If you're one of the few people who read my blog, my apologies for my recent absence as I was on vacation. I will be adding extra content this month to make up for it.
I stood over him in the back of the ambulance, grasping the 14 gauge steel needle in my hand. It looked more like a large metal straw for a frosty carbonated beverage than it did as a needle. He was completely helpless and I had an uncomfortable amount of power while he was at one of the most vulnerable moments of his life. I felt empathy for him and just wanted to help, but its hard to explain that to someone when you might have to perform a barbaric act on them. I had a certain level of anxiety that one gets before they are about to stab another human being in the chest. I did my best to put on a straight and calm face while I explained the procedure to the patient. If his condition got worse before we made it to the hospital, I would need to decompress his chest.
It all started 15 minutes earlier. A small grey sedan was mangled beyond all recognition. Where the trunk once existed was now an empty void, what remained of the trunk had been pushed into the back seat of the car. The durability and resilience of a human body amazed me as I saw the front seat passengers of the vehicle milling about with no injuries and speaking with police. The car looked liked it had entered the earth's atmosphere at terminal velocity and landed on its backside. The sheer kinetic energy of this entire incident was mind boggling considering how well everyone who was involved in the accident appeared. However, looks can be deceiving as I would soon find out.
As I scanned the scene and walked through debris I came across a young man 10 meters from the car lying in the grass. He was in his 20's and his big brown eyes made contact with mine as we encountered each other for the first time. He had apparently been dragged to his current location by his associates in the car. My partner had already began treatment of another individual near by, and after searching the area for additional patients I returned to the young man in the grass. I ordered some hesitant bystanders over for help and gave them directions on how to hold the young man's head and neck while I returned to the ambulance for more equipment.
He had pain along his spine when I touched it and difficulty walking so we had to backboard him as a precaution. We immobilized his entire body to a long plastic backboard, strapped him down with Velcro, and placed a collar around his neck. He would need an xray or ct scan at the hospital before he could be cleared to rule out any spinal injuries. As I loaded him into the ambulance, the young man began to develop some minor difficulty breathing. I loosened the straps from around his chest, but it didn't seem to help much.
I looked at the oxygen monitor I had connected to him and watched as his oxygen levels began to slowly decline as be began to complain about pain in his chest. As the ambulance began to move I listened to the young man's lungs and he had diminished breath sounds on his right side, his oxygen saturation levels where now beginning to teter on the edge of below normal and his chest pain and difficulty breathing became worse and worse with every passing minute. He likely had a collapsed lung aka "simple pneumothorax." With every breath he took air filled the pleural space around his lung, as air in this spaced increased with every breath it would become more and more difficult for the lung to expand and for him to breathe. If his condition continued to deteriorate it could get ugly. If his injury remained the same, I would simply reassure him, but if it got worse, action would need to be taken. The treatment for this injury can be pretty invasive and involves stabbing the patient in the chest with a very large needle to decompress the chest and relieve the pleural space of air around the collapsed lung. We only do this outside of the hospital when the collapsed lung develops into a life threatening condition known as a "tension pneumothorax." Unfortunately this patent's condition was continuing to deteriorate and the possibility I might have to ram a 14 gauge needle into his chest was becoming a possibility I needed to consider more and more with every passing minute.
I took the large needle out and it showed it to the guy as I explained the procedure. I then thought to myself where and how to carry out this if I needed to. I had to plunge the needle into the second intercostal space at a 90 degree angle to the chest, just over the top of the third rib, or was it he 2nd rib? Its been awhile I silently thought to myself. I was happy the guy couldn't read my mind... It had to penetrate deep into the pleural space on the right side to release the trapped air. Its not something we do very often but I had to sell it to him like I did it every day. As I continued to monitor him, his condition was getting worse and he began to teeter on the edge of possibly needing a chest decompression. Soon, it would be my big moment to shine, but it would have to wait for another day as we pulled in to the hospital at that moment and his vital signs remained stable... Alas, another day...
