#cardiophile resus resuswriting

[intubatedangel]

Barrista’s Bad Heart - part 5

Part 1: https://intubatedangel.tumblr.com/post/183302348002/baristas-bad-heart-part-1

Part 2: https://intubatedangel.tumblr.com/post/183345519857/baristas-bad-heart-part-2

Part 3: https://intubatedangel.tumblr.com/post/183380872877/baristas-bad-heart-part-3

Part 4: https://intubatedangel.tumblr.com/post/183471507287/barristas-bad-heart-part-4

***

It was tense in the cab of the ambulance. Dave and Lucy were both silent, the only noise was the siren that rang out from their vehicle. Normally they would be chatting and joking, engaging in the gallows humour that often developed after a few years on the job. But some calls were enough to dampen any considerations of humour. A young woman in cardiac arrest was one of them.

 “Control to 3008, requesting update on your ETA.” The voice came over the radio set in the dash. Lucy reached down and grabbed the handset, letting Dave focus on driving through the busy city streets. Thankfully there were plenty of bus lanes that allowed them to skip past the slow progress of the afternoon traffic.

 “3008 to Control. ETA under 2 minutes.” She paused then pressed the talk button again. “Do we have an update on patient condition?”

 “Control to 3008. Officers on scene are reporting that the patient is currently asystolic.” Lucy glanced at Dave, but he was focused on the road, weaving out of the bus lane towards the pedestrian zone where the coffee shop was located. He leaned on the horn as one car was slow to react.

 A police officer was waiting at the end to wide pedestrian street, standing over a pair of lowered bollards. He waved the ambulance through, and they slowly advanced down the street, the crowds parting before them. They had to stop half way down, Dave quietly cursing the local council’s decision to put decorative platers in the middle of the street. He put the ambulance into park and they both hopped out.

 Lucy jumped in through the side door and started to dump equipment onto the gurney. The monitor/defib, drug bag, airway supplies and the hard-plastic CPR board. She nodded to Dave as he opened the back door. They had everything they ought to need.

 They jogged the 120m to the coffee shop, a police officer stood outside keeping the crowd back. With an authoritative shout he made the crowd part for the two paramedics. They nodded their thanks as they slipped through into the coffee shop. To one side another officer was slapping a pair of handcuffs on a middle-aged woman. Lucy deliberately ignored her pleas, focusing her attention on the younger woman that lay sprawled on the floor by the counter.

 Her abdomen was bulging roughly but rhythmically as another young woman pounded on her lifeless chest. Lucy saw the ECG electrodes and followed the leads to the small monitor. Artefacts from the cpr bounced their way across the screen. The two medics stopped the gurney a few feet back, grabbing the kit and placing it on the floor.

 “How long has she been like this?” Lucy asked the young man at the patient’s head.

 “She collapsed 9 minutes ago, in v-tach. CPR started immediately. Three shocks so far, she became asystolic 4 minutes ago. We’re assuming a suspect heart condition.” George waved at the monitor. “She’s got good pulses with compressions and no outward signs of injury or reaction.”

 Lucy nodded along, storing the information in the back of her mind as she prepared the monitor. Dinah finished the minute of compressions, yielding to Dave’s firm hand on her shoulder and shuffling out of the way. The AED analysed for a moment and the small monitor returned to a flatline. Dave started compressions before the AED could tell him too.

 “Med student?” Lucy asked the young man. He nodded. She turned to the airway bag, grabbing a purple ambu-bag and handing it to him. He took it and quickly removed the pocket mask from Amelia’s face. Lucy caught sight of her pale greying lips before the mask of the ambu-bag covered them again. Without having to be told, George squeezed the bag every 3 seconds. Lucy nodded to herself, then reached over and pulled the 3 ecg electrodes off Amelia’s pallid chest. They came away with a noise like ripping off a band-aid, leaving soft red marks on Amelia’s skin.

 Lucy already had 3M Red-Dot electrodes attached to the 5 leads of the ambulance monitor. She placed three of them on the red spots where the old electrodes had been, the fourth mirrored the lower of the 3-lead electrodes, just beneath the ribs but on Amelia’s right hand side. The fifth nestled just below her right breast, next to the purple compression sensor. Lucy flicked the monitor on, turning to the drug bag as the monitor started up.

 She pulled out an IV kit, quickly poking it into the large jugular vein. She taped it down, pushed in 1mg of adrenaline, then hooked up a bag of saline to flush the epi through. She handed it off the Dinah, who squeezed the bag of fluid gently.  

 All of this had taken just under a minute. Dave stopped compressions at the AED’s command, looking to the monitor as he peeled away the AED’s pads. A piercing, monotone, whine filled the coffee shop, the flatline streaking across the screen. Unsurprising, given the epi hadn’t had time to circulate. Dave tossed the pads to one side and placed his hands directly on Amelia’s sternum, her skin cool. He began a fresh barrage of compressions while Lucy sorted out other drugs.

 She pushed them into a small port on the IV line that hung down from the saline in Dinah’s hand. With that done she shifted around behind Dave, moving to Amelia’s waist. She undid the top of Amelia’s pants, easing them down slightly, revealing green underwear that matched the bra still hooked around Amelia’s shoulders. Lucy slid her hand into Amelia’s pants, her gloved fingers finding the artery in her thigh.

