First Cardiac Arrest

[PCP]

Well, I did my first cardiac arrest the other night and my patient did not make it. On the way to the call I was running through my CPR protocol in my head and what I would do when I arrived on scene. For the most part it went the way I thought it would go. When my partner and I arrived on scene and walked in the house there were no lights on inside except for one. So I called out " its the paramedics " I never got a response, so I went towards the light and the first thing I see in the bedroom is a woman performing CPR while holding the phone between her ear and her shoulder talking to whom I assumed was dispatch. I was taken back by what I was seeing as I pictured a person laying on the floor unconscious, not seeing the patients wife performing CPR on her husband in their bed talking to dispatch.

My insticts took over and I told the woman I will take over, and I started chest compressions while I waited for my partner to arrive in the bedroom to help me move the patient to the floor. From there we ran our protocol and transported the patient performing CPR in the back of the ambulance. Unfortunatley my patient did not make it.

Once we transfered care over to the attending physician I went out and spoke with the wife to see if there was anybody we could call for her, but she said no. That was the hardest part to take, as I felt she needed someone there to comfort her while she was waiting to find out if her husband will make it or not. Fire stayed with her for a bit, but had to leave.

After the call I had took some time to think about the call and I could not help, but to think if there was ANYTHING else I could have done that may have resulted in a better outcome? After I was finished thinking to myself, I went back into the hospital to complete my PCR form and I had a chance to speak to one of the nurses and she told me I had done a good job and when I arrived that I was very calm for someone who had just done their first cardiac arrest. She also said try not to think about the call too much and sometimes things just don't work out the way we think they should. She said it gets easier as you do more cardiac arrests. Does it?

It has been two days since the call and I can still picture the wife performing CPR on the bed, as well as I keep picturing the guy's face as well. I am not sure if that is normal after doing a cardiac arrest, but I sure hope that I blank it out of my mind soon. I am not upset about the call, as I have had no problems sleeping, but for some reason I just can't get the call out of me HEAD!! It could be because it is so close to Christmas and that it was my first cardiac arrest. We had a hard time finding the house so I think what if we had gotten there sooner could we have saved him? Was I performing chest compressions well enough?

Well that was my first experience attending a cardiac arrest and I have to say it is alot different then how they make it out to be in the class room.

Well, once that call was over off I went to go do my very first seizure call..Man what a night

[Underdawg3ate1]

Sorry to here your pt didn't make it PCP, how old was he? I'm a white cloud when it comes to getting bad calls (arrests, MVA's, fire, peds, bad traumas), I think I've ran maybe 10-12 cardiac arrests in the past 8 years and sadly none of them were saves.

It is a very surreal scene to come up on, the nurse says it gets better? In my honest opinion I don't think it does. It's one thing for someone to crash in your surroundings, but when you go to a home or a business...into their surroundings it just makes it much more personal to me.

I'm sure you and your partner did everything in your power to save him, some are just past the point of no return before they even hit the floor. Some times the best thing is making sure the family is taken care of when nothing else seems to work.

Talk about the call with your partner or other crewmembers that are seasoned with these types of calls. If you dwell on it by yourself, you're just gonna burn yourself out and that's no good for you, your partner, and your pt's/family.

I remember my first Cardiac Arrest. It was right after coming home from my deployment, got called out to Dunkin Donuts for Seizures. Upon arriving on scene the rest of the crew (4 man volly crew) went inside to initiate pt care while I prepped the ambulance. The one girl came flying out saying that, "He's not breathing and has no pulse....get the AED!!" I remember like the call was yesterday, running in with the AED, two guys behind the counter with their jaws on the ground, two younger girls in the dinning area with the deer in headlights look and hands over their mouths as they watched our crew start CPR. The people in the store stated that he had just fell over and began shaking like he was having a seizure...then nothing.

I slapped on the AED and went thru the procedure, zapped once and had to deal with what he was eating. We suctioned the airway did another round of CPR, got him onto the litter and into the ambulance around the same time ALS showed up. Since I was the only driver on the call, I couldn't help with working him in the back.