Wednesday, June 3, 2015
Tuesday, March 17, 2015
Frogger
He was laying in the middle of the street surrounded by police cars as neon beams of red and blue lights bounced off his mangled body on an otherwise dark night. The police had blocked off the street and were eagerly awaiting our arrival, pointing to him like trained hunting dogs. I could hear his desperate screams as soon as I opened the ambulance door. I slung the trauma bag with my equipment over my shoulder and made my way to him, kneeling down beside him once at his side. We began our rapid head to toe assessment to look for major injuries starting at his face. To say he woke up on the wrong side of bed would be an understatement, he had seen better days for sure. His face was so swollen and he could barely open his eyes or talk. covered with bruises, blood and major swelling. As I made my way down his body during my exam I noticed a pool of blood on the street next to his leg. I cut off his pants for further investigation and made a shocking discovery. The 2 bones which supported his lower leg (tibia and fibula) were sticking completely out of his leg about 12 inches, after cutting the pants off they liberated themselves from the confines of his garments and were pointing in the opposite direction from the rest of his leg. This was an interesting site indeed as now the majority of his lower leg had little structural integrity. To see a human being so mutilated is unnatural and I immediately started thinking of a butcher shop or the meat department at your local supermarket when analyzing his injury.
A river of bright red arterial blood flowed from his legs around the injury site. It was near impossible to tell the exact location(s) of the severed artery so in addition to a makeshift tourniquet we also covered the open wound with a special powder called “Celox” which is a hemostatic agent that stops bleeding. Due to the severity of the arterial bleeding it took our priority as an immediate life threat. Unfortunately moving the patient into the ambulance and splinting his leg was not so easy. The poor fella was confused from his head injury, but was still conscious. There was no way to splint his leg or even move him off the street in the position we found him with the bone at such an unusual angle, in addition to this the injured leg had no pulse. This was a rare kind of compound fracture and precluded most splinting and moving procedures. To make matters worse, the ambulance service here is undergoing major changes and at the time of writing this has no IV pain medication such as morphine. My partner and I really felt bad for this guy, but we had no choice and began to manipulate his leg to relocate the entire thing in a neutral position in which we could safely move him and his leg and also control the bleeding. We had to transport him to the hospital and there was no other way. His lips opened wide and tears ran down his face as he screamed in agony while we manipulated the leg and splinted it. He almost passed out at one point and I wish he would have. I felt terrible, but there was nothing I could give him for the pain today and we had to save his life by taking him to the trauma center and stopping the major bleeding. All I could do was hold his hand, but only for a moment because I needed both my hands for the procedure. It was truly a primitive and medieval thing to do, but unavoidable. Re realigned the leg as best as possible and as non-invasive as we could. Once the leg was splinted we applied more celox and began our transport to the hospital. Upon arriving at the hospital the emergency doctor immediately called for an orthopedic surgeon to come down and they began to give this guy the works, along with much needed pain medication. A week later I spoke with the doctor and he said we did an excellent job of stopping his arterial bleeding and dealing with his injuries. He was satisfied with how we dealt with the leg considering what we had to work with. The injured man will have several surgeries on his leg, and also for his skull and facial fractures, but he will make a recovery, although it likely won't be %100. The patient was a victim of a hit and run accident as a pedestrian. Luckily the police caught the driver and the patient did not have any major brain damage.
Sorry for the lazy writing this week folks, I was in a hurry, promise the next story will be written better.
A river of bright red arterial blood flowed from his legs around the injury site. It was near impossible to tell the exact location(s) of the severed artery so in addition to a makeshift tourniquet we also covered the open wound with a special powder called “Celox” which is a hemostatic agent that stops bleeding. Due to the severity of the arterial bleeding it took our priority as an immediate life threat. Unfortunately moving the patient into the ambulance and splinting his leg was not so easy. The poor fella was confused from his head injury, but was still conscious. There was no way to splint his leg or even move him off the street in the position we found him with the bone at such an unusual angle, in addition to this the injured leg had no pulse. This was a rare kind of compound fracture and precluded most splinting and moving procedures. To make matters worse, the ambulance service here is undergoing major changes and at the time of writing this has no IV pain medication such as morphine. My partner and I really felt bad for this guy, but we had no choice and began to manipulate his leg to relocate the entire thing in a neutral position in which we could safely move him and his leg and also control the bleeding. We had to transport him to the hospital and there was no other way. His lips opened wide and tears ran down his face as he screamed in agony while we manipulated the leg and splinted it. He almost passed out at one point and I wish he would have. I felt terrible, but there was nothing I could give him for the pain today and we had to save his life by taking him to the trauma center and stopping the major bleeding. All I could do was hold his hand, but only for a moment because I needed both my hands for the procedure. It was truly a primitive and medieval thing to do, but unavoidable. Re realigned the leg as best as possible and as non-invasive as we could. Once the leg was splinted we applied more celox and began our transport to the hospital. Upon arriving at the hospital the emergency doctor immediately called for an orthopedic surgeon to come down and they began to give this guy the works, along with much needed pain medication. A week later I spoke with the doctor and he said we did an excellent job of stopping his arterial bleeding and dealing with his injuries. He was satisfied with how we dealt with the leg considering what we had to work with. The injured man will have several surgeries on his leg, and also for his skull and facial fractures, but he will make a recovery, although it likely won't be %100. The patient was a victim of a hit and run accident as a pedestrian. Luckily the police caught the driver and the patient did not have any major brain damage.
