The call goes out as "trouble breathing" and I see on the printout that the patient has a stoma. That's a hole in their neck to breathe through. It's, basically, a permanent tracheotomy.
We hurtle around corners to the house. Run to the door. The wife is walking circles around the kitchen table.
"In there. Oh my god! Oh my God!" Her helplessness is expressed in her flapping arms and manic look.
Through the hall to the den. I see a man, 60-ish, in a chair. His chin is on his chest. I can't see his breathing hole in his neck. Also: He "looks like Sh*t," which, most people in EMS will tell you, means he's in trouble. Sometimes you can tell right away.
I'm at his side. I tilt his head back. Flaccid muscles. I check his pulse. Flat.
"No pulse. Let's go!"
Furniture is flying! We make room to work. (Have you ever THROWN a recliner? Wow!) We slide him from his chair to the floor and start right away.
"Um, Mask?"
He's got a hole in his neck. There's no use in ventilating him with a mask that covers his mouth!
Like Obi-Wan Kenobi's voice to Luke, during the trench run, a voice comes to me, "In the event you encounter a patient with a stoma, Use a pediatric mask over the stoma hole and invert the longitudinal orientation..." (Can you tell I was trained in the military?).
Pediatric mask is attached but we can't get a seal! Crap!
"Tick, tick, tick, tick, tick!" That's already going through my head. How long has he been down? How long has he been without oxygen? Why didn't his wife tilt his fu**ing head back?!
We can't get a seal with the mask and I improvise by putting the bag-valve mask (BVM) connector, directly into his stoma.
We get a little bit of air into his lungs. (I'm listening with a stethoscope), but most of it goes into his stomach. His belly's getting more and more distended and he's becoming a bright shade of purple.
"Crichoid pressure!" Says I!
"What?"
"Push here!" I show where to push on the windpipe to close off the esophagus (on the Crichoid cartilage) and allow the air into the lungs.
A little better but the pressure in his stomach is restricting lung movement.
Dammit! Dammit! Dammit!
We're pumping and blowing (CPR) as best we can as we transfer him to our ambulance. The 'Medics arrive and pile into the back of "the Bus."
Intubation! A tube down the throat and he's suddenly pink again. It's amazing what you can do when you can get an air "pipe" directly to the lungs.
IV! A direct line into a vein to carry drugs to he heart will work wonders when you need to "restart a ticker."
Than we go into Transcutaneous Pacing. This is where an electrical shock is delivered via electrodes attached to the skin (transcutaneous) on a regular basis to coincide with a desirable heart rhythm(pacing).
Meanwhile, we're still bagging the patient (using a breathing bag to push air into his lungs).
"Check for a pulse." says the 'Medic.
"No pulse. Radial or carotid." Says I.
"Ok! Let's see what he does now!" The 'Medic increases the energy output of the pacer.
"Check for pulse." A bit later
"I have a pulse!" says I.
"No Sh*t?" says the 'Medic.
Not only that but his blood pressure has returned to 122/82. Without chest compressions!
"Right on!" says the 'Medic.
We continue ventilations until the patient begins to breathe on his own.
We transfer a patient, to the hospital, who has a spontaneous pulse and is breathing without assistance.
For weeks afterwards, the name "Lazarus" keeps coming into my head.
I did my job as a BLS provider. I fed oxygenated blood to the brain. Did that help the patient? Is he alive because of me? Did I see this patient for what he was and act in enough time to save his life?
I don't know. So much of what we did seemed to be ineffective. The more dramatic results did not manifest until the paramedics arrived. But still. Did I, somehow, make that possible?
Since then, I have found myself checking everyone's pulse who's close to me. On the subway, I'm watching everyone breathe. Those are the important things. ABC's, Airway, Breathing and Circulation.
It's reassuring to see it.
Lazarus.
--maddog
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