Needless to say we didn't get him back, saw his obits in the paper several days later and saw that he had a family, again that was surreal too just thinking that I was there for his final moments.

I still remember after over 5 years, just about everything from that call. What the people in the store were wearing....their reactions and emotions, where the pt was laying, what we did as a crew. I don't recall the exact day but is was around this time of the year as he had on a christmas like sweater on.

You'll learn how to deal with it better as you go thru more of these types of calls. Some will be better then others, peds and folks younger then you always takes a toll, but the best thing for me at least is to talk about it.

I hope this helps ya.

Sean

[PCP]

Hey Sean,

Thanks for your reply and sharing your thoughts and story as well. This guy had just turned 60. While at the home we received gave the patient 4 shocks and after the fourth one we loaded and transported with giving two more shocks in the back of the car. At the hospital the patient recevied three more shocks before the Dr. called it. I was hopeful that we may save this guy, due to having a shockable rythm. I do find it hard to believe that it gets easier as you do more arrests, due to the nature of the call and knowing that the person you are working on is someones father, mother, husband, wife, dad, mom, or grandmother, or grandfather.

As mentioned in my original post, I don't seem bothered by the call, as I am not having trouble sleeping. I am thinking about it pretty much 24-7 about how the call went and if there was anything else could have done?

I agree that when it comes to the family members that they also are experiencing a huge tragedy in their life at that moment and they are the ones who will need to be taken care of. While I was working on my patient I could not help but to wonder how the wife was making out and hoping my partner was talking with her and doing what ever she could do to comfort her.

Thanks again for your thoughts and comments. I am sure there will many more posts like this one in my near future.

Brian

[uglyEMT]

Sorry to hear PCP. Unfortunatly most cardiacs are not saves. As was stated, sometimes they are beyond our help even before they get to the floor.

Personally, I don't think it gets easier, I think what happens is you compartmentalize it better. At the time you are doing what needs to be done, in the moment. After the call, after some more experiences, you learn how to put it aside, QA yourselves and move on. Not cold or unemotional but knowing you did your best but it just wasn't in the patients cards to come back.

You did a great service to the wife. Staying with her a little after the call and offering to contact someone for her. Some times the best treatment we give is no treatment at all. I know a few times (as can be seen in other threads by me) when I was on the receiving end of a gental touch or an "it will be OK" it made all the difference in the world to me.

BTW... stop kidding yourself this call did affect you. Just because your sleeping doesn't mean anything. You state your thinking about it 24/7, you posted here so obviously it has gotten to you in some manner. It a smart thing to talk about it though, especially in a place like here where others have gone through the experiences, some times lay persons don't connect on the same level that fellow EMTs (no level here just generically calling all of us) do. It a great thing to own it and bring it to us to help. Thats the first step.

Keep your head up, walk proudly, and get back out there. But most of all don't worry, you and your partner sound like you all did everything you could, sometimes we get there first sometimes Grimm beats us to the scene.

[medicgirl05]

I remember my first cardiac arrest. I remember feeling shocked as they told the family that the man was dead. That night I went outside and though for hours about my actions. Were my chest compressions deep enough? Did I bag slow enough? Did I show the right amount of compassion to the family? I Thought about it alot....

I think with the more arrests you work you learn that you cant do that too yourself. I can work a cardiac arrest and I'll think about if things went correctly on the way back to the station. Then I put it away and don't worry about it again. It's not because you desensitize, its just that you develop a way of dealing with it.

Don't worry too much, I'm sure you did fine. Most cardiac arrests aren't going to be saves. The fact that you care is a great thing. I think that motivates us all to get better within our proffession.

[Just Plain Ruff]

I would say that thinking about this call on the OP's end 24/7 is a normal response to the situation.

That being said, if you don't begin to stop thinking about it in a reasonable time then it's time to ask for help.

My first three calls on my first shift were a pediatric code, an adult code and a seizure. I thought about that ped code for weeks and I did not know the resources available to help me.

I can still after 18 years see the parents faces, see the kids open mouth while I intubated him. I even remember the dog howling in the other room. Sadly the kiddo didn't make it. Nor did the adult.