Sorry for the lazy writing this week folks, I was in a hurry, promise the next story will be written better.
Friday, January 23, 2015
Sugar Sugar, oh, Honey Honey...
He was a charming old fellow, full of interesting stories and rustic jargon that grew better only from age. As the captivating words continued to pour off the old mans lips, his wife was quick to correct some of his recollections and would abruptly butt in, as if right on cue. An endearing smile spread across his face and he referred to her as the “minister of interior”, alluding to her power in the household. We all had a small laugh about it while gathered together in his living room. It was a cozy setting and one of the better parts of my job. I wish I had time to stay for tea but my presence was more than a social visit. He was in his 70’s and an unflattering site, his dentures had been removed, making it difficult for us not to crack a smile when he spoke. There was sugarpaste glistening all over his leathery face, and a bloody bandage on his arm. He was in this condition because of the way we had made his acquaintance 30 minutes earlier.
Just 30 minutes prior I walked through his doorway. It was a large apartment and the entire living room opened up into a vast area with vaulted ceilings and decorative lighting. There was a big yellow wrap around couch and a variety of comfy furniture and typical household decor that you might expect. However, even from the doorway he stood out to us like a beacon in the night, slumped over on the couch loudly mumbling incoherently and moving his legs as if he was riding an invisible bicycle. It was a queer site and certainly caught my attention. I took a knee next to him to check his vital signs but had to take evasive action immediately afterward. He starting swinging his fist at me and screaming. While avoiding his flailing extremities, we spoke with his wife. She informed us he's a diabetic and that he gets like this if his sugar gets to low. I caught one of his fist with my hands and held his arm down firmly whilst my partner poked his finger with a small needle. The bright blood slowly began to ooze from the wound and formed a perfect droplet, delicately clinging to the pad of his finger while the rest of his body was busy break dancing. We pressed our glucose monitoring strip against the blood drop and it began to analyze his sugar level. A few seconds later the reading came back as very low. I opened our medical kit and took out the oral glucose, which is essentially just sugarpaste. I began to slowly squeeze the tube of sugarpaste in his mouth, but he was more interested in trying to bite my fingers off. His sugar level was so low that he was extremely confused and very aggressive. I needed to keep my fingers for other things, so I had to develop another plan. I got his wife to come over, selfishly hoping she didn't need her fingers as badly as I did. However, also hoping he would recognize her enough to calm down, and he did for a moment, which is all we needed. I assisted her with squeezing the remainder of the sugar in his mouth while he continued to scream, kick, and mumble incoherently. He was struggling and sugarpaste was getting all over his face in the process. It took 2 of us to hold him down while giving him the sugar, 15 minutes later and 2 tubes of oral glucose later, he was the same. It was at this point I noticed his false teeth had become loose and he was beginning to choke on them, we quickly removed them, placing them off to the side while trying to avoid being bit He had decimated our entire supply of sugar gel like it was a diabetic appetizer.
I had to move on to more invasive procedures which I was hoping to avoid. We assisted him to the floor and gently laid his head on a couple of pillows. The old man was a fighter, he was not going down easy, he began fighting, kicking and swinging. My fingers wrapped around his his left arm and I held on tightly as the large needle punched through his skin like a pincushion. As expected, he became more livid and was struggling with more might than ever. I had managed to locate a large vein on his arm which perfect. There was not much time and it took a lot of strength to hold his arm down while the needle was in it. It was like trying to perform surgery on a rodeo bull, one wrong move and the needle would either go through the vein, miss it completely, or destroy the puncture site. The angle of the needle dropped and the teflon catheter surrounding it slid off with ease, advancing deep into the vein. I taped it down quickly, far from a work of art, but it was in. My partner connected it to the iv bag of glucose, but it was imperative the catheter remained in his vein, despite his physical movement. IV glucose can only be administered in a vein, if it touches normal tissue it destroys it. Obviously this was a risk we had to take given his condition, but we had to confirm the IV was good. I aspirated blood from the site, this was my confirmation that I was indeed still in the vein and not in the tissue. So I cranked the administration wheel to wide open while holding the IV in place, my partner squeezed the bag, shooting the glucose directly into his veins and through his entire circulatory system. Within a minute the man stopped fighting, minutes later he began to come around. After titrating the amount of glucose and re-testing his sugar level until it was at an acceptable level I slowed down the infusion. He was fine and began speaking with us. He apologized for the inconvenience and thanked us for coming to help. I don’t think he had any recollection of trying to kill me or bite my fingers off, but that's probably for the best. We disconnected the IV and bandaged the site while chatting with him for a bit and giving him tips on how to manage his diabetes.
