First code tonight

[leviathan]

I just went through my first code tonight. I'm a volunteer first responder and do all of the NHL games and concerts at the stadium here in Vancouver, but this was the first time I'd dealt with an arrest.

The call was for a pt. feeling "nauseous" but when I got there he looked very shocky and complained of chest tightness so we called an ALS crew for possible MI. I did everything right, got him on O2, took vitals and got a decent history before ALS arrived. Unfortunately we aren't provided with nitro or aspirin by the stadium.

After ALS arrived they started an IV, his eyes were closed a minute later, and he arrested another minute after that at which point they started defibrillating. His pulse returned only for him to go into vtach again and then return once again for the third time after a round of shocks...at that point they transported.

As I said I know from a treatment perspective I did everything properly, but the only thing I'm really feeling horrible about is that I don't think I was very personal with him or comforting. One thing that sticks out is I forgot to even give my name (not required, but something I like to do)...I feel absolutely horrible that I was the last person this man ever spoke to, and I was a stranger to him and he didn't even know my name

I was always anxious and waiting for a code to happen, but now that I finally experienced one, it was nothing like I expected it to be. I am really shook up and I wish it never happened. I know I'll be OK, and the next time I deal with something like this I will work much harder at comforting the patient...but I just needed to get this off my chest. Thanks for taking the time to read this.

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[12R34Y]

I just went through my first code tonight. I'm a volunteer first responder and do all of the NHL games and concerts at the stadium here in Vancouver, but this was the first time I'd dealt with an arrest.

The call was for a pt. feeling "nauseous" but when I got there he looked very shocky and complained of chest tightness so we called an ALS crew for possible MI. I did everything right, got him on O2, took vitals and got a decent history before ALS arrived. Unfortunately we aren't provided with nitro or aspirin by the stadium.

After ALS arrived they started an IV, his eyes were closed a minute later, and he arrested another minute after that at which point they started defibrillating. His pulse returned only for him to go into vtach again and then return once again for the third time after a round of shocks...at that point they transported.

As I said I know from a treatment perspective I did everything properly, but the only thing I'm really feeling horrible about is that I don't think I was very personal with him or comforting. One thing that sticks out is I forgot to even give my name (not required, but something I like to do)...I feel absolutely horrible that I was the last person this man ever spoke to, and I was a stranger to him and he didn't even know my name

I was always anxious and waiting for a code to happen, but now that I finally experienced one, it was nothing like I expected it to be. I am really shook up and I wish it never happened. I know I'll be OK, and the next time I deal with something like this I will work much harder at comforting the patient...but I just needed to get this off my chest. Thanks for taking the time to read this.

Don't beat yourself up! it sounds like you did a great job. Nobody acts the way they want to or does everything perfect like they imagine in their mind when something ACTUALLY happens. I'm sure you've played out scenarios in your mind, but the real thing just sorta happens and you react.

You've got the first one down and each additional code you work you will get more comfortable and confident in your skills.

keep your chin up and good job!

later

 

[FoughtFyr]

One thing that sticks out is I forgot to even give my name (not required, but something I like to do)...I feel absolutely horrible that I was the last person this man ever spoke to, and I was a stranger to him and he didn't even know my name

I was always anxious and waiting for a code to happen, but now that I finally experienced one, it was nothing like I expected it to be. I am really shook up and I wish it never happened. I know I'll be OK, and the next time I deal with something like this I will work much harder at comforting the patient...but I just needed to get this off my chest. Thanks for taking the time to read this.

Welcome to medicine, the world's most intimate profession. We are there when you are born, and when you die. Within minutes of meeting you we will ask you all of your secrets and place our hands in places only your spouse has touched you before...

It is part and parcel of the profession. 15+ years in the game, and I still tear up after nearly every code. When that stops - it is time to get out.

BTW - he knows your name now and probably thanks you for the spirit of hard work you brought to his care.

Hang in there...

