Ever save the same patient twice?

[HERBIE1]

Recently had a patient- a regular who has an incredibly long and complex cardiac history, hypertension, stents in legs, head, and his heart. 53 years old. He has periods where a couple times a week he develops chest pain, unrelieved by his own meds, and calls us. Very nice man, always the same complaint- chest pain. He always meets us at the curb- despite us telling him he should not- and apologizes for "bothering us". This time, we arrive but do not see him. As we start grabbing our gear, he walks out the door and approaches us. Chest pain- radiating to L arm and jaw, 8 of 10. BP 170/120, says he was just hospitalized the prior week for the same thing- it was his BP acting up. I ask him about his meds, he says he cannot remember them all, but if we give him a minute, he would gladly go back into his apartment and get them for us. We tell him that is not necessary, but he needs to write them down on an index card for the future.

We begin ALS care, as my partner is starting the IV, I put him on the EKG, and administer a NTG. As soon as my partner enters the skin, he says- "I don't feel good guys, I think I am going to pass out." We sort of chide him, saying he should be used to the routine by now and that the IV will be done in a moment, to hang in there. He proceeds to have a syncopal episode, begins to have a brief grand mal seizure and immediately goes into V-fib. Of course as he begins to shake, we lose the IV in the one peripheral vein he had left. I grabbed the pads, attach them, and defibrillate him back into a sinus rhythm. He does not wake up. I access his jugular vein, and we begin ACLS care.

Long story short, he went through multiple rhythms, we got ROSC and lost it multiple times. I was unable to intubate him due to the fact that he had so much previous trauma to his larynx that there were multiple folds of tissue that looked like a maze, but he was oxygenating well with a BVM, Upon arrival at the ER, he had pulses and spontaneous respirations, and the ER doc attempted to intubate to protect his airway. She ended up using a fiber optic scope because of the horrible condition of his airway, so I did not feel so bad for not getting the tube. LOL

Bottom line, his rhythm stabilized, soon he was fighting the tube, and had purposeful movement. I will soon check with the hospital to see how he's doing. The kicker-the first time we had this patient was several years ago, he arrested on us back then too, we got him back, and bought him another 4 years.

Same guy- 2 cardiac arrests, both saves by the same crew. Of the thousands of patients we have, the odds of this happening must be astronomical.

[akflightmedic]

Same guy- 2 cardiac arrests, both saves by the same crew. Of the thousands of patients we have, the odds of this happening must be astronomical.

I agree! The same partner for 4 years!! The odds are astronomical indeed!

[Richard B the EMT]

The same partner for 4 years? So what? I was with the same partner (without us wanting to kill each other) for 7 years.

As for the same patient being in Arrest, and ROSC more than one time? Ya got me there. More likely having Frequent Flyer Recreational Pharmaceutical abusers or street drunks.

[HERBIE1]

I agree! The same partner for 4 years!! The odds are astronomical indeed!

He's a great partner, a great medic, and I've known him for 15 years- families are very close. The reason for the longevity and close friendship? We are both very sick puppies. LOL

[usmc_chris]

We begin ALS care, as my partner is starting the IV, I put him on the EKG, and administer a NTG. As soon as my partner enters the skin, he says- "I don't feel good guys, I think I am going to pass out." We sort of chide him, saying he should be used to the routine by now and that the IV will be done in a moment, to hang in there. He proceeds to have a syncopal episode, begins to have a brief grand mal seizure and immediately goes into V-fib. Of course as he begins to shake, we lose the IV in the one peripheral vein he had left. I grabbed the pads, attach them, and defibrillate him back into a sinus rhythm. He does not wake up. I access his jugular vein, and we begin ACLS care.

Just one comment... probably not a true tonic-clonic "grand mal" seizure, but rather a Stokes-Adams Attack. I've seen the V-Fib "Dance of Death" before (as, I am sure, have many on here) and it sure does look like a seizure... until you glance at the monitor and pucker up!

That aside, how does this guy not have an AICD/pacemaker???

Also, at one of my employers, we have a dispatcher that has been a "save" at work at least twice that I know of, and apparently once at home as well. I don't know if the same medics worked on him both times at work... it would have been management staff, but those change so often around here...

[paramedicmike]

I have to admit my first thought was the same as AK... the same partner for four years? What are the odds of that happening?

This is a pretty cool story, though. I'd be interested to hear what happens after he wakes up... will he remember what happened? Does he know that you're the same guys from the last time it happened? Does he know you've been partners for four years? What does he think the odds of that are?

[Chief1C]

Probably ten years ago, we transported (the patient) roughly twice a week for two or three years. Emergency, 9-1-1, transports. I had some of my most gut wrenching calls with (the patient). (the patient) had a form of cancer that ate through (the patients) abdominal wall, so that it was open clean to (the patients) stomach. It was utterly revolting. We removed a rear window on one such trip, just to get air flow. (the patient) was a brave man, and a decorated veteran. We resuscitated (the patient) from cardiopulmonary arrest, probably six or eight times, after (the patient) would OD (the patient) would call 911. (the patient) really wanted out, but would tell us (the patient) didn't want to die. I've never, in my life, seen someone bounce back after so many "near" fatal suicide attempts. Finally, the Cancer got (the patient). But I was always alone, the first time, I figured that was that. I started CPR, the driver pulled over and came back to put the AED on, then we took off again. One shock, and (the patient) was back, needed some breathing help, but had a pulse. That happened like that every time, sometimes ALS would do the shocking, sometimes us. The last time, (the patient) never woke up, and lived on a machine till even that wasn't enough.

And now.. I'm gonna cry, b/c 1. I had a really bad week, and 2. I'm uber depressed. But C. I'm not gonna check out early, so...

Never even got a pin. Damnit. Everyone else saves ppl who don't try to take their life, and I always save ppl who tried to. It's like an oman. I still want a damn pin.

[Dustdevil]

I have to admit my first thought was the same as AK... the same partner for four years? What are the odds of that happening?

Even less likely than having the same employer for four years!

[Richard B the EMT]

Even less likely than having the same employer for four years!

Lemme see: NYC Health and Hospitals Corporation EMS from 1985 to 1996, that was 11 years, then the merger, and FDNY EMS Command from 1996 to 2010, that was 14 years. Leave us not forget Peninsula Volunteer Ambulance Corps from 1973 to 1996, which was 23 years...

[Dustdevil]

Lemme see: NYC Health and Hospitals Corporation EMS from 1985 to 1996, that was 11 years, then the merger, and FDNY EMS Command from 1996 to 2010, that was 14 years. Leave us not forget Peninsula Volunteer Ambulance Corps from 1973 to 1996, which was 23 years...

I was talking specifically about America.