# Nights Like This Make Me Wonder.....



## MedicPrincess (Apr 28, 2005)

First I should warn you....this could get a tad bit on the longer side....

Had my next to my last hospital rotation last night.  Only 5 classes to go....YEA!!!

First patient....48 y/o M, Cardiac Arrest, Unknown Down time, Last seen 50 min prior.  No sweat.  He was purple from the nipples up.  DRT.  CC. and all that.  Dr put about 3 minutes worth of effort into, checked on the handheld dopplar...nada....time of death 1812.

Next call...3 y/o M, took unknown quantity of 200 mg Caffiene pill.  Activated Charcole (and a few other top secret nurse stuff) and VIOLA!!! He is better.

Next call...2 month old Male....Cardiac Arrest.  Mom found in in the "crack of the bed" (whatever that means) with blood around his nose and mouth.  Medics grab and go, leaving mom at the scene with PD.  This baby boy gets worked for a while.  Of course all the stops are pulled, with every Pediatrician and Pedi Intern in the friggin hospital in the resusitation room.  Tube in place, they have bilat breath sounds AND bowel sounds.  Dr pulls the Medics tube and tries for one of his own.   He cannot see the cords, so Resp does their special suctioning and one of the interns tries.  She is in.  Again with the bilat breath sounds and bowel sounds.  So they pull that tube.  Dr gets the dopplar, and nothing.  So its called...time of death 1941.  Yep, my first Pediatric.  I could not bring myself to leave the room he was in.  Not a SINGLE family member was there.  I can understand the mom, as she was being held up by PD's questioning.  But NOBODY!!!! Not an Aunt, Uncle, Grandparent....NOBODY!!!! came to the hospital to be with this baby.  Pastoral care and I were the only ones in there with him (the family from the other Code told him to go in with me as that baby needs to have someone there!  Imagine, they just lost their loved one, and they were thinking about this poor baby that apparantly nobody else thought about!!)  So it was just him and I in there after the nurse disconnected everything and swaddled him.  He looked just like a little baby doll.  I just couldn't leave him alone in there.  Even when the Pastor had to step out, I was just talking to him.  When XRay came to get their films, I unwrapped him and layed him on their boards and helped to get him positioned just so.  And I kept talking to him like he could hear me, telling him what they were going to do and how it wasn't going to hurt.  And when they were done, I wrapped him up and just rubbed his head and talked to him some more.  Then when the Crime Scene detective showed up, same thing.  She was so gentle with him and even she talked to him.  Told him she wouldn't hurt him and she was so sorry she had to meet him like that.  Finnaly, the X-Rays showed no signs of abuse.  Thank GOD!!!  But still no mom.  Turns out she had laid him down for a nap and left the house.  Looks like he died from Positional Asphyxia, by rolling into the space between her matress and the wall.  It wasn't until the CSI lady said she was going to have to close off the Pedi Resusitation room that I left him.  And only because she said everyone had to get out.  It was almost 3 hours before ANY member of his family got there.  They had all decided to go to the house where the mom was.  Not a single one of them thought maybe they should be there with him. :angry: 

A few of the standard coughs, colds, non-cardiac chest pains, low back pains, ect. Then the last call.

19 month old  M....status epilepticus.  The Pedi Nurse knows this kid, thats all she would say after she said he goes into the Pedi Resusitation Room.  Sure enough, not 2 minutes after EMS put him on the bed in the hospital the boy coded.  So feverish work ensues, no tube this time, and hes back.  And back in seizure.  The nurse is telling someone to grab the RSI kid and he codes again.  And the work ensues again, this time they get the tube, and a pulse.  The ER Dr says to get him to Pedi ICU so off we go.  The kid goes into full arrest 2 more times between the ER and the ICU.  The ICU staff is familiar (to say the least.....they have his picture on the wall) with this boy.  Turns out he has Cerebral Palsey, is blind and deaf, has COPD, and is in a constant state of seizure.  He is a ward court and lives with a caretaker, however Mom still has medical decision making authority, and here is a SHOCKER....she gets a check from the state anda disability check for him.  So as long as he is alive she gets paid.  So she refuses to make the boy a No Code...he is a Full Code and apparantly they do this routine once...sometimes twice....a month.

So I am off to shower, and go to work.  I have been up since 5 am yesterday morning....and I guess if I don't drive off a cliff in the next week or so I will be fine...in the mean time its a good thing there are no cliffs here and I work in an ER, so I will be able to chat with some of the more expierenced "Grandmotherlylike" nurses today.


----------



## rescuecpt (Apr 28, 2005)

Wow, what a night.  As far as you not being cut out for it, though, based on how you wrote up the evening, you sound like you ARE cut out for it.  It's not always easy, but there are rewards.  You obviously have a very caring heart, and that, coupled with a good head on your shoulders, will make you a great EMT.