Just 30 minutes prior I walked through his doorway. It was a large apartment and the entire living room opened up into a vast area with vaulted ceilings and decorative lighting. There was a big yellow wrap around couch and a variety of comfy furniture and typical household decor that you might expect. However, even from the doorway he stood out to us like a beacon in the night, slumped over on the couch loudly mumbling incoherently and moving his legs as if he was riding an invisible bicycle. It was a queer site and certainly caught my attention. I took a knee next to him to check his vital signs but had to take evasive action immediately afterward. He starting swinging his fist at me and screaming. While avoiding his flailing extremities, we spoke with his wife. She informed us he's a diabetic and that he gets like this if his sugar gets to low. I caught one of his fist with my hands and held his arm down firmly whilst my partner poked his finger with a small needle. The bright blood slowly began to ooze from the wound and formed a perfect droplet, delicately clinging to the pad of his finger while the rest of his body was busy break dancing. We pressed our glucose monitoring strip against the blood drop and it began to analyze his sugar level. A few seconds later the reading came back as very low. I opened our medical kit and took out the oral glucose, which is essentially just sugarpaste. I began to slowly squeeze the tube of sugarpaste in his mouth, but he was more interested in trying to bite my fingers off. His sugar level was so low that he was extremely confused and very aggressive. I needed to keep my fingers for other things, so I had to develop another plan. I got his wife to come over, selfishly hoping she didn't need her fingers as badly as I did. However, also hoping he would recognize her enough to calm down, and he did for a moment, which is all we needed. I assisted her with squeezing the remainder of the sugar in his mouth while he continued to scream, kick, and mumble incoherently. He was struggling and sugarpaste was getting all over his face in the process. It took 2 of us to hold him down while giving him the sugar, 15 minutes later and 2 tubes of oral glucose later, he was the same. It was at this point I noticed his false teeth had become loose and he was beginning to choke on them, we quickly removed them, placing them off to the side while trying to avoid being bit He had decimated our entire supply of sugar gel like it was a diabetic appetizer.
I had to move on to more invasive procedures which I was hoping to avoid. We assisted him to the floor and gently laid his head on a couple of pillows. The old man was a fighter, he was not going down easy, he began fighting, kicking and swinging. My fingers wrapped around his his left arm and I held on tightly as the large needle punched through his skin like a pincushion. As expected, he became more livid and was struggling with more might than ever. I had managed to locate a large vein on his arm which perfect. There was not much time and it took a lot of strength to hold his arm down while the needle was in it. It was like trying to perform surgery on a rodeo bull, one wrong move and the needle would either go through the vein, miss it completely, or destroy the puncture site. The angle of the needle dropped and the teflon catheter surrounding it slid off with ease, advancing deep into the vein. I taped it down quickly, far from a work of art, but it was in. My partner connected it to the iv bag of glucose, but it was imperative the catheter remained in his vein, despite his physical movement. IV glucose can only be administered in a vein, if it touches normal tissue it destroys it. Obviously this was a risk we had to take given his condition, but we had to confirm the IV was good. I aspirated blood from the site, this was my confirmation that I was indeed still in the vein and not in the tissue. So I cranked the administration wheel to wide open while holding the IV in place, my partner squeezed the bag, shooting the glucose directly into his veins and through his entire circulatory system. Within a minute the man stopped fighting, minutes later he began to come around. After titrating the amount of glucose and re-testing his sugar level until it was at an acceptable level I slowed down the infusion. He was fine and began speaking with us. He apologized for the inconvenience and thanked us for coming to help. I don’t think he had any recollection of trying to kill me or bite my fingers off, but that's probably for the best. We disconnected the IV and bandaged the site while chatting with him for a bit and giving him tips on how to manage his diabetes.
Tuesday, January 6, 2015
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.
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.