- H

 

[Febrifuge]

Dude, this is all exactly the way it should be. By the by, it's also how I know you are thinking about the job in the right way, and you're the sort of person I'd want taking care of me, if I were the patient.

I think of it like this: every case I see, there may be some little thing I screw up. I try to keep the mistakes minor, and never make the same one twice. If you can do those two things, you can be one of the excellent ones. So don't worry about the name. Like FF says, the connection you make is in the quality of your work, and the humanity behind it.

 

[leviathan]

Don't beat yourself up! it sounds like you did a great job. Nobody acts the way they want to or does everything perfect like they imagine in their mind when something ACTUALLY happens. I'm sure you've played out scenarios in your mind, but the real thing just sorta happens and you react.

You've got the first one down and each additional code you work you will get more comfortable and confident in your skills.

keep your chin up and good job!

later

Thanks for the reply. You're totally right that things never work out how you picture them in your mind...I didn't expect him to arrest so suddenly and it was hard to watch it happen right in front of me. I guess it was good in a way that paramedics arrived before he coded, because I'd probably be in even worse shape if I was the one defibrillating him.

 

[leviathan]

Welcome to medicine, the world's most intimate profession. We are there when you are born, and when you die. Within minutes of meeting you we will ask you all of your secrets and place our hands in places only your spouse has touched you before...

It is part and parcel of the profession. 15+ years in the game, and I still tear up after nearly every code. When that stops - it is time to get out.

BTW - he knows your name now and probably thanks you for the spirit of hard work you brought to his care.

Hang in there...

- H

Hi FF,

I'm happy to hear that you haven't become completely numb. As harrowing an experience as it was, to think that one day I wouldn't have any emotions from someone dying in front of me would be something that I couldn't handle and I never want to lose that emotion. As stressful as it may be to experience, losing it would feel inhuman. It's funny how the little things really get at you...I was pretty calm during the process but then as they were defibrillating him I was holding back tears so my peers didn't see me crack.

It really is an intimate profession, and that's a love/hate thing for me. For me to think that I was basically the very last person this man spoke with in his life of 60 years before he died is very powerful. The fact that he didn't even know my name is what I thought about on the bus ride home, and it was at that point that I did crack and couldn't hold back the tears..

I have to speak to a Critical Incident Stress team but I'm already feeling better after I cried, and after I've spoken to my friends and family. Talking about it on here with you people who understand what I went through has also been really helpful, and I appreciate everyone's responses.

-K

 

[leviathan]

Dude, this is all exactly the way it should be. By the by, it's also how I know you are thinking about the job in the right way, and you're the sort of person I'd want taking care of me, if I were the patient.

I think of it like this: every case I see, there may be some little thing I screw up. I try to keep the mistakes minor, and never make the same one twice. If you can do those two things, you can be one of the excellent ones. So don't worry about the name. Like FF says, the connection you make is in the quality of your work, and the humanity behind it.

Thanks, Feb.

I think the main thing was at the time I obviously had no idea he was going to arrest, or that it would happen that fast. If I knew it was his last moments of his life, I would do everything in my power to make sure he really knew I cared about him and that I wanted to make sure he wasn't dying in the presence of apathetic strangers. I guess the lesson I've learned is to make sure I make an effort to make a connection with every patient. I'll follow your same philosophy and next time I will try to do a much better job at being a friend and less like a technician.

 

[leviathan]

Some good news, I just received a phone call that he survived the arrest and he's doing fine at the hospital. That definitely brightens my day.

 

[a_ditchdoc]

Some good news, I just received a phone call that he survived the arrest and he's doing fine at the hospital. That definitely brightens my day.

Congratulations. Now you can go tell him your name...

 

[leviathan]

Congratulations. Now you can go tell him your name...

In fact I may just get that chance...I didn't mention but he was an employee of the stadium so unless he decides to retire after this, I'll see him at future games and events.

 

[Underachievment]

I thought you were already a paramedic? You mention you are in the EM forum?

 

[Edivocke]

just to add a positive mood to this...

