Does It still count as a save?

[Sasha]

I had an FD ride, and a preceptor today who was a "birth by fire" kind of preceptor. He told me I was running the calls etc, he was gonna just be an extra hand. Great! That's perfect. Well I told him I was shaky on ACLS, he told me no problem, we'd go over it. Before we could, we got a call.

Pt was a 73 y/o male c/o of "feeling funny" and s.o.b. He was pale and diaphoretic. He said he wouldn't call it chest pain, but he felt funny. We put him on O2, put him on the monitor, he's in V-Tach. Got IV access, and right as we're getting ready to get him ointo the truck he goes unresponsive and into V-Fib. We shocked him right away (First time I've shocked anyone myself.) since it was witnessed, still Vfib, CPR was started, and I completely blanked out. 1mg of epi pushed, attempted intubation. Missed the first time, got it the second time. My first ever attempt on a live person. It's been two minutes, still pulseless, still in vfib. Shocked again right at the hospital parking lot and he goes from vfib to an idoventricular brady rhythm with a pulse. The whole thing didn't run near as smooth as I had hoped. It was sloppy, mainly because I would blank out with an "Uhm.. uhm... I don't know!!" and my preceptor would just respond with "Yes you do, THINK!!!!" or a "I'm gonna do this.. wait no.. I'm gonna do that. Wait." and transport was delayed because I was stupid. I didn't even get a 12 lead on scene. Just blanked out. I've been on codes before, but I was always the EMT taking orders and doing compressions, not a decission maker. I know it's going to be chaotic, but it shouldn't have been THAT chaotic and sloppy had I not been dumb.

So. We dropped him off. I'm excited and feeling good. We dropped off a patient who was with out a pulse, with a pulse, and I got my first intubation. Ever.

We dropped off another patient later in the ER and it turns out MY code had died.

I feel like if I hadn't been so stupid, he wouldn't have coded a second time in the ER and died. My preceptor's comment after we dropped the patient off? "Don't worry, school is your time to kill people."

I just feel so crappy right now.

 

[JPINFV]

Applicable Rules of the House of God:

3: At a cardiac arrest, the first procedure is to check your own pulse
4: The patient is the one with the disease.
8: They can always hurt you more.

 

[Epi-do]

Sasha, it sounds like it was just his time to go. Don't be too hard on yourself (as I am continuing to learn lately). Yes, you may have been on several arrests in the past, but your weren't in your current role. It is easy to be the one following directions, quite another to be the one giving them.

While going through class, I rode with a few preceptors similar to the one you were with on this run. The great thing about these preceptors is they aren't afraid to let you make some mistakes. As long as they stop you before doing something that will harm your patient, and do a good job reviewing the call and what you can do to improve afterwards, these are the ones that you will learn the most from. When you actually do a treatment/forget something/make a mistake/etc. it will stick with you much longer than if you never get the chance to make that decision and are simply "lectured" about it.

It really will get easier. Just hang in there, and continue to ask the good questions. Like your preceptor alluded to - you are a student, and this is the time to take it all in. On the bright side, you got your first field intubation. Congratulations on that!

When you got to this guy, he was in a lethal rhythm. You did your best. That is all you can do. There is no way to know if you could have done something different to give him a different outcome, but my guess is most likely not. As for whether or not it was a "save", I guess that depends upon who you talk to about it. I don't consider it a true "save" unless they are able to walk out of the hospital, able to function on their own, so in my book, no, it wouldn't have been one. Other people may very well say that since he had a pulse again when you got to the ER, that yes it was.

As long as learned from this run, you should consider it a job well done.

 

[fortsmithman]

Sasha don't be too hard on yourself. I have been told in the past when it's your time it's your time nothing you can do. Sasha have faith in yourself and your abilities You will go on and have a good career you will save lives. Remember have faith in yourself.

 

[marineman]

I'm in pretty much the same place as you but to me it sounds like you did a fine job. Your preceptor seemed to be on top of things and I think he would have stepped in if you had done something wrong. I would not consider it a save but I will say you did your job well, you got a patient that was PNB and delivered him to the ER intubated, with a line started and he had a pulse. Shy of rubbing a magic lamp and wishing that your PNB patient can walk into the ER under their own power there's not a whole lot more you can have go right in the field.

Shrug the later part of the story off and remember it happens, remember what you did right and what you need to work on and move on. You're too young in your career to be worrying yourself over the what if's.

 

[daedalus]

You did great for leading your first code! Your preceptor has seen so many people in cardiac arrest that it does not phase him anymore to joke around with you that you killed the patient. You did nothing of the sort and gave him his best shot at life. It was up to him and god, and the evolving MI in his chest.

Great job Sasha!

 

[mycrofft]

Have you met any of the armchair quarterbacks yet?

The "I-woulda" 's, and "You-sholda" 's?

Stick with your preceptor, but if the "kill people" thing upsets you, I'd let her/him know, (it's what I'd do with a partner).

