Call to Duty: A ‘difficulty breathing’ emergency
Written by Michael Nicely Tom Bartley | | Duty@toledofreepress.comIt’s 7:20 in the morning. Roll call at Station 5 is complete. You’ve begun your daily rig and equipment checks. As you’re restocking supplies, the tones go off: A “difficulty breathing” run off Collingwood.
Your partner, paramedic Waltino, navigates the daily commute, careful to stop completely at red lights, ensuring other motorists see him. The proper response to lights and sirens is to cautiously pull to the right and stop. Please do not stop abruptly in the middle of the road or drive to the left. Emergency vehicle drivers are trained to go left when passing.
Upon arrival, Engine 16, consisting of three firefighters and a captain, is already inside. We enter the home. Two teenagers play Xbox. There is no sign of the other crew. We ask the teenagers where the other crew is. One shrugs, one points upstairs with indifference; neither set of eyes leaves the TV screen.
Upstairs, the crew from E16 has just completed its assessment. It relays the elderly patient has a rapid pulse, elevated blood pressure, sweaty, pale skin and pronounced wheezing with increased respiratory rate. The patient used her rescue inhaler five times in the last hour prior to our arrival. She has been in respiratory distress for some time. E16 has her on oxygen.
The patient loses consciousness as she goes into respiratory arrest. A crew member puts into place a mask and bag that, when squeezed, forces air into the lungs in the absence of respirations. Another crew member assesses for a pulse and finds none. He starts CPR. This is the situation you see on those hospital dramas when the patient crashes and code blue is called. Only now you are in someone’s home and not a hospital.
The officer calls for another responder, spikes an IV bag and talks to a distraught daughter who has just arrived. The third firefighter places EKG patches on the patient to monitor the heart rhythm. Effective CPR dictates compressions for two-minute cycles, rotating firefighters to prevent fatigue. While this transpires, Waltino attempts an IV and you prepare to secure an airway.
As you ready a KING airway, which is a tube placed in the trachea to ensure a stable airway, Waltino fails at his first IV attempt due to collapsed veins. He quickly grabs an EZ-IO, a drill that puts a large needle into the shin, creating a stable drug administration platform. This is quick and successful.
Airway placement is successful. A ResQPod is attached, connecting the KING airway and bag/mask providing oxygen. This device increases the distribution of drugs and oxygenated blood within the body. The EKG shows a ventricular fibrillation rhythm. That is a wild firing of the heart’s control system. A shock is necessary to reset the heart.
CLEAR! Shock is delivered, the patient jolts, not as pronounced as on TV, but definitely noticeable. Two minutes of CPR. Administer 40 units of Vasopressin IV. This drug improves circulation to the heart’s coronary arteries. Check rhythm … still in V-fib.
CLEAR! Another shock is delivered. Two minutes of CPR. Administer 300mg amiodarone. This drug helps regulate the heart’s rhythm. Reassessing the EKG shows a normal rhythm, which indicates the patient’s heart is beating on its own. Quick check of the carotid confirms perfusion. Patient continues to require assistance with breathing.
Engine 3 arrives on the scene; its manpower is quickly utilized to bring the stretcher. It is positioned at the bottom of the stairs. The patient is then carried down with care taken to maintain the IV and airway. E3 and E16 work together to load the patient and collect equipment from the area.
It is decided E3 will return to service while E16 will assist in transport. One firefighter will drive the life squad, another assists with respirations. The driver and officer will follow in the engine. Because the patient’s pulse has returned, Waltino initiates the ICE protocol. Ice bags are placed on patient’s armpits and groin, cold saline is administered in IV and 100mcg of Fentanyl given to relax patient during this chilly process. You call in the assessment to St. Vincent’s and let them know what they’re going to have on their hands in five to seven minutes.
After transferring your patient to the ER, you prepare the patient care report as Waltino restocks the rig and cleans. When back at St. V’s after another run, you inquire how this patient was doing. Hospital states she’s doing OK now, her asthma inhaler was out-of-date and, therefore, ineffective. She is uninsured and is unable to afford new meds, which is not an uncommon situation faced daily by EMS nationwide.
Michael Nicely has been a firefighter for 18 years. He is a paramedic and certified in confined-space rescue. Tom Bartley has been a firefighter for 10 years. He is an EMT, registered nurse, rescue diver and is certified in confined space rescue.
Tags: Call to Duty