----------



## TTLWHKR (Apr 28, 2005)

> *Next call...3 y/o M, took unknown quantity of 200 mg Caffiene pill. Activated Charcoal (and a few other top secret nurse stuff) and VIOLA!!! He is better*



Whacker's Firehouse Practical Joke Guide 101

Good way to screw w/ the rookies, get some Vivarin, pop all the tablets out and put in yellow skittles or better yet, yellow smarties! ONLY if your his driver... When the night shift is half way over, and you wanna freak him out? Pull out the caffeine pill box and start popping them down one by one (remember they are just smarties). Wait an hour, and pull out the second sheet of them and eat all of them. Wait till he gets really nervous about your driving, then pull out a pill bottle with a Valium sticker on it, start to eat them (White Smarties) a few at a time, every few minutes. Now he's really getting freaked out. Then dump a bunch out into your hand, and offer "Want a smartie? I only like the yellow and white ones, so we put them in various bottles to screw with your mind." If he doesn't laugh, he'll never calm down, he'll always be uptight and anxious. If he doesn't believe you, run, I had a guy try to convince me that I needed "to get them out of my system NOW" and I should drink some ipecac w/ a bottle of sterile water.    Damn rookies. So you gotta keep at least one wrapper, in case you get this reaction.


----------



## emt3225 (May 4, 2005)

EMTPrincess said:


> Holy cow....What a night....


----------



## Luno (May 4, 2005)

I don't know if this will help you at all, but when it was my turn as the angel of death (consecutive codes and unsalvageables) what kept me sane was the first thing I learned in EMT class, "you can't save everyone, and the best performance was what you did, not what you think of later."  This isn't to say not to learn from mistakes, but no matter what you did, if you didn't cause additional suffering, you helped.  You can help someone incredibly, but they still die, but you helped them.  Peds are especially hard, but I developed a very fatalistic view of life, and it has helped me in my own struggles.  The road is hard, but where I see alot of providers fail themselves is to hold themself accountable for pt death, when it was inevitable.  If you can't leave it, it will tear you apart.  But it sounds like you're getting a trial by fire, I'd like to say it gets better, but it doesn't, the only thing that changes is how you cope.  Just my opinions, luke


----------



## MedicPrincess (May 6, 2005)

> _Originally posted by Luno_@May 4 2005, 12:15 PM
> * I don't know if this will help you at all, but when it was my turn as the angel of death (consecutive codes and unsalvageables) what kept me sane was the first thing I learned in EMT class, "you can't save everyone, and the best performance was what you did, not what you think of later."  This isn't to say not to learn from mistakes, but no matter what you did, if you didn't cause additional suffering, you helped.  You can help someone incredibly, but they still die, but you helped them.
> 
> Just my opinions, luke *


 Thanks for that.  Somehow I missed your reply.  Its funny, I had such a white cloud thing going on for so long and ever since that shift my cloud as turned pretty grey.  I work in an Emergency Room (registration).  They days I am off are realtively steady, but not to complicated.  They days I am there are CRAZY!!!!  Mulitple trauma alerts, the Psycho patients all want refills on their meds, cardiacs, busy busy busy...all day.  I go home and it all quiets down....

I talked to the Nurse Manager at work about it, she said Every has their turn with the Black Cloud....

Guess its mine....


----------



## Jon (May 6, 2005)

Tough night.


I'm the whitest white cloud there is right now. I've gone 2 months without an EMS run at work. I'm more than due. I've used more of the supplies on myself than on workers here....:angry: 

Jon


----------



## Luno (May 7, 2005)

It's kinda funny now that I look back at it, because we got so bad, we renamed ourself the "death wagon."  As a I've seen it, the people who take the angel role the hardest are the "hero" types, but most people can adapt and overcome.


----------



## CodeSurfer (May 10, 2005)

You have just gone through what I am dreading... my first peds call.  I went on one when I rode with fire, but it turned out to be nothing, but I wish you could have felt my heart rate when the call came across as a peds AMS. I thought my heart would either stop or jump right out of my chest. 

Thank you for posting, and keep up the great work you're doing good things.


----------



## ECC (May 23, 2005)

There have been literally hundreds of peds calls I have been on. All have affected my to some extent. Ask any medic or firefightter that has worked with me, and the answer is that I am a grizzled old FF/Paramedic and nothing bothers me. Except the little ones. That is the only time I am sooooo nice, and sooooo wonderful people actually have to ask: "Who are you and what have you done with the ECC?".

Princess, you did great. I do the same on all my bad peds calls. They CAN hear you. I truely believe that. Even from the better place they are on their way to.

Never change, you will be a great provider.


----------