With heart attacks we're playing for points, not the game. Sometimes the points will win it, but most often not when it is the heart. We teach people, especially laypersons, to "go for it" because they (and we prehospital folks) are starting care at the earliest possible moment. If we were told how ineffective many treatments are against evolving massive MI's we might shrug it off and fail that fraction who could survive, or stall off permanent damage by keeping the air and blood moving.

At least you found out. Often we used to never find out without approaching an informal contact at each ER.

 

[MSDeltaFlt]

Now you're learning what it's like being a medic. It's more than knowing what to do being able to do it. It's being able to do something and know when and when not to do it and how to manage the scene.

You know you're not stupid so why even ask that question? You maintanied an airway. You kept breathing for him. You maintained chest compressions. You shocked him and gave meds. People die. We all do. We all will. It's one of those nasty side effects of breathing too much.

Ride time is having to apply all of the knowledge you gained in class. Now you're learning.

 

[Veneficus]

I had an FD ride, and a preceptor today who was a "birth by fire" kind of preceptor. He told me I was running the calls etc, he was gonna just be an extra hand. Great! That's perfect. Well I told him I was shaky on ACLS, he told me no problem, we'd go over it. Before we could, we got a call.

Pt was a 73 y/o male c/o of "feeling funny" and s.o.b. He was pale and diaphoretic. He said he wouldn't call it chest pain, but he felt funny. We put him on O2, put him on the monitor, he's in V-Tach. Got IV access, and right as we're getting ready to get him ointo the truck he goes unresponsive and into V-Fib. We shocked him right away (First time I've shocked anyone myself.) since it was witnessed, still Vfib, CPR was started, and I completely blanked out. 1mg of epi pushed, attempted intubation. Missed the first time, got it the second time. My first ever attempt on a live person. It's been two minutes, still pulseless, still in vfib. Shocked again right at the hospital parking lot and he goes from vfib to an idoventricular brady rhythm with a pulse. The whole thing didn't run near as smooth as I had hoped. It was sloppy, mainly because I would blank out with an "Uhm.. uhm... I don't know!!" and my preceptor would just respond with "Yes you do, THINK!!!!" or a "I'm gonna do this.. wait no.. I'm gonna do that. Wait." and transport was delayed because I was stupid. I didn't even get a 12 lead on scene. Just blanked out. I've been on codes before, but I was always the EMT taking orders and doing compressions, not a decission maker. I know it's going to be chaotic, but it shouldn't have been THAT chaotic and sloppy had I not been dumb.

So. We dropped him off. I'm excited and feeling good. We dropped off a patient who was with out a pulse, with a pulse, and I got my first intubation. Ever.

We dropped off another patient later in the ER and it turns out MY code had died.

I feel like if I hadn't been so stupid, he wouldn't have coded a second time in the ER and died. My preceptor's comment after we dropped the patient off? "Don't worry, school is your time to kill people."

I just feel so crappy right now.

For the first time being in charge of a code it sounds like it went really well to me. Shocked witnessed arrest, early CPR, outstanding for a first tube in the field (especially since it was in the field and not the OR) On the last squad I worked on we terminated all codes on scene unless there was ROSC so I don't think your transport delay was a miss either.

I think as you do it more you will get smoother. Remember, precision builds speed, speed does not build precision. As long as CPR and defibs are being delivered, you have all the time in the world.

 

[emtbill]

Sasha,

As others have been saying, it sounds like you did a fine job. You had a very sick patient and before you could get anything done he died and you brought him to the hospital with a pulse. Good job! Let me share something with you though:

I had a very similar experience on a call while going through the clearance process at my organization. I had a little old lady who "just wasn't feeling right". I get in her house and she doesn't seem to be in any obvious distress, but during the initial assessment her pulse is about 200. So we get her in the truck and her BP is holding at about 130 systolic, and monitor shows V-Tach. I give her some Lidocaine IV and before it has a chance to do anything she starts shaking and sure enough, goes into VF. I never got any feedback on her survival, but we were still doing CPR pulling into the hospital.

Fast forwarding to me as AIC we get essentially the same scenario, execpt the patient was more symptomatic and his pressure was about 100 systolic. Sure enough, he's in V-Tach too. Based on prior experiences I didn't want to mess around with this so I ended up cardioverting him then giving lidocaine as a prophylactic with good success (read: he walked out of the hospital). Ever since then I've always been pretty agressive with V-tach.

Regardless of what should have happened though (not saying anything went wrong), it's not your fault. You're still a student and ultimetley your preceptor as the certified paramedic should be calling the shots and making sure everything goes smoothly. Feel better?

 

[medic417]

While not a save, sounds like you gave the patient a good chance. You did all that could be done. Sounds like you had a great preceptor. To many preceptors don't let students get involved, glad he let you run it. Wish the service would have been up with current standards and not drive while working a code though.

Good job. Keep up the hard work.

Sincerely coming from one of the people you have battles with you know you did good. Compliments from friends are easy to get.

 

[VentMedic]

Sincerely coming from one of the people you have battles with you know you did good. Compliments from friends are easy to get.

