I want to start off by apologizing.  I started this endeavor with the hopes of posting frequent updates about my progress through class, and divulging anything interesting I may have learned or done in my clinical time.  I have found over the last 8 months, that free time is something I will hold very dear to me from now on.  I have had little to no free time at all since I began my Medic program, and any time I have had, has been spent trying to descramble my brain and avoid the “mental collapse” I had heard accompanies the pursuit of this cert.

I am officially a Senior.  Two semesters down, and one grueling 8 week session to go.  My final is scheduled for July 29th, and Aug 9th is when I will attack the practical portion of the National Registry testing.  I have to be honest, the course itself isn’t nearly as difficult as I thought it would be.  Yeah, some of the topics still have me reeling.  Renal and for some reason respiratory are the two that gave me the biggest fits.  But, for the most part, I feel I have a fairly good grasp on what is going on.  The Cardiology section was just as I had hoped.  I loved every minute of it, and I just wish that we would have had more than 8 weeks to go over it.  I couldn’t seem to get enough.  I still have a few issues with 12 leads, and I know over time I will become proficient at being able to read a STEMI through a Bundle Branch Block, but for now, I think I am where I should be ability wise.  And besides, any medic that says they know everything to know about this field, should probably find themselves another job, right?

I’ve been lucky, or maybe unlucky, in the fact that I haven’t really had the chance to see anything major call wise during my clinical rotations.  I guess you could call me a white cloud as far as my ride time has gone.  ER time was a different story.  I could have been labeled a CVA magnet, as most of my major problem patients were seen for just this reason.  My proudest moment was being able to get a line started on an unresponsive patient that my instructor brought in.  And the fact that he wasn’t able to gain access made it even better for me personally.  Looking up at him and seeing him nod his head and smile was one of the greatest feelings I have had so far during class.

My last shift of ride time changed everything for me.  All I needed was eight hours, I honestly didn’t care if I got to do anything or not.  I was ready to back off for a while and the Medics I were riding with felt the same, as most of my classmates that had ridden with them opened the gates of Hell when they set foot in the station.  I had about 2 hours to go, staring another No Hitter square in the face, when the shrieking bells of the pager interrupted my looking over 12 leads. “Respond with your First on an unconscious person”.  My preceptor looked at me as we were walking out to the bus and said “You’re probably going to get to drill on this one.  I’m willing to bet it’s an OD”.  We climbed in, and set off sirens blazing to respond to the call.

On the way to the call, I was going through my usual en route checklist of possible scenarios and how I would treat them.  It’s my way of getting myself ready for whatever I may encounter.  My thought process was interrupted by the chimes coming from the MDT.  That’s when he turned his head towards my position in the back of the bus and said “CPR in progress.”  Instantly, my thought process stopped.  I hadn’t prepared myself for this. All the times I have responded to a call, I always prepare myself for the worst case scenario.  This was the one time that I hadn’t. Four years as an EMT, almost 10 before that as a First responder, and this right here was the first time I had EVER heard those words uttered on any call I have responded to.  After I was able to swallow the lump that had worked it’s way up into my throat, I was able to collect my thoughts and get myself ready.  I flashed back to every lab we have had for the last 4 months. They drilled arrest scenarios into our heads.  Good compressions until we can get the Lucas on.  Tube with Res-Q-Pod and capnography in place.  ICE protocols as soon as we start working it.  Remember your H’s and T’s. Megacode after megacode prepared me for this very moment. I was ready for this.  I heard JZ’s voice from the front again. “Open the cooler and get the kit out.  Grab the Lucas and unplug the portable suction.  You take that stuff in.  Don’t worry about the board, we can have one of the First’s get that if we end up needing it.

We pulled up and grabbed what we needed and headed in. Two flights of stairs was all that kept me from my first code in the field. The crew on the Squad were calm.  They both have been doing this for a minute or two, and have done this very thing hundreds of times between the two of them.  I think that rubbed off on me.  I was surprisingly calm.  We walked in the door, and I was honestly surprised by what I saw.

She was laying on the couch.  I looked around and saw nothing abnormal about the apartment.  Nothing scene wise that I needed to worry about.  They had fast patches hooked up, and let us know she was in Asystole. There was an EMT Basic student standing at the far end of the couch using a BVM, and she had that OH MY GOD look on her face. One of the first responders said “Unwitnessed arrest, caregiver left her about 80 minutes ago and she was fine.  Also, we don’t know the code status.”  The patient has some signs that she had been down for a bit.  Hands were becoming cyanotic, but no signs of Rigor. I stood there and waited for it. Is she a DNR, or a Full Code.  That’s when JZ leaned around the corner and said Code status was confirmed.  Start working her.

We moved her down to the floor and started compressions immediately.  My preceptor looked at me and said “It’s showtime.  You ready?”  He handed me the drill and explained how everything was going to pan out.  I placed the cath, flushed the line, and established access.  Just like we did in labs, I yelled out “line in and patent”.  My first I/O.  Nailed it.  He then looked at me and said, “This one is all you.  Let’s get the tube”.  I went up to the head and got everything ready.  King Vision on and working…check.  Tube lubed…check.  Preoxygenate…check.  I had the Basic student pull the bag and the OPA and got at it.  Insert the blade, visualize the chords…Holy Shit the cords….there they are!  Advance the tube and visualize it through the chords….check.  I inflated the cuff, grabbed my ears and listened.  Both lungs good, nothing over the stomach.  YES!!!  Res-Q-Pod and capnography please. I freaking nailed it.  My first field intubation.  (And I didn’t chip the teeth Dr. S)

I walked down and started pushing drugs.  They would throw questions at me as far as what we are giving and why.  I remember at one point, when they asked what we are going to give next, I paused for a second and thought,  “ALL THE EPI”.  (girl I hope you read this, because only you will appreciate the magic of that statement) JZ was lingering in the background.  He was the writer for the day, and he was trying to get as much info as he could in regards to what was going on.  We pushed Vaso, 3 rounds of Epi, Bicarb and half an amp of D50.  We tried our hardest for 25 minutes.  We granted her wishes, but ultimately, it was all in vain.

Two things stood out to me during that almost 30 minutes we spent trying to bring that woman back.  I always envisioned my first arrest being not chaotic, but loud.  People screaming out directions, and people running around trying to get lines, and push drugs, and do compressions.  It was the total opposite  Not much was said.  It was relaxed to the point that the voices in my head could have whispered and I would have heard them.  Secondly, I realized that at no point was I scared, or nervous, or wanting to run from the room screaming and waving my arms like a mad man.  That right there was the one thing that I took away from the event.  I could do this.  I knew my stuff.  Granted, it was an asystole arrest.  We didn’t have to shock, or push Ami, but everything I have been taught, has stuck.  The first time jitters didn’t set in.

I’m hoping that this is a springboard for the rest of my class.  I’m not saying I want every shift to have a code, not in the least.  I do, however, feel that I am ready to start having those major events come at me. It’s almost like all the doubt I had about being unleashed to do this left my body with that one call.  Someone very close to me has told me from day one that I will rock this.  And even though I have never doubted my ability, there was always that little voice in the back of my head that had me thinking I rushed into this.  I can truly say now, that I whole heartedly made the right decision to do this.  I do have this.  Man, I love my job.

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