# my arrest yesterday



## medic03 (Jun 9, 2005)

so I work for one of the local ambulance corps as a paid medic on the overnights 1 shift a week for some extra income. I've been there for 2 years now and it's a nice place to work. Never really had any problems there, usually get your chest pain and resp distress pt's,  but no crazy calls. Well yesterday at 9:14 am I get toned out for a resp arrest. I hop into my first responder and head out tot the call. when I arrive at the building, I see a fire truck, about 4 fire chiefs and a ton of firemen in their gear running around the parking lot. As I park my truck, one of the firemen comes running over and starts banging on my window yelling " they're doing CPR inside!"  So I get my stuff, hobble into the building (I hurt my knee the week before) and find police officers doing compressions and bagging what appears to be a mid 30 y/o male who is laying next to a huge electrical box.  there is blood all over his face and on his arms and what apperas to be electrical burns on his hands. Great, this guy is in arrest now. Unknown downtime, he was found by a coworker on the floor. PD states they got 1 shock off with an AED. Hook the guy up, he's asystole on the LP12. Continue CPR, try to intubate and this is where it gets interesting. As I introduce the blade into the mouth, I see blood in his mouth and ariway, but can't see the cords at all.  Look again, and I realize it's cuz everyhting is soooooo swollen. All I can see is pink/bloody tissue but no cords. can't even see the espohagus.  The chief of the corp that I work for shows up, he tires to look twice with the same results. End up using the combi-tube which worked great. I teach ems providers how to use it, I never had to put on in before. Very easy for those who were wondering.  Anyway, pop in an ej and start with the epi-atropine. No capture on pacing and after the 2nd round we get a few complexes. pt went into PEA for a brief second, then into ventricular standstill. Now for those who never saw this before, it's just P waves marching across the monitor.  It's concidered asystole, but it's pretty neat to see. Check it out
So we run this guy in to the hospital and he's pronounced right away, It's a shame what happened to him, but 2 good things did come of the call. A few providers that never got to see or use the combi-tube got to see it used first hand and Almost everyone there didn't know what I was talking about when I was calling the rhythm ventricular standstill, so now a few more als providers now know. 
LAst week I was telling someone how I never get any interesting jobs at that side job....  Gotta keep my mouth shut.


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## rescuecpt (Jun 9, 2005)

> *LAst week I was telling someone how I never get any interesting jobs at that side job.... Gotta keep my mouth shut.*



Just like me telling you I hadn't flown anyone in a long time.  

And you made me learn something new today.   <_<


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## Jon (Jun 9, 2005)

Can "Real" P's needle or sugical cric in New york? What about CC's???


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## ECC (Jun 9, 2005)

Medics in NY can Needle Cryc...I am unsure of CC's. But let me tell you, doing a Needle Cryc for that would have sucked...Remember you are getting air in, but from what Medic03 says the airway was so edematous that exhalation without a tube would have been nearly non existant.


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## rescuecpt (Jun 9, 2005)

P's can needle, not surgical.  CC's can't (thank Goodness).


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## emtbuff (Jun 10, 2005)

> *End up using the combi-tube which worked great. I teach ems providers how to use it, I never had to put on in before. Very easy for those who were wondering.*



The combi-tube is really nice to use isn't it.  I have inserted it myself once and seen it inserted two other times in the three years working as an EMTB.  Glad to hear you had a good experience.


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## rescuecpt (Jun 10, 2005)

> _Originally posted by emtbuff_@Jun 10 2005, 01:19 PM
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 Unless your pt is allergic to latex.  Then it's not so nice.


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## ECC (Jun 10, 2005)

> _Originally posted by rescuecpt_@Jun 10 2005, 02:44 PM
> * Unless your pt is allergic to latex.  Then it's not so nice. *


 Then they are screwed.


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## medic03 (Jun 11, 2005)

> _Originally posted by ECC+Jun 10 2005, 04:21 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (ECC @ Jun 10 2005, 04:21 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt_@Jun 10 2005, 02:44 PM
> * Unless your pt is allergic to latex. Then it's not so nice. *


Then they are screwed. [/b][/quote]
 well they are dead anyway, so who cares.....


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## emtbuff (Jun 11, 2005)

> _Originally posted by medic03+Jun 11 2005, 01:05 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (medic03 @ Jun 11 2005, 01:05 PM)</td></tr><tr><td id='QUOTE'>
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well they are dead anyway, so who cares..... [/b][/quote]
  Yep I would have to agree.


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## ECC (Jun 11, 2005)

> _Originally posted by medic03+Jun 11 2005, 01:05 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (medic03 @ Jun 11 2005, 01:05 PM)</td></tr><tr><td id='QUOTE'>
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well they are dead anyway, so who cares..... [/b][/quote]
 My point exactly.


