

BRAVO ZULU.

Now don't let this become the quickest route to a Paragod syndrome in history.

[AnthonyM83]

BRAVO ZULU.

Now don't let this become the quickest route to a Paragod syndrome in history.

LOL Absolutely not.

My comments were totally from a psychology perspective. Like if room starts filling with smoke, but no one else runs out, the person will stay also. Or if a man with a business suit starts walking despite the Don't Walk sign, everyone else does too. It just boggled my mind what made these experienced people take or not take action, yesterday. It was just observational ramblings...

Edited April 13, 2009 by AnthonyM83

[Lone Star]

*bows to the Great Anthony*

I'm in absolute awe!

I just hope that when I grow up and start doing that kind of stuff, I'll be as cool under fire as you obviously were!!

Have one on me!

[brentoli]

*bows to the Great Anthony*

I'm in absolute awe!

I just hope that when I grow up and start doing that kind of stuff, I'll be as cool under fire as you obviously were!!

Have one on me!

He was just lucky none of the nurses noticed the big wet patch traveling down his leg!

[AnthonyM83]

Modified from one of the oldest tricks in my book.

When too drunk to a speak or walk, just lean against something, hold a drink, and pretend to be in thought, while occasionally scanning the room (so people don't think you're fading). The less you do, the less they notice. Works the same for counteracting adrenaline rushes

[brentoli]

So what drink did you have in your hand?

[AnthonyM83]

So what drink did you have in your hand?

Nice.

A "Miller" Lite

(Actually a Mac 4)