DOA and a Bad Shot

I worked in the ER this weekend in a very busy ER department and I must say it was the best experience I have had yet. I ran IV's, drew blood, performed several EMT skills, many of which I have never done before except on a doll, and even saw something those working in the field have never and may never see!

1500-0300 was my 12 hour shift.

1645- Paramedics called the ER telling us to be ready. They were bringing in a cardiac arrest. Total down time so far was 35 minutes. He was dead. They brought him in the trauma room which was filled with doctors, nurses, a paramedic on staff and myself. I was first to perform compressions on the man. His eyes where open, he was intubated, his clothes completely removed.

The man was a referee during a football game and just dropped. Bystanders began CPR and hooked up an AED, the AED continuously told them "No shock advised." He was in asystole (flatline)  from the get go. He was DOA . As soon as he was placed on the bed in front of me I felt his arms, they were already cold. We worked him for what felt like hours performing CPR and pushing epi and atropine. Nothing worked. The doctor observing our life saving efforts said "Please stop CPR....Alright.....we will call it....4:45."

The man was a large man, which made compressions difficult,  but during our efforts we were getting some perfusion but there was no use, he was gone. With each compression I could hear him gurgling and had to remind myself a few times he was not coming alive again and gurgling but my compressions were creating the gurgling from the fluid accumulating in his airway now.

Later that night we discovered through his family he is a donor. His organs could don't be harvested due to the lack of perfusion during his down time but his corneas were eligible for donation. (This is the part I mentioned earlier that some in the field have never seen and may never see.) I watched a man from a donor bank remove this man's corneas. It was amazing how they do it and it was fascinating to see the parts of a human eye as I did. Once the corneas were removed I held them up to the light and it was an eerie feeling knowing I was seeing through this once alive man's eyes.

1752- A supposed security guard was brought to us in the ER by paramedics because he had been shot in the face. The GSW was just under his left eye and he had about a 2 inch long gash along with an exit wound. His zygomatic bone was obliterated, which was clearly observed during CT scan. Three Police officers accompanied him and kept watch over him for the several hours he was there in our care. He was conscious and vitals were stable. The bullet had barely missed his left eye. He had no vision problems what so ever...lucky man.

So what happen? No one really knows but him. He claims he and his partner were sitting in a vehicle. He was the passenger. His partner was cleaning his gun, no cleaning equipment was found in the vehicle, and the gun accidently discharged shooting him in the face. Hmmm things did not add up based on the path the bullet traveled through the man's face. He later changed his story saying he was in the driver’s seat which still didn't make sense. He stuck to his story last I had heard.

We also had a female prisoner who had second and third degree partial thickness burns from a boiling water pot being hurled at her back thanks to another inmate. The rest of the night was fairly calm, one drunk who punched a wall fracturing her hand, we splinted a few other bones, had a few chest pains, a headache, a mentally ill patient and a few other minor complaint patient’s. I finished my shift smoothly.

That was my night in the ER. 

County Paramedic Service Ride Along Experience

Shift is 1800-0600 (06:00P – 06:00A) I’m riding with Matt Kerger* and Dave Phillips* One EMT and one paramedic. They show me around, we go through the ambulance showing me where everything is. I tell them both just how nervous I am and I just don’t want to get in their way on calls. Matt tells me “You’ll be fine and I promise you, you won’t be in our way.” Dave says “For sure! Don’t be afraid to get involved. Hopefully we’ll have some good calls for you.” The three of us are waiting for our first call of the night as we kick back watching “Two and a Half Men” and I of course brought my homework and 1000 pound EMT book to get some studying in during our down time. 

2130 (09:30P) 3 ½ hours pass, Matt has his feet up in the recliner now watching the news while Dave catches some Zzzzz’s in his recliner. The tones sound…”Time to go” they say to me. I throw my stuff in my back pack and we load in the ambulance. Dispatch: “80 year old female at **** nursing home with epistaxis (bloody nose). We arrive at the nursing home to find a kind woman who has been having trouble with constant bloody noses, slight confusion and minor nausea (blood running down the back of the throat into the stomach = upset tummy) Code out was emergent and code back was routine. Transferred care to the hospital.

