# 3 EX's on 24o shift



## MICU (Dec 10, 2006)

Sat (12/9) I were with the MICU from 15:00 till 23:00, when I came to the station the Paremedic told me that they had a old EX today, we start the shift checking everything and all we got a call from the BLS that they have found, with FD an EX. We got there, Asystole in 3 leds.
The shift went quiet the para told it his first time to have 2 EX's in less then 16o shift. the same para did the the night shift as well when he got to a 45 year old man who did a VF while sleeping, they did a hour and a half ALS cpr on him, but it was too late.
I think its the first time we had 3 EX's in 24 ours over here in Down town Eilat:unsure:


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## Airwaygoddess (Dec 10, 2006)

I have always been told that folks die in sets of 3, at least that is what the old time nurses said!!  Be safe and well MICU!!


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## Ridryder911 (Dec 10, 2006)

I am assuming an EX is a cardiac arrest?... Only ex I know of is ex-spouses..lol


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## KEVD18 (Dec 11, 2006)

who works a code for an hour and a half?????


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## yowzer (Dec 11, 2006)

Ridryder911 said:


> I am assuming an EX is a cardiac arrest?... Only ex I know of is ex-spouses..lol



EXtrication? But from the sounds of it, it's just arrests.


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## DT4EMS (Dec 12, 2006)

KEVD18 said:


> who works a code for an hour and a half?????



Folks who are "serious"....... A local MD went into arrest and was worked for nearly 2.5 hours. 

With great CPR, they were able to keep his color good and I was told he kept a sat in the 90's.

Still didn't make it though........


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## KEVD18 (Dec 12, 2006)

DT4EMS said:


> .....2.5 hours....Still didn't make it though........



and there you go. 2.5hrs worth of work. scores of exausted people. how many rounds of drugs would you give over that time, and at what cost? 

theres a point when you realize that regardless of your skills or capabilities, the pt is going to die. working a code that long is pointless. even if a stable rythm was achieved, the pt would have had a real poor outlook


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## DT4EMS (Dec 13, 2006)

Makes you wonder if a "bum" would have been worked that long. Point was.... it was an MD that coded. How long would you work your partner if their color was still good and a sat in the 90's because of good CPR? 

Hard to answer that question................ at least for me anyway.


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## KEVD18 (Dec 13, 2006)

not really to hard for me, but then again, i cant stand either of my regular partners........

i get your point. but even with good color and sats in the 90's, the ischemia to the various tissues systems, the heart chief among them, would be fatal or nearly so well before the 2.5hr mark. just isnt advantageous to work a pt that long. even if they "live" probably brain dead. more than likely will code again in short order. an interesting corralary(sp?):

pt codes. ems activated. als responds, revived on scene. packaged and t/p'd. codes and is revived twice enroute. u/a at recieving er, pt codes at least three more times. family at bedside, refused to sign dnr. pt finally "stabalized", transferred to cardiac icu. pt codes three more times overnight before the md and lcsw essentially demand a dnr be signed. pt codes for something like the 9th or 10th time and is finally allowed to expire. moral of the story: when its your time its your time. while all the medical science in the world may be able to keep your heart pumping and lungs breathing, your quality of life is going to be crap. had that pt ever actually stabalized enough to d/c home, my guess owuld be that they have <6mo to live and wouldnt have done anything more excerting that a bm in that time span. 

are there people that recieve extraordinary levels of care(2.5hr code...). absolutely. is it appropriate? imho, no.


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## DT4EMS (Dec 14, 2006)

The one thing that is for sure in this business is there is nothing "for sure". I can't tell you that I have ever worked a code for way more than an hour........ nowhere near 2.5.

I have been involved with numerous codes in my 16 years in EMS. Some I have arrived on scene and never started working it because they were down for over 10 minutes with no CPR and some I have worked that should have been called sooner.

It is a judgement call. One that rests on the shoulders of the team leader. I am fully aware of end organ perfusion considerations during CPR and prolonged down time. Question being.......... if a person has an O2 sat in the 90's  ( I am sure ETCO2 was on as well) and the  team leader deemed it appropriate.............. who am I to question.

I am a paramedic.......... MD's are a heck of a lot smarter than me. They are human and entitled to mistakes as well............ but error on the side of pateint care will always win out in my book.


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## Jon (Dec 14, 2006)

I remember seeing the head doc of the ED do tihs, once, during -P school. we flogged the guy for 90+ minutes, and every time he got ready to give up, the pt. would get a pulse back for a minute, then stop again.

It was kind of fun, because more than once he asked around "does anyone else have any other ideas?" and we tried high-dose epi, bicarb. We defibulated "fine v-fib" a few times and got a rythym change... it was an ACLS mega-code from h@ll... but an intresting experience. The guy actually still had brain function, but his heart was shot and it gave out finally in the ICU.

Honestly... he could have been called 5 minutes after coming into the ER.


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## Para-Devil (Dec 16, 2006)

Yea, I have always heard its in sets of 3, but still thats a very unusual thing, i have never heard of that, and im sure it wasnt too fun.


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## WannaBEMT (Dec 28, 2006)

I know when I 1st read the opening line I was like WOW this person ran into 3 EX's (ex-lovers, etc....LOL) in the same night!  


Jenn


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