Cardiac Arrest. Your first time..

[62_derick]

I am new to the ems world been an emt for 10 months and employed for 9 months. I have had 4 cardiac arrest in the 9 months of employment and 1 while going through school.

Now with the company I work with we get our fair share amounts of Codes and the schedual I work is 4, 10 hours days my medic and I just ran our first code this past saturday and the most recent one on this past Monday.

The first one was getting called out for Breathing Difficulties at a residence, we arrive on scene and find a female in her 80's that looks sick, she had SOB low bp of 74/40 and we moved her from the house to the rig in 2 mins, get her to the ambulance and the pt goes unresponsive cpr and acls started immeditly and another unit called in to assist.

Now on monday we get called out to one of our local Nursing Homes for breathing difficulties again. We respond with about a 2 min response time go up the floor and find out the that pt has become unresponsive. immediatly go in to cardiac arrest mode I strap the pads on and the four lead and start compressions and so on.

Now what I wanted to ask everyone if they could give me some advice on how to deal with the after affects of working a code. Of all my 5 codes I have been on none of them have been able to be brought back. Monday was the first time I had been there to be the first to start compressions and still have the feeling of the ribs breaking while doing cpr. Does that feeling always stay with you? and How did everyone react to there first time?

I have never thought about quiting and going onto a stright BLS truck where we do transports and a few emergancy calls. I know that I am new to being an emt and have started off working pt on a als truck and now full time on an als truck. I like being on an als truck to be able to see different calls and to help out different types of illeness. So if anyone could give me some advice would be greatly appreciated.

Outta the 5 codes I have worked 4 of them 1 of them was a pediatric cardiac arrest that was pernouced prior to our arrival.

Thanks

 

[Shishkabob]

I've only had 1 code, and it was working as a Paramedic during my internship.


It was 4 in the morning when the tones went off for an unconscious person. We get in the ambulance and head off and the quint leaves behind us. Right after we get on to the main road dispatch relays that it's a "full code, CPR in progress".

Arrive on scene at the nursing home and find the 'nurses' doing 'CPR' on the guys Xyphoid process, with the BVM not touching the patients mouth. I tell them to stop CPR as we assess.

No breathing, no pulse, but no obvious signs of death that would prohibit us from doing the arrest. I have the EMT start compressions as I hook up the monitor... asystole. We package and take to the ambulance.

Once in the rig, I start an IO on his tibia as one of the medics attempts to pass a tube, which was a no go due to the ability to see inside his trachea just by looking at his neck.. we just bag and get decent chest rise. I pushed 1mg Epi 1:1 and 1mg Atropine, and due to the suspected long down time, I pushed a full amp of Bicarb.

I alternate compressions with another medic while the EMT drives to the hospital, pushing another couple mgs of Epi and Atropine. We arrive and take the patient in where I give a report to the doc and time of death was called right there. Remained in asystole the whole 30 minutes we had him.




I still have the full code summary on my desk.

 

[62_derick]

Wow thats interesting. The very first one I did was on an elderly female found by neighbor unresponsive, I was with the fire department at the time while I was going through my emt class and was certified in cpr/aed and we did cpr on her until the ambulance arrived.

So how did you feel after your first code?

 

[Epi-do]

Honestly, I don't even remember my first code. I do remember a couple of the "early" ones in my career, but I haven't got a clue what my first one was.

As for the feeling of breaking ribs when you start doing compressions... Everyone is different, but that feeling never "stayed with me," but, since I feel like I am employed by the grim reaper, it isn't something that I have forgotten. That's mostly because I seem to average 1-2 cardiac arrests every month, and it seems like about every 3rd one I get has to be worked. (And trust me, I don't work them unless I absolutely have to. There is no point in transporting a corpse, especially red lights and siren, in my book. I would much rather leave them where I find them, even if I do have to work them on scene before I can call them.)

Also, don't feel bad about not getting most of them back. Honestly, at least in my experience, that is the norm. Most people go into cardiac arrest for a reason. Even though there are some reversible causes, I personally haven't had that many that would fall into one of those categories.

