The Chicken or the Egg
Oh, what a strange career I've chosen when a 'good day' includes people dying. I will reiterate that it is not that I want people to become sick or injured, but if they are to get sick or injured, I am happy when it happens on my shift.
Our call came out as a fall, which could mean absolutely anything. Further information was they it was down 5 steps, but they weren't sure he was breathing. Hmm, that's certainly when the call took an interesting turn.
We got on scene and a guy ran up to me, shouted, "You've got to hurry!" and ran back into the house. I followed him to the head of the basement stairs. At the bottom of them, was a guy on his back in a pool of blood that was more or less pouring out of his nose, as his wife was doing CPR. Initial thought: "Oh, shit." I head down with my partner right behind me. The wife stood up, said 'Thank God' and ran up the stairs never to be seen again. So we didn't really know the story, but the conclusion was the same.
I put him on the monitor and he was in asystole. I shouted up to one of the EMTs that we needed someone to do CPR, and another to hold c-spine. Of course these calls always happen at the bottom of basement stairs in a three foot wide hallway. We got him CPR'd and bagged and two lines and several rounds of drugs in. An advanced airway would have to wait. I have never suctioned so much blood out of an airway and with every breath we gave him, blood was splattering everywhere. I backboarded him and the FD arrived to help us get him out.
In the ambulance, my only objective was to get a good airway in. With surprising deftness (given how long it's been since I've attempted a real tube) I readied my supplies and peered into the airway with my Mac 4. There was so much blood in his airway it was unbelieveable. I initially thought "What the hell is going on in here?!" but after a lot of suctioning, the most amazing thing happened. I realized that I was looking into his trachea and passed the tube with ease. I inflated the bulb, removed the stylet, attached the BVM, and with bated breath, I squeezed the bag. CHEST RISE! My partner checked for breath sounds, and declared that I was in, woot!! The CO2 was 35, and I took a time out for a happy dance. It was an atraumatic ride to the hospital. I did some deep suctioning, and got copious amounts of blood that seemed to have no end.
They worked him for a little longer in the ER. By then he had racoon eyes that could indicate a skull fracture, and was still in asystole. The question remained unanswered as to if he had cardiac arrest, then fell down the stairs, or if he fell down the stairs and suffered an injury that caused him to go into cardiac arrest.
Either way the outcome was unfortunately the same, but still my first tube success. It is good to subscribe to the theory that this event would have happened whether I had been there or not. Someone would have intubated him, but I'm glad it was me.
Our call came out as a fall, which could mean absolutely anything. Further information was they it was down 5 steps, but they weren't sure he was breathing. Hmm, that's certainly when the call took an interesting turn.
We got on scene and a guy ran up to me, shouted, "You've got to hurry!" and ran back into the house. I followed him to the head of the basement stairs. At the bottom of them, was a guy on his back in a pool of blood that was more or less pouring out of his nose, as his wife was doing CPR. Initial thought: "Oh, shit." I head down with my partner right behind me. The wife stood up, said 'Thank God' and ran up the stairs never to be seen again. So we didn't really know the story, but the conclusion was the same.
I put him on the monitor and he was in asystole. I shouted up to one of the EMTs that we needed someone to do CPR, and another to hold c-spine. Of course these calls always happen at the bottom of basement stairs in a three foot wide hallway. We got him CPR'd and bagged and two lines and several rounds of drugs in. An advanced airway would have to wait. I have never suctioned so much blood out of an airway and with every breath we gave him, blood was splattering everywhere. I backboarded him and the FD arrived to help us get him out.
In the ambulance, my only objective was to get a good airway in. With surprising deftness (given how long it's been since I've attempted a real tube) I readied my supplies and peered into the airway with my Mac 4. There was so much blood in his airway it was unbelieveable. I initially thought "What the hell is going on in here?!" but after a lot of suctioning, the most amazing thing happened. I realized that I was looking into his trachea and passed the tube with ease. I inflated the bulb, removed the stylet, attached the BVM, and with bated breath, I squeezed the bag. CHEST RISE! My partner checked for breath sounds, and declared that I was in, woot!! The CO2 was 35, and I took a time out for a happy dance. It was an atraumatic ride to the hospital. I did some deep suctioning, and got copious amounts of blood that seemed to have no end.
They worked him for a little longer in the ER. By then he had racoon eyes that could indicate a skull fracture, and was still in asystole. The question remained unanswered as to if he had cardiac arrest, then fell down the stairs, or if he fell down the stairs and suffered an injury that caused him to go into cardiac arrest.
Either way the outcome was unfortunately the same, but still my first tube success. It is good to subscribe to the theory that this event would have happened whether I had been there or not. Someone would have intubated him, but I'm glad it was me.
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