So right.

I think Sasha knows if she'd screwed up some of us would have been all over it.

Good job for your first one!

 

[Sasha]

As long as learned from this run, you should consider it a job well done.

I did learn a lot, actually. Especially the need to speak up. I've actually got a quiet voice offline(shocking, right?). It reiterated what my instructor had been trying to beat into my head since our first P1 scenario "Speak UP!". I had to repeat myself three or four times because my preceptor just didn't hear me. And the need to stay calm, it would have gone a lot smoother had I been calmer. I think that single call was far more educational and eye opening than all of my other FD rides ever were.

On the bright side, you got your first field intubation.

I was shocked that I got it! My hands were shaking so bad! In the back of my mind I could just hear my instructor "God darn it!! GET OFF THE TEETH AND LIFT!"

I have been told in the past when it's your time it's your time nothing you can do.

But darn it, I got a pulse back! They're not allowed to die after the pulse comes back. It's simply not allowed!

To many preceptors don't let students get involved, glad he let you run it.

In hindsight, I'm actually pleased he let me do it. It was so much different than being "in charge" in a class scenario. I've had the preceptors who don't let you so much as touch a stetcher. I'm trying to schedule the rest of my clinicals to coincide with my preceptor's shifts.

As for whether or not it was a "save", I guess that depends upon who you talk to about it.

I was just being kind of sarcastic with that. I don't count it as a "save" either.

Thanks for all of the encouragement. I'm just dissapointed in myself and starting to re-evalute if I'm cut out for an emergency setting.. I'll get over it

 

[medic417]

I'm just dissapointed in myself and starting to re-evalute if I'm cut out for an emergency setting.

Never make a decision after a stressful call. If we all did there would be no EMS left.
Nothing to be dissapointed in your self for based on the info you provided.

 

[Sasha]

Never make a decision after a stressful call. If we all did there would be no EMS left.
Nothing to be dissapointed in your self for based on the info you provided.

It's not the call, but my state during that call. I was jittery, nervous, hesitant, etc. Had trouble remembering things I had a good grasp on in class. Not something I'd want in a provider running on someone I cared about.

 

[BLSBoy]

Sasha, DOWN.

Relax girl. You did yer job, got a tube (good job!) and got him to the hospital.

You are (almost) a Medic now. Bring out the big girl voice. You are responsible for the patients care.

So grow a set of balls, and make the call!

Seriously, ya did your job. Don't second guess yourself.

 

[JPINFV]

It's not the call, but my state during that call. I was jittery, nervous, hesitant, etc. Had trouble remembering things I had a good grasp on in class. Not something I'd want in a provider running on someone I cared about.

Were you not jittery, nervous, hesitant, forgetful when you were doing your clinicals for EMT-B and when you first started working as an EMT-B?

 

[medic417]

It's not the call, but my state during that call. I was jittery, nervous, hesitant, etc. Had trouble remembering things I had a good grasp on in class. Not something I'd want in a provider running on someone I cared about.

Hang in there. It sounds like you recalled more than you realized. It will get easier with experience.

Plus if you left us who could I fight with?

 

[MSDeltaFlt]

I did learn a lot, actually. Especially the need to speak up. I've actually got a quiet voice offline(shocking, right?). It reiterated what my instructor had been trying to beat into my head since our first P1 scenario "Speak UP!". I had to repeat myself three or four times because my preceptor just didn't hear me. And the need to stay calm, it would have gone a lot smoother had I been calmer. I think that single call was far more educational and eye opening than all of my other FD rides ever were.


I was shocked that I got it! My hands were shaking so bad! In the back of my mind I could just hear my instructor "God darn it!! GET OFF THE TEETH AND LIFT!"



But darn it, I got a pulse back! They're not allowed to die after the pulse comes back. It's simply not allowed!



In hindsight, I'm actually pleased he let me do it. It was so much different than being "in charge" in a class scenario. I've had the preceptors who don't let you so much as touch a stetcher. I'm trying to schedule the rest of my clinicals to coincide with my preceptor's shifts.



I was just being kind of sarcastic with that. I don't count it as a "save" either.

Thanks for all of the encouragement. I'm just dissapointed in myself and starting to re-evalute if I'm cut out for an emergency setting.. I'll get over it

It's not the call, but my state during that call. I was jittery, nervous, hesitant, etc. Had trouble remembering things I had a good grasp on in class. Not something I'd want in a provider running on someone I cared about.

As I said. Now you're learning.

 

[Sasha]

Were you not jittery, nervous, hesitant, forgetful when you were doing your clinicals for EMT-B and when you first started working as an EMT-B?

Of course I was, but I was also a totally different person back then, too. At some point, though, you gotta sit back and realize EMS isn't for everyone.

Of course, I do realize that before I go turn in my EMT patch and throw my hands up in defeat that I'm my worst enemy and can be overly critical because I think of things I could have done differently and better, after the fact. I'm sure all these feelings will pass, just frustrated and venting, I guess.