So far in my EMS career (volunteer), I'd started CPR on 4 patients so far with no success (in conjunction with the Lifepak 12).

However, on March 18th, I had my first save.

We arrived on the scene, and the man was already in cardiac arrest. He had taken two expired Nitros, and we were told he had just fallen over.

I started CPR while my partner hooked up the Lifepak 12. We shocked him twice, and he came back. ALS then arrived, and administered Nitrolingual spray and 4 aspirins. We made it to the hospital under 5 mins, and he was fine.



All and all, I hate waiting for ALS...I wish I was ALS...and hopefully I will start training as an EMT-I soon

 

[leviathan]

I thought you were already a paramedic? You mention you are in the EM forum?

No, I said it was my career. In other words, the *direction* I'm following right now on the sidelines. Sorry for the confusion.

 

[12R34Y]

This is very very bizarre. the guy was in full cardiac arrest and then you shocked him and he woke up enough immediately to take nitro and to chew baby aspirin?

I"ve shocked one guy who did wake up after one shock, but is that what you are saying?


We did NOT give him nitro needless to say. just curious?

later

 

[leviathan]

This is very very bizarre. the guy was in full cardiac arrest and then you shocked him and he woke up enough immediately to take nitro and to chew baby aspirin?

I"ve shocked one guy who did wake up after one shock, but is that what you are saying?


We did NOT give him nitro needless to say. just curious?

later

Curiously enough, the guy we resuscitated came around after the second return to NSR, was breathing spontaneously and awake, but then crashed again. I guess it happens.

 

[Underachievment]

No, I said it was my career. In other words, the *direction* I'm following right now on the sidelines. Sorry for the confusion.

I'm sorry. You are not clear. A career is not something you follow on the 'sidelines' as a volunteer at a stadium once in a while.

You aspire to be either a paramedic or a physician. BIG difference.

 

[Underachievment]

This is very very bizarre. the guy was in full cardiac arrest and then you shocked him and he woke up enough immediately to take nitro and to chew baby aspirin?

I"ve shocked one guy who did wake up after one shock, but is that what you are saying?


We did NOT give him nitro needless to say. just curious?

later

Second this, sounds fishy- NTG is the last thing you would give post-defib with a 5 minute transport

 

[fiznat]

I'm sorry. You are not clear. A career is not something you follow on the 'sidelines' as a volunteer at a stadium once in a while.

You aspire to be either a paramedic or a physician. BIG difference.

Dude who cares? Does it really matter in this thread at all?

 

[12R34Y]

I'm sorry. You are not clear. A career is not something you follow on the 'sidelines' as a volunteer at a stadium once in a while.

You aspire to be either a paramedic or a physician. BIG difference.

Gettin' a little riled up aren't we?

He's a regular poster. We all know who he is. Let it go.

later

 

[Underachievment]

Nice to see the closed circuit of EMS is alive and well...

Since when did field medics start becoming overly gushy about contacts? How many partners and preceptees have you told to toughen up?

Sorry, my purpose was to pinch a little and see where he went with it. My advice to Leviathin is to move on, now. Wait until you run a code yourself and things don't go well at all. You may even accidentally kill someone. You will have to pick yourself up and move on to the next call- maybe even a second code. You may very well have the innards- but from my experience and what you specifically wrote above and elsewhere about medical school concerns me- I will tell you what I would tell a preceptee- The only way you will make it to being either a paramedic or an ER physician is to assert yourself and move past exploring your feelings. Longterm volunteering in this field with the stated intent of working it as a career has undertones of being hesitant- if you are serious don't continue dipping your feet in to test the water.

 

[Squad51]

I'm sorry. You are not clear. A career is not something you follow on the 'sidelines' as a volunteer at a stadium once in a while.

You aspire to be either a paramedic or a physician. BIG difference.

