The Code

I interlaced my fingers, stacking one hand on top the other while firmly placing the palm of my hand on his chest. I pushed down hard and fast, as soon as the chest recoiled I plunged back down on it. The young man was in his late twenties and had called the ambulance for trouble breathing. Unfortunately when we arrived we found him not breathing and with no pulse. As we continued CPR and slipped a simple oral airway down his mouth, I attached the cardiac monitor pads to his chest in order to see what rhythm he was in. We paused CPR for a moment so I could examine the rhythm on the monitor. The room was silent and the family was surrounding us in the living room, hoping and waiting. Unfortunately it was a non-shockable rhythm, so I went back to bombarding his chest with compressions. We really wanted to get him back for a couple reasons, his young age, and the time he had been down. My partner and I switched roles, he took over chest compressions and I began to ventilate the patient. We continued switching back and forth every 2 minutes and even managed to start an IV before our backup arrived.

Once the second ambulance crew arrived we gave them a report and assigned one of them to begin administering intravenous adrenaline, while the other took over chest compressions so I could take a look at the guys airway. I was not sure why this young man stopped breathing. I questioned the family and he had no known medical conditions. At this point we had been doing CPR for well over 10 minutes with no changes, so I went to intubate the patient (place a breathing tube in the trachea). I also began to become suspicious that maybe he had choked on something so I also needed to look for anything that may be lodged itself in his airway. I performed a laryngoscopy and suctioned, but saw nothing out of the ordinary. However, while I was perusing deep into the depths of the man's throat I encountered a problem. The breathing tube was having difficulty passing his vocal cords and I could not get it to advance. I had to go to a backup device known as a "combi-tube." The combi-tube is a monstrous and large device that you blindly insert down someones throat when intubation is not possible. I lubed it up generously and shoved it down his mouth as the family gasp and screamed. After securing it we were getting good ventilations with it and had given the man several rounds of IV adrenaline by now, but still no changes. Normally we would consider terminating efforts after about 20 minutes and pronouncing the man dead, but due to the unusual nature of this cardiac arrest and his young age, a few members of the crew decided they would feel more comfortable transporting him to the emergency department, so we did. They continued working on him at the hospital, between us and the hospital he had been worked on for over an hour, but he was a goner. Although not the most creative writing this week, I just wanted to share what we do on "a code" for those who may not have been familiar. On average we get a code about once a week on my shift.