Had I known what resources were out there I would have taken advantage of them but I didn't and now I'm freaking nuts ha ha ha

You are normal for thinking about this call. Waht you have to understand and be able to recognize is when it's gone on too long. I don't know what that timeline is for you or for anyone else, it's a personal number.

Remember that there are people out there in EMT city land and also your community who have gone through what you are going through right now.

Keep a positive attitude, do not let the job define you and leave your work at work and not bring it home.

Take care.

[island emt]

PCP Welcome to the club

You have lost your virginity and every code from here on out will get a little easier. After a few hundred you won't even remember the most recent one.

Remember it's not your emergency and we are not GOD! The truth is ALL people die at some point in our existence.

Yes this call has seriously affected your head. Talk to some of the more seasoned crew about whats going on in your head. It can cause long term mental health issues related to PTSD.

[DwayneEMTP]

I do think that you may give yourself a little trouble by being so committed to arrests. They are dead, and in the very best systems in the world the odds are excellent that they are going to stay dead.

I don't get emotionally involved in arrests really as they are truly the dumbest calls we run. They are as close to cookbook medicine as one can possibly get. There is nothing that I can do to comfort this pt, nor to hurt them, very few s/s to investigate, my index of suspicion for them being dead is very high. Just pretty much the only time that we're going to shotgun medicine.

It's hard to know for sure if you did everything that you could have done when you only really explained that you did compressions and delivered some shocks. I'm sorry, I can't remember if you're BLS or ALS so I'm not being critical, I'm just not sure what you should have done within your scope. But I can tell you this, if you did good quality compressions and delivered shocks on a shockable rhythm, then you did do 100% of the things scientifically proved to make any difference at all in decreasing mortality/morbidity.

For me, these calls are all about the families. I truly love caring for the family members after a tragedy like this. I'm not sure why, but I do. It did make me a little batshit at first that I got at least temporary ROSC on nearly half of the arrests that I chose to work and yet still didn't have any saves!! I mean, c'mon! If the heartbeat came back for 10 minutes then surely the friggin thing could keep going long enough to get them out of the hospital and give me bragging rights!! Yeah, not so much. I'm not sure how many arrests I've worked, but there have been a bunch, and no saves. The EMS Gods don't seem to care one little bit about how I feel on these issues.

Someone said that it's ok to think of this call 24/7, but I disagree. I can see 24 maybe, but if it's been more than just a few days I think that maybe you need to talk to someone that can guide you. Interrupted sleep is certainly a sign of an emotional bruise, but certainly not the only sign.

I'm guessing that you did fine. As you do more of these I believe that you'll come to find that being as emotionless as possible is a plus on arrests. Arrests aren't so much about good medicine as they are about making sure that you push all of the correct buttons near the correct times.

Keep your chin up brother!

Dwayne

[Just Plain Ruff]

maybe the 24/7 was me but I didn't mean it that way.

what I meant was that the poster is going to think of the call a LOT. If it lasts more than a week or so with them reliving it over and over then they need to get more help than this forum can give.

I also think that we are jumping way ahead of things when we start telling the OP that they need help when in fact they might not need it. We are also jumping the gun by saying that this call seriously messed with their head as we do not know that for sure.

Let's not get this poster too out of whack until they get a chance to talk to someone about the call.

At least let's give them the benefit of the doubt before we call them nuts!!!

by the way Merry Christmas everyone

[mobey]

Well, I did my first cardiac arrest the other night and my patient did not make it.

I just want to touch on this, just as Dwayne did.

The pt recieved an injury to the body, be it traumatic or medical. The body has HUGE compensitory mechanisms to deal with injury that automatically kick in, (Tachypnia, clotting cascade, shunting, colladeral circulation etc etc)

If these mechanisms are not sufficiant the body begins shutting down.

My point is this: The patient "didn't make it" before you were dispatched. You were attempting to reverse death.

I had trouble dealing with my first couple cardiac arrests, until I accepted this fact.

But to answer your question, YES... even now, I think about my arrests for at least 48hrs.