Well, yes, I told you "More to Come" and here it is!
We get called to a townhouse for one having trouble breathing. Dispatch has done a great job of getting information and we know that, even though she's 42 years old, she's already had a heart attack, suffered from congestive heart failure (CHF), and has an extensive history with a LOT of drugs.
In the door & up one flight of carpeted stairs.
This place smells horrible.
There are a lot of concerned people standing around who, I assume, are family.
Another flight of stairs. (Why is this so common!???)
Into the bedroom where she's lived for the past couple years (we can tell that walking in).
She's on a big recliner. She's got all the signs of a lifetime of being unkind to her heart. I see all this and I see her chin on her chest (not natural). Right away, I can see that "trouble breathing" is now "NO breathing!"
ZIP! I slide in and check a pulse while moving her head up to open her airway.
"I got nuthin!"
This galvanizes the other two medics I'm working with. Mind you, this is my second shift with them. The last one was exciting as well.
It's game time!
CC-Rider and I quickly move our patient from the recliner to the floor. MedicToMyRight (who, strangely enough, is again to my right) dives in to help. We also have some well-meaning, enthusiastic volunteer firefighters too.
The room is suddenly crowded.
As my patient's head is wedged between the recliner and the wall, I can't immediately get a quick assessment of her airway other than getting a basic airway (OPA, or OroPharengyalAirway) in her mouth.
I roll it in and she doesn't gag. This means that the airway is "tolerated." This also means that the patient is in a bad way. The control of the gag reflex comes off the brain directly and if there is no gag reflex, that can be pretty bad.
At this point, Volunteer Firefigthers are "bagging" (pushing oxygen via a special bag) into this woman. There's a lot of gurgling. We're having a tough time getting air into her lungs versus her stomach. (Can't breath through your stomach so, that's bad.)
I check again for a pulse and find none. I start chest compressions. All my paramedic training and the most important thing I can do for this woman (Really!!!) is something I learned about 12 years ago (CPR!).
Now, let me take a moment to tell you about OPAs. They are merely a piece of plastic curved in a way to keep your tongue from falling back in your throat. The more modern ones are very much like a curve plastic stick that does the job while allowing air to move around it. The older ones, however, are more like curved TUBES that, essentially do the same thing but are a pipe going into the back of the throat.
Neither one, however, does a dang thing to keep air from going into the stomach, versus the lungs. (two pipes down there, remember!)
The OPA that I grabbed from the bag was the old style. As I started to slam down on her chest with all my might, the pressure of the air in her stomach, combined with the full meal she just ate contrived to make a geyser.
Each time I pumped on her chest, we got a bit of vomit shooting 12 to 18 inches up in the air.
The Vomit Comet rides again!!!!
It's at this point that CC-Rider and MedicToMyRight look at me. They shake their heads. Last shift we had a code and this is looking to be the same way.
Down 2 flights of narrow stairs, through the living room and into the medic unit we go.
We intubate, hook her up to a monitor and give her a TON of ACLS drugs.
All the while we're being driven by a volunteer firefighter who's wearing a full stetson hat, a torn t-shirt and his bunker pants.
He hits every bump and curve at 65MPH.
We all get puked on as we bounce around the back of the ambulance like ping-pong balls in a tornado.
...and he gets lost on his way to the hospital.
Basically, he exemplifies every un-professional characteristic of our volunteer service (keep in mind that I'm a volunteer and riding as one during this call).
What a donkey!!!!
After the call, as we're cleaning up, I pull him aside.
"Hey, man, Howareya?"
"..Um...Ok"
"Great..thanks..listen,...can I ask you a favor????"
"...Um...Ok.."
"Yeah,....great...Listen, Um...Don't ever drive a medic unit agin..Ok?"
He's gettign defensive at this point...."What?"
We've walked away, out of earshot of everyone else, by this point. I put both hands on his shoulders.
I look him right in the eye.
With the most firm and benevolent, fatherly look I can put on my face. I say:
"It would be bad."
I keep looking at him.
He's thinking this is some kind of man-fight and gives me a defiant look.
I keep looking at him.
"What?....Welll...Sh**........"
I keep looking at him.
His shoulders hunch and I can feel him getting tense. He tries again to be tough...
I keep looking at him.
"F*** you!"
I keep looking at him.
"F*** it, I hate the ambulance!" He says with a flame in his eye.
Success..
--maddog
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