Every now and then I marvel at how far EMS has come, I did three calls on Sunday that had they happened fifteen years ago would have gone quite differently.
The first was a CHFer. Obese woman, filled up with rales, felt like she was suffocating with the nonrebreather on her. I strapped on the CPAP and in no time, she had pinked up and was breathing easier. No need for intubation, no struggle hoping the nitro and lasix would work before she crashed, just sit back and enjoy a nice ride into the hospital with a now stable patient.
The second was a cardiac arrest in a nursing home, Man found in a chair not breathing. I arrived to find CPR in progress and a mouth full of fluid. It was like staring into a submerged cave with just a tiny air pocket at the top. I was able to lift up enough to see the chords. I slid the tube in and the capnography confirmed a good intubation. The high initial reading – 95 – suggested a respiratory cause of the arrest. After ventilating off the excess C02, she went down to the 20’s with CPR, but then after some epi and some of the new CPR, she jumped again to the 60’s — a sign of ROSC. When the epi wore off, the ETC02 went back to the 20’s and we started CPR again. We got her back a couple times, but would lose her as the epi wore off. We ended up transporting and they worked her briefly at the hospital before calling her. Had I used the EZ-IO which I have used on my last three codes, I could boast of that change, but she had too big of an AC for me to ignore the standard peripheral IV. To date I have used the EZ-IO on eight codes, including on three one legged diabetic dialysis patients with no visible IV access.
Had this call occurred 15 years ago, I would have sweated the tube with all the rough jostling (I did have to pull it back one time when a nurse’s aide was a little rough with the bagging. At the time there was only me, my partner and two nurse’s aides, who for the most part, once coached, did quite well). I think also had this call happened 15 years ago, we would have never gotten ROSC even briefly because the old CPR wasn’t quite up to snuff.
One bad thing about the last fifteen years is the prevalence of MRSA. This man had it in his sputum and since there was so much secretions from this call, we(my partner doing the bulk of it) had to spend quite a bit of time cleaning up everything (while I spent the bulk of my time typing in the electronic run form, which while I am getting better at still takes a fairly long time, particularly entering all the cardiac drugs in the their proper times. I mentioned there was only my partner and I. Normally we have at least a police officer to back us up, but when one hadn’t arrived, we called dispatch, only to be told he was on scene. It turns out because the room — a rare single (used probably due to the respiratory MRSA) was very tight — she chose to wait in the hall. Or maybe it was because despite the mask, gloves and yellow gown she had donned, she didn’t want any part of the patient requiring “universal precautions.”
The last call was a woman with degenerative arthritis and severe back problems who was in ten of ten pain had been throwing up her dilaudid. We were able to medicate her and give her a peaceful pain-free ride into the hospital for which we got warm thanks and appreciations from the patient and family.
I have tried to rank the new innovations, but I can’t. They are like my children — I love them all the same. So instead of ranking, I give you my Hall of Fame (in alphabetical order).
Electronic Run Forms (a pain to do, but my run forms are now legible and the combined collected data will no doubt be fascinating and add to research gains)
Liberalized Pain Management Guidelines
Wave Form Capnography
Hall of Shame