 

[viccitylifeguard]

i still remember my first full code : i was a 17y/o lifeguard and it was a 92y/o male in the swimming pool. 615 am he starts freeking out in the hottub i thought it was a seizure at first once i ran the 20feet to get him out he was fully unconsious no breathing no pulse.
we put in an opa put on a pocket mask with o2 and started cpr . the part i remember most is that it took 30 min for the ambulance to get to my location (the base was only 1km away and it was a straight road with no lights ) when they did arrive i was asked to keep compressions going and then once we started to transport i was told to get in your comming with us. it was an experience ill never forget . i saw it through from start to prouncment of death at the hospital.

 

[trevor1189]

The only thing about a code that bothers me is the crunchy compressions and vomit (luckily the majority I've been on no vomit has come up).

After the first round of compressions the crunching stops and its all good from there. Just remember, if you feel crunching or hear snapping and you are going the depth you are supposed to keep going, it happens. I've seen people back off on the depth after feeling those pops and cracks. Broken ribs is a very small price to pay for a chance at ROSC.

 

[truetiger]

My first code took place during my first medic clinical at a big hospital. As I was hopping from room to room doing assessments, I walked past a room in which a full code was in progress, and everyone was wearing masks. Initially I figured I'd just catch the next one, as I see they're all wearing masks and she's dead, I don't want what she has.... One of the nurses noticed me peeking in and grabbed me. I was told she was tubed and to take over compressions.

After the code, the charge nurse asked for my info, as I would be contacted by the hospital pending the results of the PT's blood work, to see if I needed to receive tx as well.

 

[Shishkabob]

EDIT: Read incorrectly what Trevor said.

 

[ZVNEMT]

my first was my first day ever on an ambulance, during my clinicals. got a call to a "skilled nursing facility" for an elderly female in respiratory distress. it was a few years ago so i don't remember the vitals, but i do remember the pulse was very weak, very slow, shallow respirations. I also remember the medic not being given the paperwork because the nurse was busy on the phone talking about the previous nights american idol. As we loaded the pt up, she just stopped breathing. I didn't realize it until the medic asked me how well i know my cpr. i started compressions, the driver drove like a lunatic, i whacked my head against the cabinets pretty good, must have broken every rib in that poor woman's body (she was very small, emaciated looking, and frail. but full code). it sucked, i was just kind of shocked for a while. had 2 more codes on my next 2 clinicals. since school i've only had 2 codes in the 2 years ive been working here

 

[MrBrown]

No cardiac arrest in 3 years :unsure:

 

[CAOX3]

No cardiac arrest in 3 years :unsure:

Your done now.

Thats like saying its awful quiet in the ER.

 

[Melclin]

I've had 2 (four if you count the DOAs) in roughly 2 weeks on the road. I attract death and misery on placements

My first was a bloke who'd been run over by a tractor (I'm sure I've posted this before). It was pretty intense. I remember getting the pads out and thinking, s**t I've never actually seen the real pads because in training we use those click on dots on the manequin. Did compression, ventilations. MICA called it after about 25 mins of varrying PEA and asystole. I also remember cleaning the bloke up a bit after the mess we made so his family could spend some time with him. I found that to be oddly intimate and a nice way to feel like I could do something positive in a bad situation.

My third was a young girl who hanged herself. Off a towel rack. I remember thinking that all she need to do was put her hands out to save herself. She must have really wanted to die. It was the most god awful thing I've ever seen in my life and the only job I've ever done, that I wouldn't want to do again. Looking after the people who found her and counseling them afterward was a very rewarding experience though and all in all, I'm glad I had the experience. It only makes me wanna be an ambo more.

No cardiac arrest in 3 years :unsure:

That bones. I should come over and do some placements on your truck. I'll kill half the bloody town just by being there, but at least you'll get the experience

 

[firetender]

My first few probably involved mouth-to-mouth because that's what we did back then until we actually got used to and trusted the new-fangled equipment (much of which broke down at first...no joke here), but I don't remember so it must not have been as traumatic for me as it was for them because apparently I'm the one who survived!

