1st code

So, as the title implies, I had my first code the other night. It went as I expected and as any other cardiac arrest ever went, badly. It came out as shortness of breath, en route we were informed that CPR was in progress. So, I drove slightly more like a maniac and tried not to over think what I wanted to do first. When we arrived the FD was doing CPR, bagging, and said that their AED was showing no shock advised. Already the patients chances were slim. What made them more slim was that the halls of the apartment we were in were lined with bookshelves and we had to literally drag the patient out before we could even put him on a backboard. Once we got him in the ambo, I asked my partner to got for a line, and I plugged the pads into our monitor. Asystole as predicted. As I set up for the tube I was pleased to see that I didn't falter even though it had been quite some time since I had intubated even a fake person. I tried twice, feeling successful both times, but my first bag dangerously inflated the patients stomach. Ew. This added to the already significant amount of vomit everywhere, as it nearly sprayed out of my botched tube attempt. So, going down the advanced airway algorithm, I turned to the combitube. This is a marginally clever dual lumen tube, that instead of going in the trachea, most likely goes in the esophagus and then occludes it, forcing most of the air you bag in into the lungs, more or less. I literally couldn't mess this up, thus we had an, albeit crappy, airway.

Meanwhile my partner had been equally successful with a line, but had put the EKG electrodes on, confirming asystole even further. At this point, I just had her start driving, as there wasn't much to do without a line or proper airway. On the way I tried pacing the patient, without success, and gave the shortest most informative patch in my career. "En route with priority 1 patient, cardiac arrest, asystole, combitube airway, no IV access, we'll be there in 2 min."

When we arrived, I gave my short report, as we didn't know much, and hadn't really done much either. The doc tried to give me crap about not doing anything, like putting meds down the tube. If he had been more insistent that I was wrong, I might have found it worth explaining that we don't give drugs down a combitube, and without IV access, my hands were tied. Instead I just left the room feeling a mix of emotions that I didn’t expect. It’s pretty good practice not to get too emotionally attached to patients. But I didn’t feel like that, I felt more well, hideously disappointed about my lack of successful tube. But I guess I at least got some semblance of an airway. I reminded myself that that was my first tube attempt (on a non cadaver) ever. I still felt guilty. I think the other overriding feeling was, as much as I hate to say it, disgust. I don’t do well with certain bodily fluids, but I congratulated myself on not losing it, and doing a pretty good job ignoring it. The images are still in my head, and I felt the need to change my clothes, even though I managed not to get anything on me.

So, we took the time to clean up, which took a while, thanked the fire fighters on scene, and I carefully wrote my report, another call logged.