Monday, December 29, 2014
Gloomy Day II
The chubby little boy was flailing his arms about like a mad man, his eyes were as big as saucers when he caught a glimpse of us rounding the corner. I presumed he was trying to direct us to the location of the emergency, but the more I focused my attention on him, and his awkward physical gestures; the more profound the dumbfounded look on my face announced itself. He started running like a whacky waving inflatable tube man and we followed closely behind. The grey clouds continued to move overhead as we made our awkward journey. Despite taking less than a minute to get to his location from the car accident we had just left, I had all but forgot about that now. Eventually the plump little boy lead us into a ramshackle apartment building, up to one of the top floors. The door to the apartment was open and we made entry with all our bulky equipment in hand and draped over our shoulders. Down the hall in a small bedroom laid an older man sprawled out on a terribly small mattress. He hadn't shaved in a few days and had cultivated himself a colorful pasture of black and white whiskers which to had dinsley sprouted from every pore on his face. In the middle of his vast field of facial hair was a prominent gaping mouth, with lips wide open. He awkwardly struggled as a fish out of water would have, fighting to suck in air. His nostrils flared attempting to increase in volume and direct more air into his body. The muscles of his neck, chest, and stomach were all firing like pistons, straining in an attempt to continue breathing. He could only speak in 3 or 4 word sentences and was in severe respiratory distress.
We gave him oxygen which he desperately attempted to suck in as we moved him downstairs.
By this time he was breathing around 5 times the normal rate and not really moving much air into his lungs despite the extreme effort on his behalf. He was getting tired, he couldn't keep this up for much longer. By now he could only speak in 1 or 2 word sentences and was pending respiratory arrest at any moment. I had seen it before, his time was almost up and he would just stop breathing any moment. He needed a special ventilator called Cpap or Bipap, but we didn't have this, in the absence of that he needed a procedure called “RSI”, which we did not have the resources and materials for either. I wasn't sure he was going to make it to the hospital, so I got the breathing tube ready in case he went into respiratory arrest. It was frustrating not having the things we needed to help him. As we loaded him into the ambulance I saw the terror in his eyes, the anxiety on his face, and the violent effort he was using to fight staying alive. Every breath was a challenge for the old man, and every breath could be his last. I had no choice but to take a “bag valve mask” which we mostly use during CPR to ventilate people. I showed him the device and told him it was going to be uncomfortable, but that I needed to force air into his lungs, he agreed and begged me to do so. After connecting oxygen to the device, I smashed the mask against his face firmly to create a tight seal when he was about to inhale and squeezed the bag full of oxygen attached to it, manually forcing much needed air into his lungs. The procedure was uncomfortable and adequate, but he was working with me and would motion with his hand when he was ready for me to squeeze in more air, in return I would press the mask firmly onto his face, smashing his nose in the process to create an airtight seal, then squeeze the bag of life saving oxygen, pushing it deep into the depths of his lungs while he tried to desperately inhale. It was primitive and crude procedure, but it was working, it was buying us time and his condition started to improve slightly. We arrived at the hospital and I was wheeling him out of the ambulance while ventilating him with the bag valve mask, he glanced up to the sky. He looked into the face of the dark grey clouds of todays gloomy day, perhaps in a moment to come to terms with the possibility of death. It only lasted a second before we cleared the hospital doors and got him inside, the doctor immediately placed him on the pressure ventilator he desperately needed to stay alive. I visited his room 15 minutes later and he was breathing fine with the help of the bipap ventilator he needed. He thanked me for helping him breathe and said he was feeling much better. All he needed was this one simple device to breath, luckily he got it in time. We probably saved his life, but only barely.