On one level, it's simple; you're buying time for the person. Sometimes, things get knocked out of whack and they can still get back to function. Sometimes, they need a kick in the pants. You're the kick. You don't know; you never know, but you're the one that got called to the scene so you do what you can, which is what you were taught.

And those ribs do break! Sometimes it's because you slip, or because there was something there you didn't know about, or whatever shut down the heart set you up, or... But ribs break, nothing feels quite as creepy, and more than likely it only takes a couple times before you're SO aware of how you're doing compressions it's almost certain if it happens again it's because of circumstances way beyond your control.

...and that's something you learn to live with because ultimately, it all boils down to moment-by-moment knowing you're giving it your best and when the inevitable mistake comes, you learn from it and what you learned then becomes part of your bag of tricks.

And, by the way, right now nobody beats death. But it's important that we have an army out there trying. Think of what a miracle it is that anyone gets "saved" at all. And now and then, you get to be part of it! You can look at yourself as a Sacred Soldier or a Flesh Mechanic, the end result is the same; you're a participant in life's longing for itself.

See...but that's just the way I look at it. What if you took the time to develop your own Mission Statement of who you are in relation to the work you do? It can go anywhere. It's something you can return to to remind yourself why you got into this whole mess in the first place!

There's a percentage of medics (yes, in this Forum!) who become better medics by looking at themselves and what they do from different perspectives and on different levels. It takes all kinds and I just want to encourage everyone to share their explorations of "self" here as well.

 

[CAOX3]

First medical arrest: Pretty uneventful.

First traumatic aresst: MVA with ejection followed by severe deceleration: Sheer terror followed by a few expletives whispered under my breath, followed by the distinct feeling I wasnt going to be upright for much longer if I didnt sit down and I may have vomited. h34r:

When I got home a conversation with my mother about what a terrible mistake I made choosing EMS as a career and I dont believe I slept that night, other then that it was pretty uneventful.

First pediatric arrest: I was little more experienced however I recall a few of the same feelings I discussed above. Back then they were quick to remove you from the truck and CISD was common practise. I dont remember participating much, I do remember the begining of a thirty pack of red white and blue, a pack of smokes and there may have been a bottle of wild turkey involved or maybe it was mad dog 20/20.

I was young when I started in EMS and I was emotionally unprepared for what I encountered.

I have matured since then. Now I drink the good shiit.

Kidding

A solid support structure is extremely important, being able to recognise the signs that a provider isnt in a good place mentally is also a part of this job.

 

[AnthonyM83]

Can't help you much with getting over the feeling of ribs breaking, as I never got that "feeling". Just the thought of "wow, ribs are breaking, glad they warned me about it or I'd be scared". Then turned my attention to everything else going on.

I can though share that during intense calls, I tend to dissociate with any emotions about the call or myself. Everything is very robotic, cold, calculated, academic (as best as possible, there's always snags that come along). This allows me to do the best work and the patient wants me to do my best work.

During a code, it's all about how well I can do the skills. If I start thinking about "saving the patient" I might psych myself out, distract myself with emotions, worry, and brain power that should all be going toward what I'm doing (physical skills, academic thinking, on-scene communication).

I will say that all our "saves" had great compressions, started early and continued efficiently throughout.

 

[Smash]

So how did you feel after your first code?

Hungry.

 

[Shishkabob]

Hungry.

Agreed. I was STARVING that when I got back to tge station I just ate.

 

[Euclidus]

My first few probably involved mouth-to-mouth because that's what we did back then until we actually got used to and trusted the new-fangled equipment (much of which broke down at first...no joke here), but I don't remember so it must not have been as traumatic for me as it was for them because apparently I'm the one who survived!