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## ffemt8978 (Jun 11, 2005)

> _Originally posted by ECC+Jun 11 2005, 03:29 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (ECC @ Jun 11 2005, 03:29 PM)</td></tr><tr><td id='QUOTE'>
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My point exactly. [/b][/quote]
 Since we can give an Epi-Pen to anyone in need of it, we'll combitube 'em and then hit 'em with the pen.   <_<


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## cbdemt (Jun 12, 2005)

We just learned about ventricular standstill in class last week.  Bet it was pretty crazy to see!


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## rescuecpt (Jun 13, 2005)

> _Originally posted by ffemt8978+Jun 11 2005, 10:54 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (ffemt8978 @ Jun 11 2005, 10:54 PM)</td></tr><tr><td id='QUOTE'>
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Since we can give an Epi-Pen to anyone in need of it, we'll combitube 'em and then hit 'em with the pen.   <_< [/b][/quote]
A, it's pretty freaky to watch.  Seb, talk to Brian Anderson about his experience with it.

B, I can't do that, (epipen, that is) since that would be running 2 protocols at once -(cardiac arrest and anaphylaxis) I need to call medical control for that around here.


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## ECC (Jun 14, 2005)

> _Originally posted by rescuecpt_@Jun 13 2005, 12:09 PM
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> A, it's pretty freaky to watch.  Seb, talk to Brian Anderson about his experience with it.
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 Medics can.  That is run two protocols at once...FIX the problem first! Besides I do not use no stinking epi pen!  :blink:


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## rescuecpt (Jun 14, 2005)

> _Originally posted by ECC+Jun 14 2005, 01:53 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (ECC @ Jun 14 2005, 01:53 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt_@Jun 13 2005, 12:09 PM
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> A, it's pretty freaky to watch. Seb, talk to Brian Anderson about his experience with it.
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Medics can.  That is run two protocols at once...FIX the problem first! Besides I do not use no stinking epi pen!  :blink: [/b][/quote]
 well, considering pretty much the whole county lost the right to do d-sticks... we're slipping towards PA.     We can do them, but have to call medctrl first, even medics.  (Most depts. lost it, but a few - I think 2 or 3 - didn't)


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## medic03 (Jun 14, 2005)

> _Originally posted by rescuecpt+Jun 14 2005, 02:09 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (rescuecpt @ Jun 14 2005, 02:09 PM)</td></tr><tr><td id='QUOTE'>
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well, considering pretty much the whole county lost the right to do d-sticks... we're slipping towards PA.     We can do them, but have to call medctrl first, even medics.  (Most depts. lost it, but a few - I think 2 or 3 - didn't) [/b][/quote]
 Negitive Erika, only about 6 dept lost the right to do D-sticks due to paperwork issues.  They should all be up and running pretty soon.


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## rescuecpt (Jun 14, 2005)

> *Negitive Erika, only about 6 dept lost the right to do D-sticks due to paperwork issues. They should all be up and running pretty soon. *


My buddies (including various Chiefs and Marty M @ County) told me it's a lot more than 6, but you know a lot more than I do because you're a medic and I'm not.  


PS - I know one dept that won't be up and running until this little miss finds a medical director (not jeanne) to sign paperwork.


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## PArescueEMT (Jun 15, 2005)

> _Originally posted by rescuecpt_@Jun 14 2005, 10:32 PM
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 Ummm...

D-stick?

You are kidding, right? you are going too give these medics D50, but not a f-ing glucometer?

Has anyone else seen the study on hyperglycemia and CVA? SEVERE negative outcomes with hyperglycemia present.

Jon


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## medic03 (Jun 15, 2005)

> _Originally posted by rescuecpt_@Jun 14 2005, 09:32 PM
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 well since I sat medical control last night and there were 6 dept  names on a list in front of me saying they can't do d-sticks, that's how I came up with that #.  There were 7, one dept got it back right away. I have no idea what's going on with your dept.


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## medic03 (Jun 15, 2005)

> _Originally posted by PArescueEMT+Jun 15 2005, 07:00 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (PArescueEMT @ Jun 15 2005, 07:00 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt_@Jun 14 2005, 10:32 PM
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Ummm...

D-stick?

You are kidding, right? you are going too give these medics D50, but not a f-ing glucometer?

Has anyone else seen the study on hyperglycemia and CVA? SEVERE negative outcomes with hyperglycemia present.

Jon [/b][/quote]
 it's not the county that's not letting them, it's the state. They messed up on their paperwork to use the glucometers and the state pulled their right to act as a "lab" and do d-sticks. As for the whole CVA v. hypoglycemia, when I was learning to become a medic and I rode in NYC, we didn't have glucometers. You had to take a good history and good physical assessment. Don't get me wrong, the glucometer would have helped a lot, but you can get around it if needed.


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