SHAKING WIRES/SAVING LIVES
What's up everybody? Despite my never-ending requests for written comments on the blog, I haven't received many. I have enjoyed it when people come up to me and say that they have read and enjoyed the blog. Keep coming to see me in person, but leave a note here also.
OK- Check out my two new links. Death Clock will actually brighten your day. DHMO is an ongoing threat to the world, and you can make your own assessment of what should be done.
Now for the new story. I wrote in the last post about my old friend Scott, whom I referred to as the greatest medic I have ever seen. I thought of two quick stories that illustrate just how much things have changed. Both of these mini-stories involve an obsolete communication device and one medic's manipulation of wires on the device to achieve his patient treatment goals. (N.B.: In my maturity, I have come to realize that some of this stuff was pure chutzpah/hubris/balls on the part of the medic, rather than medical magic or even sound medical practice, but these are cool stories anyway- You medics just keep quiet)
Quick poll among EMS providers: Who among you knows what a "bedside portable" is? Back in the day, this was a radio telemetry unit that allowed for communication with the hospital via a handy-talkie handset, and it also had a transmitter for ECG info. They were used for field communication with the hospital. It was about 12 inches wide, 5 inches high, and 2 feet long. These units have long been replaced by cell phones and other means for transmitting data. In the WWW, the bedside portable was always a dicey means of communication, and Scott used that to his full advantage...
Example Number 1 (1989): Called out for CPR in progress, I-95, on the shoulder, at about 0200. Arrived on scene to find a 40 Y.O. biker dude in full arrest, and an upset State Trooper taking his best stab at CPR. Down time is reported to be less than five minutes on our arrival. Scott and his partner, Lee (who may be the #2 or #3 medic ever- also a Navy Corpsman) go to work on the guy. They shock him. They get their lines going. They do some drugs. They look at the monitor and go "hmm." Cars whiz by. They keep saying that they ought to be able to save him. Time to call the hospital. They break out the bedside portable. Lee calls the hospital. The situation is explained over the radio. The hospital asks for telemetry of the ECG. Scott and Lee discuss the situation. They are both sure that they can get the victim back, but they have exhausted their defibrillation protocols. The monitor shows a flatline, and they want to shock him again. More shocks are contraindicated and beyond permitted protocol. Despite a total flatline, Scott winks at Lee, picks up the ECG wires and shakes them rapidly. Lee transmits the ECG, which the hospital interprets as "ventricular fibrillation". Scott asks for authorization to deliver more defibrillations, and that authorization is granted. The next set of defibrillation actually converts the guy. Biker dude gets to hospital with a pulse and survives. No shit, this actually happened. I have witnesses.
Example Number 2 (1989 0r 1990): Called out for auto accident with extrication. I-95 in the median, car into tree. Engine arrives first and finds the driver, crushed in the car and very gravely injured, but alive. Rather than wait for hydraulic rescue tools, our friend Billy uses what the kids call "retard strength" to pry the door off the car with a halligan bar and then drag the guy out. Our boy the victim is all fucked up. The short list of his injuries is: bilateral femurs, one open; bilateral wrists, both open; head injuries, open and closed evident; chest is visibly not right; jaw smashed. Prominent "U.S.M.C." tattoos all over his arms. "Scott the Doc" goes to work on him. Start with airway. Scott hands me a bag mask and has me go to work on breathing for the guy, whose respirations are trailing off. It is not easy going with the BVM, because of throat/neck/jaw trauma. Soon thereafter, the victim stops bleeding. He loses pulse. In a burst of EMS work like none I have seen (before or since), Scott gets two huge lines going, gets some drugs on, and gets a pulse back. The stuff coming out of the wounds starts to look like Kool-Aid. Not good. Not much blood left in there. Scott goes to intubate, but can't see anything because of too much trauma. Another medic breaks out the bedside portable and hands the handset to Scott. Scott quickly explains to our Operational Medical Director (yes, the boss of EMS) that he has a restart on the guy's heart, but in the absence of decent airway, he's going to die. They have some argument, of which I only hear Scott's side. Scott actively plays with the wire connection where the phone connects to the box. Scott tosses the handset to his partner, complaining that he can't spare the hand to talk on the phone, plus it's "all static