I hope everyone had a wonderful Easter weekend, it’s the first time in a looong time that I’ve missed an Easter Sunday service. I love sunrise service! Instead, I had a very busy, very stressful weekend at work. (Fri, Sat and Sun night) I was in the “slowest” zone of our rotation Saturday night and ended up having a Cardiac Arrest first thing Easter Sunday morning. Mad props to my partner and to the FD already on scene doing CPR. This is only the second cardiac arrest I’ve “run” officially, the rest of them there was always another paramedic on scene who got there first. And, very apropos for Easter, this was the first Cardiac Arrest I’ve ever been a part of where we got a pulse back. Oy.
Let me explain a little something about working a cardiac arrest. You know on TV, besides the LOUSY rendition of CPR (you don’t bend your elbows to do chest compressios), everyone is all busy and shouting orders and looking important with their scrubs and white coats and snarky terse comments. A real cardic arrest can be frustratingly boring and a lot of physically hard work. CPR, done correctly, is no joke. Try doing CPR for two minutes, take a 20 second break, and repeat. Now imagine you’re trying to do it while wheeling a stretcher down a hallway, now try while going 90mph in the back of an ambulance down the interstate, now down country roads, now wheeling the stretcher into the hospital. Imagine doing this for 40 minutes. Let me tell you something, you’re arms will give out, your legs will give out, and tomorrow your abs will feel like someone repeatedly punched you in the gut. Cardiac Arrests are dang hard work and I truly thank God that the Fire Department has a bunch of adreniline junkie guys who will do CPR till they drop.
Only one person can do CPR at a time, however, so this is how Cardiac Arrests work from my perspective. Game plan, I handle drugs, my partner does airway. We get on scene, FD is already doing CPR and have airway managed. The first 2-3minutes of a cardiac arrest is where it is pure chaos. The AED pads needs to be switched over to our monitor and the four leads put on, airway assessed and additional airway management done if necessary, plus capnography and rescue pod need to be added to the BVM, an IV needs to be established-if no IV get the bone drill and ZZZZZZZZZttt! IO them (bone needle through the tibia under the knee). All this needs to happen pretty much at the same time. The rhythm needs to be assessed once a 2 min cycle of CPR is done and then the first drug needs to be given. After that, you stand around….2 minutes of CPR….rhythm check! YAY get to shock and/or push another drug! Flush w/NS aaaand back to waiting…..2 minutes….oh goodie finally another rhythm check!… as a paramedic, I feel absolutely useless during those 2 minute waits and two minutes seem like an awful long time. Your adreniline is on overload, too, especially after those first few hectic minutes. I’m still fairly new at this, so I haven’t perfected the calm, almost bored look some medics have acquired while working a code, I am pretty fidgety. I get the next drug I think I’ll need to use prepped and make sure I have all the alternatives within reach, I’ll check lung sounds to make sure my airway guy is doing ok, I’ll get a bag of fluid hanging, I’ll…sit…and…try to ….find someting….BAH! It’s really annoying.
To make matters worse-from that perspective- but better for the patient- is when they regain a pulse. Oof. So we get a Blood Pressure, keep double checking the pulse, push Sodium BiCarb ready, cover pt with a blanket… H’s and T’s…Pt loses a pulse? Restart CPR. Push Epi after rhythm check, another cycle CPR, another drug, another cycle CPR… Pulse again?! Fudge. Now I REALLY feel useless. Another BP done, monitor the airway (again)….theres not much else for me to do. If an antiarrhythmic was used I can hang a drip…keep checking airway…pulse…BP…rhythm…tidy the ambulance…remember to breathe…
So the cardiac arrest was my Easter morning wake up.
I’ll leave you with two of my new favorite “Chief Complaints” from pts showing up at the ED.
“I cut my mouth on a taco and it hurts.”
“I’m cold, hold me.”
Hope everyone had a glorious Easter celebrating the glory of our risen Saviour and our subsequent salvation and freedom in Christ!