I just worked a full-on code for 25 minutes. The guy was pulseless and apneaic for that entire time. We did CPR, intubated him, shocked him 'til he smoked (literally) and pushed enough drugs to explode an elephant's heart but we got him back.

It all starts with CPR. If you don't know it, I suggest you learn. You could save someone's life and that's pretty cool.

4/15/2008 10:36:44 PM

they do the hypothermia protocol? Wake county is number 2 in the nation on cardiac saves, just behind seattle.

the "new" cpr is amazing, such a departure from the old school of thought.

4/15/2008 10:39:53 PM

Wake's Cardiac Arrest survival rate went from 6% to 48% under the experimental protocol. We have the equipment purchased to do it on the ambulances but the protocol has not trickled down to us in the sticks yet. We were in the hospital and we used the existing ACLS (Advanced Cardiac Life Support) protocol until we exhausted it, then we rinsed and repeated.

New protocols take a while to be processed by the bureaucracy but that's the wave of the future.

4/15/2008 10:45:50 PM

tr00.

BLS f0 life

4/15/2008 10:45:52 PM

Hey a-hole, he was probably in heaven! Who are you to interfere with God's plan?!!!!1












I kid, but I actually have heard someone say something like that. Great work, you guys do an amazing job.

4/15/2008 10:48:25 PM

He probably was. I was wondering what it was like for him. I broke all his ribs but we were getting distal pulses from all the blood I was circulating with chest compressions. He was staring blankly at the ceiling and then around the 20 minute mark started to move a little and exhibit respiratory effort... then his eyes moved and he was staring at me, not long after than he was at least semi-conscious and looking around .

It's fucking intense.

4/15/2008 10:51:19 PM

acls ftw! i did the same thing last sunday.

4/15/2008 10:59:50 PM

thread of the day.

gg Beardawg61

4/15/2008 11:10:06 PM

I used to have their greatest hits. Proud Mary is a personal favorite.

4/15/2008 11:15:35 PM

Quote :

"Wake's Cardiac Arrest survival rate went from 6% to 48% under the experimental protocol. "

hellz yea it did. if you're gonna arrest, wake county is one of the best places to be. just sayin'. we good.

25 minutes - did he have any neuro function left? :\

but gg beardawg

it's kinda freaky when they open their eyes and stare at the ceiling when you do CPR, isn't it?

4/15/2008 11:18:50 PM

what is this "new" cpr and how is it different from old cpr?

Also I thought evan said in the other thread that shocking people lots of times like that wasn't actually done like you see on TV>

[Edited on April 15, 2008 at 11:25 PM. Reason : ]

4/15/2008 11:24:47 PM

Quote :

"did he have any neuro function left?"

Yeah man, we kept him satting in the high 90's and pink the whole time. Dude, I may break ribs but I do CPR like I friggin' mean it. He was awake when I left to watch the premier of Deadliest Catch. He flew to Mission shortly after that.

4/15/2008 11:26:08 PM

damn good to hear man!


I'm seeing this chick thats paramedic and a firefighter, so I'm hearing all this constantly

thought I was done with it after I left the FD

4/15/2008 11:31:08 PM

Quote :

"Wake county is number 2 in the nation on cardiac saves, just behind seattle. "

I wonder why Seattle is so high.

4/15/2008 11:32:22 PM

Quote :

"what is this "new" cpr and how is it different from old cpr? Also I thought evan said in the other thread that shocking people lots of times like that wasn't actually done like you see on TV>"

ACLS refers to using advanced therapies including a variety of drugs and electrocardioversion and defibrillation vs. just doing simple CPR. There is a trend in CPR protocols towards more & faster compressions to circulate blood rather than breathing for them. Although when you've got them intubated that's a moot point. Under the new hypothermia protocols we're going to start pushing massive quantities of chilled fluids into the patient to reduce the body's oxygen requirements and therefore tissue death from ischemia.

It's true that you don't shock people repeatedly like they do on TV. First of all I've never seen a pair of paddles in a modern hospital. We use adhesive pads. Additionally, if they are in one of the two shockable rhythms, ventricular tachycardia or ventricular fibrillation as was the case tonight, you're gonna do a full round of CPR, 2 minutes with 100 compressions per minute, stop, analyze, shock if indicated, check for a pulse, rinse repeat, and per ACLS you'll also be pushing drugs like Vasopressin & Epinepherine among others.