anyway". Scott is looking down on his work while firmly and loudly telling his partner that he is not going to sit by and let the guy die because of no airway. His partner looks up from the phone handset and says: "The doctor says to do what you have to do to get an airway". Scott, a second's hesitation and without looking up from the victim's face, points to the ambulance and says: "Somebody get me an OB kit". Sure everyone was confused by this, but it came in a matter of seconds. Scott didn't want a bulb syringe or a chux, he wanted that big, fat, scalpel that was in the kit. He popped off the safety guard, felt around the victim's throat for a second, and deftly cut a big hole in the guy's neck. He put two fingers in the hole, felt around, said "OOOH RAH!", and then slid the endotracheal tube between his fingers into the guy's trachea. I was knocked out. A surgical chric in the field was (and is) so far off the protocol ranch that it is not to be believed. I slapped the BVM on the tube, and lo and behold, beautiful chest rise and effortless ventilation. Time to go to the hospital. (No helicopters, bad weather). By the time we get out of the ditch, on the cot and into the ambulance, the easy ventilation has ended, and the victim has clearly paradoxical breathing. He lived for a while, but ultimately died. One must have some red blood cells to transmit oxygen to tissue in order to survive. This guy was circulating Ringers Lactate or D5W or whatever. The massive breach of protocol was ultimately resolved in favor of Scott was a Corpsman, his duty is to treat Marines, and that is what he was doing when he cut the guy's throat. On that basis, our OMD was willing to overlook the entire incident. It was helpful that the procedure was perfectly done, despite adverse field conditions. Again, no shit. I have witnesses.
Two stories where Scott manipulated wires to cheat the system and actually preserved life. Don't try to trace this back, the names have been changed to protect the heroic.
Go to the links, leave a comment, come see me. Peace and be safe....
DTXMATT12
OK- Check out my two new links. Death Clock will actually brighten your day. DHMO is an ongoing threat to the world, and you can make your own assessment of what should be done.
Now for the new story. I wrote in the last post about my old friend Scott, whom I referred to as the greatest medic I have ever seen. I thought of two quick stories that illustrate just how much things have changed. Both of these mini-stories involve an obsolete communication device and one medic's manipulation of wires on the device to achieve his patient treatment goals. (N.B.: In my maturity, I have come to realize that some of this stuff was pure chutzpah/hubris/balls on the part of the medic, rather than medical magic or even sound medical practice, but these are cool stories anyway- You medics just keep quiet)
Quick poll among EMS providers: Who among you knows what a "bedside portable" is? Back in the day, this was a radio telemetry unit that allowed for communication with the hospital via a handy-talkie handset, and it also had a transmitter for ECG info. They were used for field communication with the hospital. It was about 12 inches wide, 5 inches high, and 2 feet long. These units have long been replaced by cell phones and other means for transmitting data. In the WWW, the bedside portable was always a dicey means of communication, and Scott used that to his full advantage...
Example Number 1 (1989): Called out for CPR in progress, I-95, on the shoulder, at about 0200. Arrived on scene to find a 40 Y.O. biker dude in full arrest, and an upset State Trooper taking his best stab at CPR. Down time is reported to be less than five minutes on our arrival. Scott and his partner, Lee (who may be the #2 or #3 medic ever- also a Navy Corpsman) go to work on the guy. They shock him. They get their lines going. They do some drugs. They look at the monitor and go "hmm." Cars whiz by. They keep saying that they ought to be able to save him. Time to call the hospital. They break out the bedside portable. Lee calls the hospital. The situation is explained over the radio. The hospital asks for telemetry of the ECG. Scott and Lee discuss the situation. They are both sure that they can get the victim back, but they have exhausted their defibrillation protocols. The monitor shows a flatline, and they want to shock him again. More shocks are contraindicated and beyond permitted protocol. Despite a total flatline, Scott winks at Lee, picks up the ECG wires and shakes them rapidly. Lee transmits the ECG, which the hospital interprets as "ventricular fibrillation". Scott asks for authorization to deliver more defibrillations, and that authorization is granted. The next set of defibrillation actually converts the guy. Biker dude gets to hospital with a pulse and survives. No shit, this actually happened. I have witnesses.
