First Code Save

[island emt]

In the 40+ years I've been in EMS, I can count on one hand the rosc's that survived to walk out of the hospital w/o major deficits.

Three of them were witnessed arrests [by us] and the other two were rapid bystander CPR with defibrillation in under 5 minutes from arrest.

Had a Save last week who was in resp arrest and pulse less than 30 by carotid on my arrival at the dock where he was brought in by fishing boat.. Went pulseless several times over the next 10 minutes. with a non shockable rythm.

Got airway opened with a nasal as he was clenched tight. Regained spontaneous pulses at 50 bpm. Lungs were tight all fields with wheezes & rhonchi. neb tx by mask and he started breathing normally. Still unresponsive, ????/ maintained airway and monitored 12 lead showed a-flutter with non st elevation & some wierd depression waves irregularly, along with a few runs of psvt along the way during the 35 minute transport.

To quote Paul Harvey:

Now the rest of the story!!!

Come to find out he had been chewing fentanyl patch with his morning bagel and had OD'd on it

As they were getting set up in the ER to paralyze him for intubation, someone decided to try narcan, 2mg got a little response and 2 more brought him almost fully awake.

Didn't see that one coming.

He was sent to ICU for three days and released.

[Arctickat]

Do you track those numbers or are those numbers tracked by your company for each person? Another way?

I track the numbers for the entire company. I use the Physio Control software suite. Since 1993 we've only done 127 codes, so it's not like it's a lot of work.

[BushyFromOz]

what does that say about CSU trained, vic ambos bushy?................told you to stay in nsw..

Tells me that im unlucky that none of my ROSCS were in the 30% of our arrests that go home alive.

Hey Bushy! Good to see you!

Thanks bloke, hard to keep up with this joint... im busier than a one legged man in an ass kicking contest... can barely find time to sleep

[Kiwiology]

Good work mate

When i first got hooked on this deal known as the Ambulance Service every job had to be a cardiac arrest or it was not a "real" job, I'd secretly hope each time we got tone called it would be loudly announced over the station speakers that it was a cardiac arrest, for if it was not a cardiac arrest it was not a real job.

Now that I've grown up a bit I absolutely fucking hate cardiac arrests and wish to never ever go to one. Brutally invading somebodies house and their person only to jump up and down on their chest and electrocute them, have four or six people haemmorhaging around their living room and giving the family false hope only to go "well he's dead, cya" and go back to the station is not my idea of a "real" job; I would rather go have a cuppa and bikkies with Nana after picking her up off the floor.

[chbare]

However, the occasional outlier does occur. Had one recently while precepting students. Patient experienced V-fib arrest in front of the EMS crew and was successfully defibrillated with ROSC. Patient coded in the ER and cath lab with successful defibrillation attempts and CPR. Ended up going to the theatre for a CABG. Post operatively the patient was moribund. A balloon pump was inserted, we had the patient on multiple pressors and dobutamine along with an antidysrhythmic infusion. Also ended up giving blouses of insulin and starting an insulin infusion and we had to administer bicarb for a profound metabolic acidosis. My students and I cared for the patient throughout the week. The patient went from being completely unresponsive to being successfully extubated and having us help the patient into a chair by the end of the week. The patient was neurologically intact and conversing with family. Interestingly enough, the patient's spouse was very happy to have us around and caring for the patient and even said that they hope the students were learning. Pretty gratifying all around and several of the students have come away with a very different appreciation of the ICU.

[Kaisu]

I've had the survival to discharge a couple of times that I know of. A lady that coded in the back of my rig, then coded 3 times in the cath lab. I went up a few days later to see her. She was sitting up and thanking me for being her "saver". The one I will never forget is the 3 1/2 week old discharged 2 days later with no deficits. You just never know.

[Kiwiology]

There were recently 39 cardiac arrests in an 8 day period here, only 2 survival to discharge

CH, not to derail but what was the point of the insulin in your pt?

[chbare]

Euglycaemia following cardiac surgery.

[Kiwiology]

Ta, here is a recently aired piece on out of hospital cardiac arrest here in NZ, the Intensive Care Paramedic in the story is a guy I know not really well but sort of, he's only in his mid 20s which is extremely young for an ICP here.

http://www.3news.co.nz/Paramedics-talk-about-saving-lives/tabid/367/articleID/244947/Default.aspx