Four Electrodes

At night I empty my pockets on the dresser. Once a week I clean the dresser top off. Crumpled gloves. ECG strips. Narcotics slips. Med lists scribbled on a notepad. An empty drug or saline vial. Four ECG electrodes stuck together.

The call is for the man who can’t be woken up, cold to the touch.

He’s on the living room floor, lying on his left side, his head resting on his hand in a sort of horizontal Rodin “The Thinker” statue pose, his head being supported by an invisible pillow, his neck rigored. It turns out he was found on the couch, and then was put down on the floor.

The officer tells me no one had seen him since last night when he had complained of chest pains. He was just visiting the house. Actually the truth was his wife had just booted him out of his.

While my partner gets the patient’s name and date of birth from the officer, I lay the monitor by the dead man’s side and unwind the leads. I open up a fresh pack of electrodes and attach them to the leads. I put one on each exposed ankle, one on each wrist. I turn on the machine and stare at three long flat lines. I print out a six second strip. Then on another piece of paper, I write my name, license number and date of birth, along with the time of presumption. The officer will need the information for his report. I shut the monitor off, and then carefully peel the electrodes off. First the right ankle, and then the left. I attach each electrode to the next so at the end I have four electrodes stuck together. I put them in my pocket, and then I roll up the lead wires and put them back in the monitor pouch. On my way out the door, I hand the officer the piece of paper with the presumption information.

The electrodes stay in my pocket all day until I discover them at night when I empty my pockets. A couple days later, I clean the dresser top off and the electrodes go out in the trash.


  • RevMedic says:

    I come home with ECG strips all the time. My wife looks at them and then looks at me strangely. I’ve been thinking about blogging about them, but you beat me to it! I couldn’t think up anything to say anyway.

  • Brendan says:

    Wonder how his wife feels now. Speaking of which, a hell of a lot of people seem to die in your town! lol

  • Anonymous says:

    It’s a decent sized city though, to be fair, with what seems to be a large proportion of the population that don’t get the regular medical care they should.

  • Anonymous says:

    If the pt has obvious rigor why do u need to do a 3 lead

  • PC says:

    Our protocols call for a six second strip of asystole on all paramedic presumptions. I’m not certain why it is required. maybe because every now and then you hear about someone being presumed who turns up alive.As far as people dying in my town, we have an incredibly old population — lots of nursing homes, lots of elderly housing projects, lots of old people living in old houses.

  • Chrysalis Angel says:

    Sad, that the last words to his partner in life may have been angry words. Those of us with love in our lives are blessed.

  • FireResQGuru says:

    I thought I was the only one who emptied the remnants of my shift on the top of the dresser. The other morning my wife looked at me quizically after exiting the bathroom. “Why is there a pair of gloves in the trash can?” Thruth was, they were clean. I had grabbed them on the way into a call, only to realize they were too big, and then stuffed them in my pocket.The other day, I found supplies in the pocket of my jacket. I stuffed them in my pocket to bring outside to the truck, but got side-tracked and forgot to put them back on the truck. So I had to make a quick call to let the crew on the truck that night know they were short a few items, then bring the stuff back the next day.

  • Anonymous says:

    Every presumption makes me worry a little. Well, aside from brutally obvious deaths. Those I’m not concerned about. The ones I fret the most over are blunt trauma deaths. In nightmares, I will presume a body dead only to have them wake up while I’m waiting for the cornoner. They scream at me. Or in my nightmares, I get a call from the ME asking why their patient woke up during autoopsy. Creeps the hell out of me. I always wonder, “Maybe it was a cardiac event? What if this 26 year old had something unusual. Brugadas or something. Maybe they’re alive.” Maybe we should be working it. Maybe they’re viable.Young blunt trauma is difficult. I saw one young person who had no obvious signs of trauma. This was about a month ago. They were a traumatic death, I am certain. But pristene would describe it. Not a mark, scratch, or imperfection. It looked like they were sleeping. Save for the pale greyness creeping across their skin. That kind of look that would get the, “Oh, you look cold! Are you sick? Here’s a blanket.” That’s how they looked. Cold and sick.But my partner always interjects: dead is dead. You don’t fix dead. Blunt trauma, penetrating trauma don’t matter. A traumatic arrest is a traumatic death. Leave it be. Besides, he tells me, even if they’re still alive now, with their injuries, by the time the coroner gets here they’ll be dead. Harsh, but a good partner to keep things grounded. I told my partner about my nightmares. He gets them too.We don’t need the monitor in traumatic deaths per protocol. Listen for a heartbeat, feel a pulse. Have mechanism of trauma? It’s a trauma death. Write it as such on your ticket. Obviously, if there’s a doubt about traumatic vs. medical, you can put the monitor on and run a 3 lead trip. PEA? Well, better work it. They’re going to die, however. It’s best to leave the dead to rest. I am pretty conservative. I use the monitor more than our medical director would like. Inability to recognize a traumatic death is not a sign of competency. I’m sure in time I’ll get more comfy with it.

  • Brendan says:

    Something else I wonder about sometimes- with the increase in calling trauma codes onscene, is EMS going to start contributing to the already short supply of donated organs?

  • Anonymous says:

    Locally its the opposite: we aren’t allowed to use the monitor in making presumptions. Its considered a “BLS decision”, in that based on a BLS assessment you should be able to determine if the patient is beyond care.Accordingly, if you apply the monitor, you’re supposed to be working it.I can see both sides. Personally, I’d rather have the strip confirming asystole.However tho, something to consider: If you had someone cold and stiff, and you put the monitor on and for some reason had vfib, would you work it? Or VF in the presence of injuries incompatible with life? I guess thats the merit of making it a “BLS skills decision”, in that you are treating the patient/corpse not the monitor.

  • Anonymous says:

    Anon’s comment about young blunt force trauma patients brought back a bad one for me.A car had gone over a hump-back bridge at a speed in excess of 120mph. It became airborne, sliced through a utility pole six feet off the ground, and impacted the ground, shattering apart.The driver suffered extreme trauma, including partial decapitation. No problem there for me.The passenger was another matter. He was still strapped into his seat (five-point harness), eyes open, a smile on his face and not a mark on him.Only when you shone a torch directly on his face could you see the greyness around his eyes, on the tips of his ears, and at the point of his chin.A friend who’s an autopsy assistant later told me the passenger had died as a result of the combination of concussive brain injury and the depressant effects of alcohol on the central nervous system. Essentially, the passenger’s five-point harness kept him in place while his brain careered into the front of his skull at 120mph.That was a truly freakin’ incident.

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