4/15/2008 11:33:06 PM

they're actually even advocating just compression CPR because a lot of people get gross out with mouth to mouth especially in non hospital setting where there is no ambubag on hand or barrier device. even acls relies on good bls--what's 1 of epi gonna do if it's not circulating?

btw the code blue i had sunday was one of the longest i've seen at about 50 minutes--went vfib to PEA to torsaddes, to pea again, to vtach and keep switching pea to vtach then finally stable at sinus tach. brought back to life alert but intubated, respirator, broken ribs. a-line in and a 2 cvls on groin and chest...made DNR byfamily afterwards--wtf?

4/16/2008 12:01:12 AM

I know the new protocol theoretically calls for compressions only, and I firmly believe that's where you do the most good. But they make masks that fit on a keychain now and only cost a few bucks. The Red Cross may give them away. I always carry a full mask with me (and a BVM most of the time.) Masks are so cheap and compact that there's no excuse to not have one. Also think about this. One situation where you are probably more likely to get someone back with BLS (basic life support) CPR alone than in any other situation is in a drowning. In the case of a wet drowning the new theory that there's enough air in the lungs to just do chest compressions goes out the window. And it's a certainty that the patient is going to puke/cough if you get them back, so why not carry a mask? OK, if you're a pussy or just get caught off guard, yeah do compressions... better yet, appoint an idiot bystander to breathe for them and tell'em they're a hero.

4/16/2008 12:21:55 AM

Quote :

"I'm seeing this chick thats paramedic and a firefighter, so I'm hearing all this constantly "

is her name Carol?

4/16/2008 1:04:01 AM

so at 25 mins how much brain damage is to be expected? i mean he had to have a severely reduced oxygen flow to the brain, right?

4/16/2008 2:24:22 AM

Quote :

"they're actually even advocating just compression CPR because a lot of people get gross out with mouth to mouth especially in non hospital setting where there is no ambubag on hand or barrier device. even acls relies on good bls--what's 1 of epi gonna do if it's not circulating?"

tr00f.

and the compression-only CPR is basically what we're doing in wake county. airway is obviously important, but it's of secondary importance to circulation in this particular situation. you can have all the oxygen in the world, but if it's not perfusing your organs, it's not gonna do shit.

Quote :

"btw the code blue i had sunday was one of the longest i've seen at about 50 minutes--went vfib to PEA to torsaddes, to pea again, to vtach and keep switching pea to vtach then finally stable at sinus tach. brought back to life alert but intubated, respirator, broken ribs. a-line in and a 2 cvls on groin and chest...made DNR byfamily afterwards--wtf?"

holy mother of god

on that note, torsades is my favorite rhythm, it just looks so cool

and the family DNRed him after all of it? ahahaha... i wonder why...

4/16/2008 2:33:50 AM

Quote :

"I wonder why Seattle is so high. "

they don't send dual paramedic trucks on BS calls like we do here in WC, AKA having more available for treating the ALS calls... among other things

http://emsresponder.com/article/article.jsp?siteSection=1&id=7358

[Edited on April 16, 2008 at 8:02 AM. Reason : ]

4/16/2008 8:00:50 AM

good for you man! hearing stories like this make me miss my stint as EMT but then again, i dont miss getting up at 4am b/c some senior wants a free ride to the hospital.

[Edited on April 16, 2008 at 9:26 AM. Reason : asadf]

4/16/2008 9:26:04 AM

Quote :

"so at 25 mins how much brain damage is to be expected? i mean he had to have a severely reduced oxygen flow to the brain, right?"

he said he was getting peripheral pulses...and assuming someone was ventilating appropriately and he wasn't bleeding, i'd say that's about as good as normal sinus rhythm. so no brain damage would be expected.

this hypothermia stuff sounds pretty cool, any draft protocols available for it? i'd love to have a look (just finished ACLS training this week so the old protocol is fresh)

4/16/2008 11:02:19 AM

Quote :

"is her name Carol?"

nah, jessica

she lives at atlantic beach and works down that way

4/16/2008 12:08:44 PM

i've got another question - when is it an appropriate to intubate? it's pretty obvious if they are fully arrested and unresponsive, but what about someone who has a pulse and is responsive but extremely SOB (low pulse ox and showing signs of hypoxia) even on the non rebreather wide open at 15L? do you bag valve? or sedate and intubate? is it always pretty obvious or do you ever sort of "prophylactically" intubate?