Not really, I'm in medical school now. I've worked on an ambulance as a firemedic for the first few years (MD/PhD). I am on a volly squad where two docs serve (1 EM, 1 anesthesia). When I get through residency, I will definately go back to riding the rig. So I aspire to do both!

BTW - many years prior to med school as full time fire/EMS in an urban setting

 

[Underachievment]

Not really, I'm in medical school now. I've worked on an ambulance as a firemedic for the first few years (MD/PhD). I am on a volly squad where two docs serve (1 EM, 1 anesthesia). When I get through residency, I will definately go back to riding the rig. So I aspire to do both!

BTW - many years prior to med school as full time fire/EMS in an urban setting

Cool. I wasn't directing this at you, though.

 

[deleted6669]

Congratulations. Now you can go tell him your name...

and he can do what one of my post code saves in the icu did- ask me" so you're the one who lost my dentures?"
that's gratitude....sorry I was focused on running the code, intubating, starting the line, and defibrilating...should have kept better track of the dentures!

 

[leviathan]

Nice to see the closed circuit of EMS is alive and well...

Since when did field medics start becoming overly gushy about contacts? How many partners and preceptees have you told to toughen up?

Sorry, my purpose was to pinch a little and see where he went with it. My advice to Leviathin is to move on, now. Wait until you run a code yourself and things don't go well at all. You may even accidentally kill someone. You will have to pick yourself up and move on to the next call- maybe even a second code. You may very well have the innards- but from my experience and what you specifically wrote above and elsewhere about medical school concerns me- I will tell you what I would tell a preceptee- The only way you will make it to being either a paramedic or an ER physician is to assert yourself and move past exploring your feelings. Longterm volunteering in this field with the stated intent of working it as a career has undertones of being hesitant- if you are serious don't continue dipping your feet in to test the water.

It sounds like you're letting your personal experiences paint assumptions about me with a brush that doesn't fit with reality. I have absolutely no hesitations at all, and have absolutely no idea how you see my volunteering 30 hours/week now as "hesitation". Of course I would be finishing my paramedic license if I wasn't in school full time, and I fully intend on doing so once I finish with university. I love EMS and plan to work as a paramedic for the rest of my life. The only part I'm unsure of right now is whether this will be my sole career, or if it will be in conjunction with being a physician. In the future, asking me about my intentions rather than wrongly reprimanding me for your incorrect assumptions would be appreciated.

 

[Underachievment]

It sounds like you're letting your personal experiences paint assumptions about me with a brush that doesn't fit with reality. I have absolutely no hesitations at all, and have absolutely no idea how you see my volunteering 30 hours/week now as "hesitation". Of course I would be finishing my paramedic license if I wasn't in school full time, and I fully intend on doing so once I finish with university. I love EMS and plan to work as a paramedic for the rest of my life. The only part I'm unsure of right now is whether this will be my sole career, or if it will be in conjunction with being a physician. In the future, asking me about my intentions rather than wrongly reprimanding me for your incorrect assumptions would be appreciated.

No popularity contest here. Experience dictates extremes are worrisome. So is unfettered defensiveness. Consider this to be from a thoughtful perspective. Its your affair how emotional you want to invest in this call. Criticism comes hard in this field- your longevity will depend how you handle it.

 

[Underachievment]

It is part and parcel of the profession. 15+ years in the game, and I still tear up after nearly every code. When that stops - it is time to get out.

- H

I couldn't disagree more- especially when it comes to separating home from work. Losing empathy is certainly one thing- abject commiseration is another.

 

[Edivocke]

Second this, sounds fishy- NTG is the last thing you would give post-defib with a 5 minute transport

Sorry if it sounds fishy...but I can't argue against what the paramedic did. It wasn't exactly 5 mins...more like 7-12 minutes...but I was just giving a brief estimate of time.

I remember his blood pressure and his heart rate was constantly rising on the LifePack 12.

In the state of Maryland, EMT-B's aren't allowed to give aspirins so that wasn't my decision, and I didn't administer the NTG.

Don't kill the mood, I'm just glad the guy made it.