           

0100 (01:00A) Dispatch: “32 year old female has drank an 8 oz bottle of hairspray. PD on scene, please stand by.” We run emergent to our destination, a farm house about 10 minutes away on the outskirts of the town south of us. We pull up behind a fire truck about a mile down the road from the house, We’re waiting for a “Code 4” from PD which tells us the scene is safe for us to enter. Code 4 is required being as this Pt is mentally unstable and this may have been a suicide attempt. 

PD “Code 4” We move in to a nice farm house and are directed upstairs. We find our Pt sitting on her bed, legs up to her chest, she is tearful. Her small bedroom full of fire fighters, sheriffs, police officers all staring down at her and now us. 

Matt approaches her questioning her in a calm and understanding voice, I stand back observing. She is refusing treatment; little does she know she gave up this right due to  her unstable state of mind. The Sheriff informs her she either goes with us in the ambulance or she goes with him. She chose us. 

We help her to the ambulance. She is crying hysterically and is explaining to us that her mother, whom she lives with, calls her fat and is constantly ridiculing her, yet she is thin and obviously of a fairly healthy weight. Her father is out of the picture and she is also on antidepressants. Matt asks “So why did you drink the hairspray?” She is an alcoholic and it may have just been to get some alcohol however, she is a regular pick up for paramedics and is known by name….she is constantly seen for overdoses and possible suicide attempts, although she continually denies trying to commit suicide.

0300 (03:00A) Dispatch: “PD requesting paramedics at **** Apartments for Pt involved in an altercation and now displaying an altered level of consciousness.” We arrive in a fairly rough side of town at some run down apartments on 11^th Avenue which are also connected to a bar. We walk through the dim lit hallway to find a middle age man arguing with a police officer saying “I was protecting myself and my girlfriend!” The girlfriend standing there obviously frightened and had urinated her pants. The man is bloody on his face and without a shirt, he refused treatment and we moved on down the hall.

We turn the corner to find several police officers in this tiny cramped hallway telling other apartment tenants to stay in their apartments. Two men are in cuffs surrounded by police and one man appears to be unconscious on the floor lying in right lateral recumbent position, he’s the patient. All three men are somalian men who had been harassing the girlfriend, her boyfriend stepped in trying to protect her and long story short…the boyfriend kicked the other three men’s asses. 

I was somewhat scared despite the fact there were more police there than anyone else so I stood back observing, again. Matt, Dave, fire fighters and other police officers placed the Pt on the back board, the Pt was extremely combative and it took fire fighters lying on top of him to strap him in. The Pt is now screaming obviously not unconscious. 

We take him to the ambulance and he suddenly stops screaming, stops moving and closes his eyes. Dave hooks him to the ECG monitor and we see his heart rate suddenly plummeted to 30. An IV was started and Narcan was slowly pushed. Now that the Pt, who has been picked up before by paramedics and is reported to be a spitter, is now passed out I volunteer to take his BP, I am unable to hear it. Only a few minutes pass and the Pt is suddenly awake again and seems to be in stable condition. We arrive at the hospital. The back opens, other paramedics hop on the ambulance and begin making fun of the man for his poor dental hygiene. I am taken back by the amount of unprofessionalism I am witnessing as an EMT student, as a human being.

I loved riding on the ambulance, Matt and Dave were awesome. I do wish however that I wouldn’t have been so scared to touch the Pt’s. Dave told me I did a great job but hopes I get more involved next time. Moral of the story…don’t be afraid to act. Your preceptors, fire fighters and police officers will appreciate your confidence in yourself and they will appreciate the fact that you TRIED, even if you mess up they acknowledge the fact that you tried.

*Names have been changed