By this time he was breathing around 5 times the normal rate and not really moving much air into his lungs despite the extreme effort on his behalf. He was getting tired, he couldn't keep this up for much longer. By now he could only speak in 1 or 2 word sentences and was pending respiratory arrest at any moment. I had seen it before, his time was almost up and he would just stop breathing any moment. He needed a special ventilator called Cpap or Bipap, but we didn't have this, in the absence of that he needed a procedure called “RSI”, which we did not have the resources and materials for either. I wasn't sure he was going to make it to the hospital, so I got the breathing tube ready in case he went into respiratory arrest. It was frustrating not having the things we needed to help him. As we loaded him into the ambulance I saw the terror in his eyes, the anxiety on his face, and the violent effort he was using to fight staying alive. Every breath was a challenge for the old man, and every breath could be his last. I had no choice but to take a “bag valve mask” which we mostly use during CPR to ventilate people. I showed him the device and told him it was going to be uncomfortable, but that I needed to force air into his lungs, he agreed and begged me to do so. After connecting oxygen to the device, I smashed the mask against his face firmly to create a tight seal when he was about to inhale and squeezed the bag full of oxygen attached to it, manually forcing much needed air into his lungs. The procedure was uncomfortable and adequate, but he was working with me and would motion with his hand when he was ready for me to squeeze in more air, in return I would press the mask firmly onto his face, smashing his nose in the process to create an airtight seal, then squeeze the bag of life saving oxygen, pushing it deep into the depths of his lungs while he tried to desperately inhale. It was primitive and crude procedure, but it was working, it was buying us time and his condition started to improve slightly. We arrived at the hospital and I was wheeling him out of the ambulance while ventilating him with the bag valve mask, he glanced up to the sky. He looked into the face of the dark grey clouds of todays gloomy day, perhaps in a moment to come to terms with the possibility of death. It only lasted a second before we cleared the hospital doors and got him inside, the doctor immediately placed him on the pressure ventilator he desperately needed to stay alive. I visited his room 15 minutes later and he was breathing fine with the help of the bipap ventilator he needed. He thanked me for helping him breathe and said he was feeling much better. All he needed was this one simple device to breath, luckily he got it in time. We probably saved his life, but only barely.
Monday, December 22, 2014
Gloomy Day I
The thick grey clouds spanned across the horizon, first casting their shadow over the sea, and eventually over the edge of the city. Onlookers paused briefly during the hustle and bustle below to glance up at the heavens, if even only for a moment. Such an event was a rare sight in this part of the world and deserved some form of appreciation. Gradually, the subtle darkness swept across soft rolling sand dunes, busy downtown streets, and the homes of millions. It continued to consume every inanimate object and living creature, devouring all in its path. Eventually it quietly encompassed everything as far as the eye could see. It was mid-afternoon and although a gloomy sight to most, the sudden overcast reminded me of home. However, its dimsyl presence was more than just coincidence, it set an eerie ambiance for what lay ahead.
The radio chatter soon replaced any thought provoking reflection which lay in the clouds, the transmissions began to increase, ambulance after ambulance being called for assistance, finally, my number was up. We hit the lights and sirens and began to navigate the grey gloomy afternoon streets. Our ambulance had an unquenchable thirst for fuel that we generously fed with speed. We were really picking up momentum, weaving around non-compliant drivers,swerving around obstacles, our tires screeching; truly complimenting the loud sounds and bright lights that continuously erupted from the speeding ambulance. We continued barreling towards our destination, dawning our gloves and documenting our times while trying to avoid accidents and subconsciously thinking how driving in the middle east is insane. Moment later I could see the police lights around a motor vehicle collision in the distance. We finally came to a rolling stop at the scene of the accident as I opened my door, only to see that another unit had beat us to the incident. The other crew waved us on because our help was needed elsewhere, the city was out of ambulances and calls were backed up in a queue. There was another call just around the corner. Both of my feet never even hit the ground and I reluctantly closed my door as we headed towards another emergency. Unbeknownst to me it would be a matter of life and death. To be continued…
Saturday, December 6, 2014
Its Raining Men...
He could feel the cool breeze against face as it tickled his eye lashes and gently caressed his hair. He was lost in thought and it was a perfect moment for it, a moment unlike any other he had ever experienced. It was early in the morning and the city was still fast asleep. Only a handful of cars and people could be seen on the otherwise busy streets of downtown. He was about 30 and had been working away from his home country for sometime, but today was his big day. He took in the view and admired the empty streets as the gentle breeze gradually developed into an ever growing wind, relentlessly whipping against his face as it continued to pick up speed. Soon its force made it difficult to keep his eyes open and his clothing began flapping recklessly against its power. However, the power of the wind would soon be trumped by another force, gravity.
On this otherwise peaceful and quite morning, the silence was suddenly shattered as his body hit the hard pavement below. His journey came to end. He had jumped off the highrise building from about 80 meters above just seconds earlier. There was no surviving this fall, but I was called by the police to pronounce him dead moments later. I arrived to find the police combing the area and taping off the crime scene. I took a knee next to him and looked into his glossy eyes which were still wide open. I looked back at myself in the reflection of his eyes and couldn't help but wonder. Wonder what his last moments were like and if he had any regrets. Unfortunately, there was nothing I could do for him and I had to disregard my own thoughts and callously go through the motions of doing my job. After confirming his death for the police and printing a "flat line" ECG rhythm for my report, I left the ECG electrodes I had placed on his skin in place, and covered his body. Minutes later we were off to another emergency where we could be of better assistance.
Subscribe to:
Posts (Atom)