On one level, it's simple; you're buying time for the person. Sometimes, things get knocked out of whack and they can still get back to function. Sometimes, they need a kick in the pants. You're the kick. You don't know; you never know, but you're the one that got called to the scene so you do what you can, which is what you were taught.

And those ribs do break! Sometimes it's because you slip, or because there was something there you didn't know about, or whatever shut down the heart set you up, or... But ribs break, nothing feels quite as creepy, and more than likely it only takes a couple times before you're SO aware of how you're doing compressions it's almost certain if it happens again it's because of circumstances way beyond your control.

...and that's something you learn to live with because ultimately, it all boils down to moment-by-moment knowing you're giving it your best and when the inevitable mistake comes, you learn from it and what you learned then becomes part of your bag of tricks.

And, by the way, right now nobody beats death. But it's important that we have an army out there trying. Think of what a miracle it is that anyone gets "saved" at all. And now and then, you get to be part of it! You can look at yourself as a Sacred Soldier or a Flesh Mechanic, the end result is the same; you're a participant in life's longing for itself.

See...but that's just the way I look at it. What if you took the time to develop your own Mission Statement of who you are in relation to the work you do? It can go anywhere. It's something you can return to to remind yourself why you got into this whole mess in the first place!

There's a percentage of medics (yes, in this Forum!) who become better medics by looking at themselves and what they do from different perspectives and on different levels. It takes all kinds and I just want to encourage everyone to share their explorations of "self" here as well.

Excellent post.

I had my first code a few days after I got my certification. It was winter and just after a very heavy snowfall... we were called to a VERY large 50-something female who was outside laying on the snow and unresponsive. She had her shovel still in hand and a little path that looked to be leading to her car. I remember that everything in my brain seemed to click over to some... robot mode or something... everything sort of just worked like clockwork. I also remember having that thought, "wow, I'm glad they warned me that the ribs were gonna do this." That part was definitely odd at first, but I can't stay that it stayed with me. It was like there was just no time for emotion to enter the equation.

The medic I was with must be related to Melclin because he seems to have more than his fair share of codes & DOAs! We actually say Mikesystole instead of asystole because his name is Mike. This being my first code I was expecting her to start gasping for breath and looking around at us after we did CPR for awhile, but that didn't happen. I suppose this call was a reality check for me! After the call I asked Mike how many times he has seen ROSC on a code, and he told me less than 10%. We do what we can, when we can. If you feel like there was something more you should have done or that you fumbled the call, learn from the experience and take it with you. Make sure you're better on the next call. If you followed your protocols and did the best job you know how to do, add it to your experience bank. We can't save them all!

 

[EMTinNEPA]

In two years I've had 5 or 6 codes that were worked. My most recent was definitely my most memorable though.

I was on clinical time as a student paramedic on a single medic squad. The MICU in the town over from us was dispatched for a cardiac arrest and because the dispatcher had a brain, he sent us as well. In addition, a second MICU was on their way back from the hospital, so they swung down to help.

By the time I got there, the tube was in and the IV was halfway in. Since I wasn't allowed to push medications yet, I resigned myself to doing CPR, ventilating, and putting stuff together.

43 year-old obese male on the second floor of the residence. Due to the tight stairwell, extrication with a reeves was impossible. About thirty minutes into the code, the fire department placed the patient in a stokes, secured the stokes with rope, and lowered the patient down a ladder through the second story window. It was like something off a TV show.

In total, the patient was coded for about an hour, received multiple rounds of epi and atropine, 4mg of narcan, endotracheal intubation, a 16 in his LAC and an IO in the left tibia. Asystolic the entire time I was there, but apparently he was initially in a fine v-fib. ER doc pronounced on arrival.

Despite the outcome, this code will always stick with me as my most memorable, if only for the fact that it was the first code where I had an idea what was going on ALS-wise and the one that rescuers went through the most extraordinary measures I've ever seen. Definitely one I will never forget.

Aside from my first code, which was a 28 year-old female OD, the others were all, for lack of a better term, routine.

 

[Melclin]

4mg of narcan,

Um...why?