4/16/2008 1:02:13 PM

in the field, depending on the respiratory drive, and rr i would bvm.

4/16/2008 1:59:16 PM

lol intubate

NEVER STICK YOUR HANDS IN A PATIENTS MOUTH


oh yeah, theres this intubation thing where you may have to

4/16/2008 6:16:01 PM

Quote :

"when is it an appropriate to intubate? it's pretty obvious if they are fully arrested and unresponsive, but what about someone who has a pulse and is responsive but extremely SOB (low pulse ox and showing signs of hypoxia) even on the non rebreather wide open at 15L? do you bag valve? or sedate and intubate? is it always pretty obvious or do you ever sort of "prophylactically" intubate?"

The protocol varies by county and/or medical director. Also there's a difference between just intubating an unresponsive pt. and one who has a respiratory drive and may even be conscious. On the pt. you described we would probably end up using RSI (Rapid Sequence Intubation) where we administer Versed, Succinylcholine, and Vecuronium. Versed sedates the pt. and pretty much ensures they'll have no memory of the events. Sux is a short-acting paralytic that will knock out the respiratory drive. Vec is a longer acting paralytic to maintain. Our medical director gives us a lot of leeway with RSI, particularly because was frequently have very long transport times. I hear that medics who work next to a level 1 trauma center don't get to do it nearly as much as we do out in the sticks.

4/16/2008 9:43:52 PM

stick to doing CPR and quit moderating

4/16/2008 10:37:35 PM

Quote :

"this hypothermia stuff sounds pretty cool, any draft protocols available for it? i'd love to have a look (just finished ACLS training this week so the old protocol is fresh)"

PM me, i'll send you a copy of wake county's protocols. we actively implement it.

Quote :

"i've got another question - when is it an appropriate to intubate? it's pretty obvious if they are fully arrested and unresponsive, but what about someone who has a pulse and is responsive but extremely SOB (low pulse ox and showing signs of hypoxia) even on the non rebreather wide open at 15L? do you bag valve? or sedate and intubate? is it always pretty obvious or do you ever sort of "prophylactically" intubate?"

in wake county, dr. myers doesn't want to see intubation until every BLS adjunct has failed... that means an OPA, 2 NPAs, obviously repositioning, correct mask seal, etc.

personally, i tube codes. it's easier. once you've got the tube, you don't have to worry about mask seal or anything - just check it every time you move and you're golden. it's also a lot easier to just tell the first responder to squeeze the bag whenever the blinky red light (on the res-q-pod) flashes instead of demonstrating proper mask sealing and bagging techniques in the middle of a code (not saying anything against them, i love my first responders, it's just that sometimes we get n00bs who freak out during codes and forget everything they've learned)

"prophylactically" intubating is basically the premise behind RSI. you RSI someone who you think is either going to arrest in short order or is starting to decompensate, etc. - i.e., obvious signs of deteriorating respiratory effort.

if someone's responsive and making some sort of respiratory effort, i usually don't tube them unless it's secondary to facial trauma, arrest secondary to anaphylaxis, or conditions that could quickly destroy an airway.

just use your best judgment. it's usually pretty obvious when you need to tube someone. once you've done a couple, you'll get a feel for it.

Quote :

"they don't send dual paramedic trucks on BS calls like we do here in WC, AKA having more available for treating the ALS calls... among other things"

ugh... don't even get me started on that

but i admit there's a balance... while it's nice that every EMS call in wake county is required to have a medic truck dispatched, there is definitely something to be said for using intermediate level trucks to handle the B.S. stuff (and call for medic intercepts if needed). having a medic on every call is indeed sometimes wasteful, but if things go south (like they always do when it's least convenient for them to do so) the resources are already there, not 5 minutes out

4/16/2008 10:54:40 PM

it is pretty cool inst it ? i worked a coded guy at a biscuitville in durham and after about 15 minutes of CPR i brought him back while we were on the ambulance to durham regional. pretty neat feeling

4/16/2008 11:04:29 PM

wake county is now number 1 btw. Seattle was artificially inflating their numbers by excluding some specific arrest scenarios. Wake reports everything. when people re ran the numbers including everything in Seattle, we FAR outsurpassed them. We dominate the national average. Wake county is the best place in the nation for you to go into cardiac arrest.

