Well, She's alive....for now

"Person down" the radio advised. Not much more needs to be said. We know that means someone, somewhere isn't breathing. Seconds tick by, minutes make the difference. We were en route to help her. Dispatch came back saying "language barrier, family attempting CPR". The fire engine called on scene quickly, and we were close behind them. We grabbed handfuls of equipment, slung straps and bags over out shoulders, and hiked up the steep, weathered steps leading to the porch. The home was an old, run down duplex, like all the others on the street. The grass was sparse and brown, and broken glass bits protruded in between the gravel on the path. The homes in the neighborhood had seen better days. If you've seen the movie "Gran Turino" you can picture the general idea. Same situation, much worse conditions. The housing used to be for workers of a local textile mill. The mill has long since been turned into urban loft living, and immigrants have taken over the neighborhood. Nobody for six blocks spoke English. We pushed our way into the humble abode. It was dark and hot inside. Our patient was on the hardwood floor on her back, not breathing. She was on the floor, but one could tell that when she was upright, she was built of short stature. I noticed her hands and feet. Small and delicate, but not afraid of hard work. We rolled her onto the backboard and carried her out so we could work in the truck.

The supervisor had showed up as we were loading her up inside the house, and didn't hesitate to jump in. He grinned like a schoolkid as he sat in the captain's chair in the back of the ambulance. That was the airway seat, and it was his way of saying he wanted the tube. That was fine with me. It was my call, and my patient, but I have intubated enough people that it has lost all of it's novelty. I'm sure the supervisor has as well, but it's probably been a long time since he got one. Someone else started an IV with some fluids on her. I started pushing drugs, and analyzed her heart rhythm on the monitor. Asystole. Flat line with a tiny little squiggle here and there. According to her family she had complained of difficulty breathing then collapsed. She hadn't been down long at all. She still had a fighting chance. Her brown skin was showing signs of discoloration, and purple was peeking through. We pushed a round of drugs and did some CPR. The monitor showed fine v-fib. Probably just the drugs working, but we had to shock it. Surely she would go back into flat line and stay there after that. But she didn't.



The monitor showed a better rhythm but still no pulse with it. We pushed more drugs and did more CPR. We checked her blood sugar and gave her more medications. Her rhythm on the monitor showed more organization, more like it should, but she still had no pulse with it. It only took us three minutes to get to the hospital, and we were met on the ramp by anxious techs, ready to get her into the ER and spread out a bit and work. They took her into a waiting room, and the chaos began. A nurse began writing furiously as we rattled off what happened, how we found her, what we did for her, and what drugs we pushed. Someone felt her neck and another gloved hand palpated her femoral artery. "She's got a pulse" someone announced flatly. It was probably just the drugs. Surely she would code again, and more drugs would be pushed. More CPR would be done. Only she didn't.

Her blood pressure stabilized without the help of dopamine or other pressor drugs. A ventilator breathed for her. Her heart kept beating on it's own. Her ribs were broken. Her body lay in a delicate balance. For now, she's alive. We did what we could.