Example Number 2 (1989 0r 1990): Called out for auto accident with extrication. I-95 in the median, car into tree. Engine arrives first and finds the driver, crushed in the car and very gravely injured, but alive. Rather than wait for hydraulic rescue tools, our friend Billy uses what the kids call "retard strength" to pry the door off the car with a halligan bar and then drag the guy out. Our boy the victim is all fucked up. The short list of his injuries is: bilateral femurs, one open; bilateral wrists, both open; head injuries, open and closed evident; chest is visibly not right; jaw smashed. Prominent "U.S.M.C." tattoos all over his arms. "Scott the Doc" goes to work on him. Start with airway. Scott hands me a bag mask and has me go to work on breathing for the guy, whose respirations are trailing off. It is not easy going with the BVM, because of throat/neck/jaw trauma. Soon thereafter, the victim stops bleeding. He loses pulse. In a burst of EMS work like none I have seen (before or since), Scott gets two huge lines going, gets some drugs on, and gets a pulse back. The stuff coming out of the wounds starts to look like Kool-Aid. Not good. Not much blood left in there. Scott goes to intubate, but can't see anything because of too much trauma. Another medic breaks out the bedside portable and hands the handset to Scott. Scott quickly explains to our Operational Medical Director (yes, the boss of EMS) that he has a restart on the guy's heart, but in the absence of decent airway, he's going to die. They have some argument, of which I only hear Scott's side. Scott actively plays with the wire connection where the phone connects to the box. Scott tosses the handset to his partner, complaining that he can't spare the hand to talk on the phone, plus it's "all static anyway". Scott is looking down on his work while firmly and loudly telling his partner that he is not going to sit by and let the guy die because of no airway. His partner looks up from the phone handset and says: "The doctor says to do what you have to do to get an airway". Scott, a second's hesitation and without looking up from the victim's face, points to the ambulance and says: "Somebody get me an OB kit". Sure everyone was confused by this, but it came in a matter of seconds. Scott didn't want a bulb syringe or a chux, he wanted that big, fat, scalpel that was in the kit. He popped off the safety guard, felt around the victim's throat for a second, and deftly cut a big hole in the guy's neck. He put two fingers in the hole, felt around, said "OOOH RAH!", and then slid the endotracheal tube between his fingers into the guy's trachea. I was knocked out. A surgical chric in the field was (and is) so far off the protocol ranch that it is not to be believed. I slapped the BVM on the tube, and lo and behold, beautiful chest rise and effortless ventilation. Time to go to the hospital. (No helicopters, bad weather). By the time we get out of the ditch, on the cot and into the ambulance, the easy ventilation has ended, and the victim has clearly paradoxical breathing. He lived for a while, but ultimately died. One must have some red blood cells to transmit oxygen to tissue in order to survive. This guy was circulating Ringers Lactate or D5W or whatever. The massive breach of protocol was ultimately resolved in favor of Scott was a Corpsman, his duty is to treat Marines, and that is what he was doing when he cut the guy's throat. On that basis, our OMD was willing to overlook the entire incident. It was helpful that the procedure was perfectly done, despite adverse field conditions. Again, no shit. I have witnesses.
Two stories where Scott manipulated wires to cheat the system and actually preserved life. Don't try to trace this back, the names have been changed to protect the heroic.
Go to the links, leave a comment, come see me. Peace and be safe....
DTXMATT12
posted by DTXMATT12 at 11:31 PM
2 Comments:
WOW... Thats some old school awsome. Think we'll see MedicChris try that some time soon with the safty pads/MDCs?
I remember that call. I wasnt actually there. I was still a junior fire fighter. They cancelled all junior duty crews while the investegation took place. The heavy rescue I was assigned to went on some insane calls during that investegation.
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