4/16/2008 11:05:44 PM

Quote :

"it is pretty cool inst it ? i worked a coded guy at a biscuitville in durham and after about 15 minutes of CPR i brought him back while we were on the ambulance to durham regional. pretty neat feeling"

BISCUITVILLE. lawl. what a stereotypical place to code.

and yes, while CPR is awesome, the only definitive treatment for pulseless v-tach and v-fib is defibrillation.

4/16/2008 11:26:04 PM

lol yah a regular passed out in his tray of pancakes for about 20 minutes. before anyone realized he hadn't moved.... i mean i'm decently sure he was beyond vegetative, and doubtful he survived. but when i left the ER he had heart and respiratory function restored.


gonna re-get my B cert in august when my class is over. so maybe I'll work with a few of you folks probably going to go medic, possibly career. i've no desire to use my degree in a related field lol

[Edited on April 16, 2008 at 11:30 PM. Reason : .]

4/16/2008 11:28:43 PM

you fucking rock Beardawg61, great job man

"he who saves a life saves the world" - Hebrew Talmud

[Edited on April 16, 2008 at 11:58 PM. Reason : .]

4/16/2008 11:54:53 PM

somewhat off topic - anyone ever successfully thumped someone out of an arrythmia? or is that only in movies



[Edited on April 17, 2008 at 12:02 AM. Reason : ]

4/17/2008 12:01:28 AM

The only way to make that work is to scream, "Live damn you, live!" while doing it.

4/17/2008 12:06:54 AM

Quote :

"ugh... don't even get me started on that but i admit there's a balance... while it's nice that every EMS call in wake county is required to have a medic truck dispatched, there is definitely something to be said for using intermediate level trucks to handle the B.S. stuff (and call for medic intercepts if needed). having a medic on every call is indeed sometimes wasteful, but if things go south (like they always do when it's least convenient for them to do so) the resources are already there, not 5 minutes out"

no no no... don't get me wrong, a medic on each bus is great, it's the DUAL medic trucks that blow my mind. ESP when WCEMS won't let first responders drive their units, so you have 1 medic, and 1 or 2 emt's/mrs in the back on a code... I've driven all of Cary ems' units (except big orange, and that will be mine soon too), to let the ALS guys do their work. I think a medic and a basic should be sufficient on any bus in the county. We have 5 dispatchable DC's with a 6th being a possibility, not to mention the non-system supervisors. Heck put some peak load BLS units on the road like they used to have, just make them non-convalescent. use them for those "sick calls" to nursing homes or urgent cares, or any alpha or low bravo runs. we don't use our resources well in this county, at least on the blue and white buses...

4/17/2008 12:09:34 AM

i dont know who is in which truck, im just glad yall come when we call ya

[Edited on April 17, 2008 at 12:31 AM. Reason : .]

4/17/2008 12:30:33 AM

Quote :

"no no no... don't get me wrong, a medic on each bus is great, it's the DUAL medic trucks that blow my mind. ESP when WCEMS won't let first responders drive their units, so you have 1 medic, and 1 or 2 emt's/mrs in the back on a code... I've driven all of Cary ems' units (except big orange, and that will be mine soon too), to let the ALS guys do their work. I think a medic and a basic should be sufficient on any bus in the county. We have 5 dispatchable DC's with a 6th being a possibility, not to mention the non-system supervisors. Heck put some peak load BLS units on the road like they used to have, just make them non-convalescent. use them for those "sick calls" to nursing homes or urgent cares, or any alpha or low bravo runs. we don't use our resources well in this county, at least on the blue and white buses..."

oh yeah, i never understood why wake did that...

hell, wake is so messed up anyway... *sigh* that would be a MUCH more efficient use of resources... i mean, if wake did stuff like cems, and just had at least one medic on a truck (with the other person being of any level) that would help things a LOT.

of course, it speaks for itself... anyone who compares cems (or any other agency, for that matter) with wake can see that, haha.

p.s. big orange is fun to drive... the cab is LITERALLY 4 feet off the ground, haha

[Edited on April 17, 2008 at 1:56 AM. Reason : i also love how it's like only 3 inches shorter than the height of the bay door ]

4/17/2008 1:54:24 AM

gg Beardawg, and all other medics.

Thank you for what you guys do.

4/17/2008 7:50:28 AM

hey hey a thump is worth 30J


ive read stories of nurses running into rooms responding to vtach alarms...and when they hit the lever to snap the bed into CPR position, they "startled" the pt back into sinus....

4/17/2008 1:18:26 PM