The new guy

We recently released new meat into the streets of the City, cleanly pressed uniforms and anxious to get some 911 action under their belts. Maybe they can start off with a low speed MVA or Erma on another of her Doctor's ideas of preventative care: An ambulance to St Farthest. No, Mr Black Cloud brings a full code, with some complications.

THE EMERGENCY

A man has reported difficulty breathing.

THE ACTION

This is a run from the busy house I spoke of on twitter. Both units assigned to this house are in the top 10 busiest in the nation, one of them top 3. When the Medic van used to be there, they were top 10 as well. Makes for little sleep, but a lot of blog fodder.

This call, however, was one that shows the importance of advanced intervention and assessment skills, and was only 1 of 2 legitimate emergencies we encountered, the other being a decent kitchen fire I'll share shortly.

But I digress. The new guy.

Into the living room converted to care facility and we meet the BLS engine who beat us in the door by mere seconds. The family states the patient was just talking to them, coughed and fell asleep right before she heard sirens. She states there is no DNR.
Pale, apneic, the faint remnants of life pulsing away at maybe 20 at the tiny carotid.
"Do we move him to the floor?" The BLS team asks.
"No, get a bag on high flow, I want to hear what is in his lungs and get it out, I need that suction unit." And the gears begin to churn as the ALS machine comes to life.

Pt now supine, pads are on and the BVM is making no difference in auscultated lung sounds, but I know what's coming so I instruct the engine EMT to pull the OPA and start suctioning.
"Suction what? OH MY GOD!" His voice raised as the fluid began to spill out of our patient's mouth and into the awaiting suction tip.
"When did you feed him last?" I asked the family, noting the J tube in place.
"We gave him his bottle and medicines maybe 5 minutes before we called you."

He was backed up. In the seated position, the fluid likely backed up his esophogus and began to trickle into his trachea and lungs, slowly drowning him.

"Now to the floor," I instruct and the airway is now clear and we can get to work. A reassessment shows the faint rate of 20 is now slowing to 10 and below when I instruct them to start CPR. These guys paid attention in the refresher and it showed. The 7.5 ETT passed easily after a bit more suctioning of the orange juice colored, milk consistency liquid and we were getting a decent capnography wave as the ambulance arrived.

The new EMT had just recently hit the "Available" button in his new ambulance when this job came in. First day, first bell. Lucky him.

Into the room, you can tell this is his first field code as he's not sure where to stand or where to go. Then his training kicks in. "Next CPR cycle, I'll step in. Do we need anything from outside until then?" Nice.

We're into the second round of the AHA's bible when I pull out the narcan. You never know. His list of medications was as long as my...well...it was long.

As I announced it was going in so the other medic could keep track and think of anything else to try, the new EMT, now on the BVM stopped, opened the patient's eyes and said, "But his pupils are fixed and dialated!" I grinned.

In the end our patient had a ticket wherever he was headed before we arrived, but helped the new guy get over the first day jitters.