Last week of day shifts

Recently finished my day shifts with my first Preceptor Brittany. The last week with her we had some good calls. We had another cardiac arrest and a GSW (Gun shot wound) to the chest. The cardiac arrest was another 450 + lbs. person, and she went down in her bathroom. I don’t know why, but it always seems like extremely obese people live in really tight quarters and have lots of stuff through out their house. The doorway into the bathroom was the size of a coat closet door. (That’s like 2/3 the size of a regular door!) It is not uncommon for the Fire Department to beat us to the scene, and for some reason they decided to start working the lady right there in the bathroom!

Now, I will give a little EMS perspective here. When we arrive on scene of a known cardiac arrest or Full arrest (No breathing & No pulse/heart beat) we want to move the patient to an open area so that we have the space to work and move about the patient. This may seem a little rough, or rash, but it is for the patient’s best interest. Another thing that has to be taken into consideration is that the first EMS crew on scene may not have the man power to actually carry the patient and so that patient may be pulled, pushed, rolled, etc. to get them in an open area. It’s not a pretty site, but what part of EMS is pretty?

So, back to the cardiac arrest call. The Firemen decided to start working her in the is small bathroom, which her head was right against the edge of the tub so any attempt at placing an airway (like an ET tube or King airway) was going to be extremely difficult. In fact, there was a Fireman in the bathtub reaching over the side attempting to place an airway. Now, I would’ve loved to make an attempt taking care of the airway, but that would have been a huge circus act trying to climb into the tub with the Fireman and take over bagging the patient while he would have to climb over me to get out, so I just left the airway to him. I instead, placed an IO (a needle drilled into the bone) in the patient’s right leg and started pushing meds. It was my 3^rd successful IO. We also ran out of the 1/10,000 concentration of Epinephrine, so I had to mix 1/1,000 into Normal Saline to make the 1/10,000 concentration. We ended up giving Epi (Epinephrine) 11 times! We never resuscitated the patient and I believe the ER pronounced her dead a few minutes after we transferred care to them.

The GSW call started out with Dispatch telling us that shots had been fired within the residence. As we are driving to the call, dispatch says, “PD is on scene and says the scene is safe to enter.” As we arrive, the Fire Department is also scene and as we walk into the residence the patient is laying on the floor, no treatment of any sort has been initiated. The woman was on her hands and knees and would not work with us whatsoever, so that we could examine her wounds, but we could tell that there was an entry and exit wound. She had shot herself clean through the right side of her chest; the exit wound was proximal to the scapula. We quickly got her onto the cot and loaded her into the ambulance. This woman would not work with us at all. I was lucky to get an IV. She kept rolling around and finally my preceptor just decided to let her lay/kneel however she wanted. We had prepared to dart her chest because her lung had collapsed, but she would not hold still and we had a short transport time to the hospital.

            When we arrived at OU’s Trauma Center, their trauma team was ready to go. I stuck around and watched them insert a chest tube into the side of her chest to drain the blood and fluid from her thoracic cavity. Watching them place the chest tube made me feel sorry for the lady. It was obvious that the patient had an extensive history of drug abuse. As we were transporting her to the hospital she kept saying that she was sorry for shooting herself and that she knew she had made a mistake. (Uh, Yeah! That would be a huge mistake!) I don’t know if I mentioned that she had used a .22 caliber pistol. I think she just wanted some attention, but then again, maybe she was sincere in her attempt to end her life. Hopefully, she won’t ever make the same mistake again.