 “Good femoral” She told Dave, looking up at George. His fingers were against Amelia’s neck. He nodded in agreement, feeing the same surge of blood being forced out of Amelia’s stopped heart as Dave squashed it between her sternum and her spine.

 Lucy returned to the bags, opening up the airway supplies and readying the intubation kit. She eyeballed Amelia’s petite frame and decided on a 6.5mm tube. She tore open the packaging, pulling out the tube and spreading some lubricating gel along the back edge, then set it down on a sterile drape next to the young woman’s head.  Lucy held a laryngoscope blade alongside Amelia’s jawline, then opted for one slightly smaller. She checked the light of the laryngoscope, attached the blade, and set it beside the tube.

 “Let’s check for a rhythm.” She told Dave. He pressed down twice more, then turned to watch the monitor. The alarm was different this time, a deep two tone ringing, and a much coarser rhythm bounced its way across the screen, uncoordinated and erratic, but at least the ventricular fibrillation was shockable.

[intubatedangel]

Barrista’s Bad Heart - part 4

Amelia’s chest twitched, like it was being pulled inwards. Her limbs shook slightly as the effect of the shock translated down her body. And then she became still. There was silence in the coffee shop for a stretching moment.

 “Begin CPR” The monotone voice of the AED commanded. With a glance at the small monitor George confirmed that the shock had not affected the dangerous v-tach rhythm. He interlaced his fingers and rose to his knees once more. He brought the heel of his hand down on the purple block. Some of his fingers gently brushed Amelia’s left breast as he positioned his hands, then he began to press down.

 The AED beeped out a rhythm to follow, the screen showing an analysis of each compressions. Each and every one was in the perfect centre of the target zone. It brought him no joy though, no pride, knowing that there had been an opportunity to prevent this. An opportunity he had missed, because he had been afraid of a middle-aged harpy.

 A timer in the corner of the screen counted down a minute, after which I told them to stay clear while it analysed. Dinah ignored it, having stepped around George to kneel by Amelia’s head. She leaned over, gently tilting Amelia’s head back, and gave the lifeless young woman a rescue breath. George’s hands, resting on the CPR block, rose slightly as the breath inflated Amelia’s lungs. As the air left her lungs, and her chest sank, the AED chimed that another shock was advised.

 George pulled back, the AED charging as Dinah gave Amelia a second breath. The red button flashed as the charge finished building and George checked that Dinah was clear. She raised her hands and nodded. George delivered the second shock to Amelia’s ineffective heart.

 Her chest twitched again, marginally more aggressively this time. The cups of her bra slid away to either side, revealing her nipples. Her head fell to one side. Dinah’s fingers immediately plunged into Amelia’s neck, as George looked at the small monitor.

 “Still no pulse.” Dinah murmured, cursing under her breath.

 “She’s gone into VF.” George replied, shaking his head. “Come on Amelia, don’t do this.” He hissed as he followed the AED’s command to resume CPR.

 He focused so intently on delivering compressions that he barely noticed the pair of police officers entering the coffee shop. One of them came over to Dinah and asked if they needed assistance. She explained they’re med students, and they’re doing all that can be done until the ambulance arrives. The officer nodded, handing her a small green case from his belt, then went to assist his partner in sorting out the situation.

 Dinah popped open the case and took out the pocket mask. George finished his round of compressions and leaned back to let the AED analyse again. He panted, half from exertion, part from frustration. He could see the shockable rhythm on the 3-lead monitor, but the fully automatic AED had no way to override the analysis phase. Dinah gently lifted Amelia’s head and eased the strap of the pocket mask down to the right place. She checked it was secure, then forced a breath in through the valve. Amelia’s chest rose greedily, then sank, the pocket mask hissing slightly as the air eked out of the return valve.

 The AED began to charge for the third time. “Let’s switch.” Dinah told George as she raised her mouth from the plastic mask. George nodded, shifting out of the way as Dinah slid around Amelia’s body on her knees. He tried to stretch some feeling back into his legs as his friend checked everyone was clear and pushed the flashing button.

 He watched as Amelia twitched, her chest being plucked upwards, her legs flicking out and splaying further apart. Her hand knocked against the face of the counter, fingers curled loosely. Dinah tuned to him and shook her head gently. He leaned over and caught sight of the monitor, a barely wavering line ran across the centre of the display. Amelia’s heart had stopped completely. She was now asystolic.

 ***

 George knelt by Amelia’s head as Dinah began her first round of compressions, pumping the young Barista’s chest in time with the AED’s metronome. He could feel the way her body rocked gently as he cradled her head, keeping her airway open. He leaned in close as the minute reached its end, sealed his mouth over the valve and blew hard. He watched her pale chest swell, her soft breasts rise, as his air filled her lungs.

 The AED stated that no shock was advised and started another minute countdown. Dinah returned her hands to the purple oval, locked her arms straight, then began rocking back and forth. Locks of her hair spilled forward, swaying with the rhythm of her compression. George gently placed his fingers on the cool flesh of Amelia’s neck, relieved to feel a small surge with each of Dinah’s compressions.

 He brushed her hair back slightly with the back of his other hand and used his thumb to ease open Amelia’s right eye. The chestnut coloured iris slightly reduced the size of her pupil as it was struck by the fluorescent lights of the coffee shop. It was a good sign. They were keeping her alive, they just needed to keep it up until the ambulance arrived with drugs to help get her heart beating again.