Posted by: medicblog999 | October 10, 2009

Simple actions can save lives

As any paramedic or EMT will tell you, the opportunities to really make a difference dont come around very often. The times when you can say that you actually did save a life.

There are many times that we can say that we relieve or ease ย someones suffering, or help them get to the place they need to be, to continue their care. Even just reassure them and let them know that everything is going to be alright.

These are the reasons why we come to work day after day and night after night. Some would argue that it is self indulgent, but the feeling of actually helping someone or even sometimes saving their life is a wonderful one, not generally experienced by the vast majority of the population on a daily basis!

This was one such time…..

Working with my crew mate Tim, we were dispatched to an elderly male collapsed outside of a local cafe. No further information was immediately available, so this could be one of many different scenarios we were travelling to. During the drive, I had the ‘spidey sense’ feeling come over me, and looked over to Tim.

M999: “This is going to be an arrest, I can just feel it”

As we arrive on scene, I glance into the door way and see our patient sitting slumped against the door. His head virtually resting on his knees, obviously unconscious. Even from this distance I can see the all too familiar blue/purple/grey tinge to his lips and face.

M999: “Told you….Lets have the stretcher straight off and we will get him into the back”

As Tim lowers the tail lift and gets the stretcher from the back of the ambulance, I grab the first response kit, Oxygen and defibrillator. As I arrive at the patient, a member of staff (who is just standing over him) says

“He is still breathing isnt he?”

M999: “Er….No, no really. Can I get into him please…..Thanks!”

I get behind him and place my arms under his. I pull his dead weight up and around to the side so that I can manoeuvre him away from the door and onto the path,lying him down in the process. As soon as he is down on the ground, on his back, with his head and neck at the proper angle he takes a couple of agonal gasps. For those that dont know, these are like a last ditch attempt by the brain to try and get some oxygen into the brain and heart to maintain life. They are also the reason why recent CPR guidelines have changed from “is the patient breathing?”, to “is the patient breathing normally?”.

A patient’s heart could have stopped and they could still have a few agonal gasps before they stop as well. Many members of the public understandably assume that an agonal gasp means that the patient is breathing and therefore has a heart beat.

(Just as a side note – here is a video clip from you tube of a successful resus which shows a great view of ‘agonal respirations’ at 3:30 in to the clip)

In this case, it just so happened that my patient did actually still have a heart beat, although going a little slow. Cool, we might get this one back!!

Oro pahryngeal airway in, Bag and Mask on, good seal and good ventilation…..Champion.

Tim brings the stretcher along side and we hoist our patient onto it and move him into the back of the ambulance. Now for the choices, how do I maintain his airway?

He is tolerating the OPA, therefore I consider intubation or LMA. In this case, I opt for one of the iGel LMAs that I have been trialling. It goes in easily but my gentleman decides that he doesnt really like having a big piece of plastic/rubber pushed down his throat and his gag reflex starts to kick in (Great!!, these are all good prognostic indicators). As I was getting good air entry from bag valve mask, then it’s a no brainer to just go back to OPA and BVM which he tolerates well. Tim gets the ECG and monitoring attached, then takes over ‘bagging’ our patient whilst I gain some IV access. I then decide to free up one hand by attaching the face mask to our ventilator instead of manually compressing the bag to ‘breathe for the patient’. I set the ventilator to CMV/Demand, which means that the machine will do the breathing for the patient at a set rate, but if it detects that the patient attempts to take a breath for themself, then it will provide support for that intake of breath also (Clever stuff really!)

Once all thats done, it’s just time for a quick pre-alert radio call to the hospital and off we go, lights and sirens up to the hospital.

On the way, as I test for response to verbal stimulus, his eyes flick open for ย a short split second. I try again and the eye’s spring open once more. 5 minutes down the line and I hear the ventilator change its rate in response to a deep breath taken by our patient. His heart rate is back to normal limits now and things are most certainly looking up.

By the time we transfer him to the waiting team in resus, he is now making regular efforts to breath and open his eyes when you verbally prompt him to.

He isnt out of the woods yet, but is certainly on the right path.

I complete my paperwork then pop back behind the curtains to see how he is doing before I leave. I find out that his name is Richard and according to his records is a 74 yr old COPD sufferer. He is now breathing regularly and doesnt need bagging. The doctor in charge of the team gives us a ‘well done lads’, and off we go with a bit more of a spring in our steps than before.

So did we save a life, that day?

5 hours later, we were taking a routine admission patient into the medical admissions unit of the same hospital. Once we had got that patient moved over onto her bed and handed over, we left the ward, moving past the various patients waiting to be seen and moved onto the ward they will be spending their time in. I passed one man happily tucking into his evening meal (which actually looked rather tasty – or maybe that was just because I was starving) and had to stop and take a second look.

M999: “Tim, look!!…Thats Richard!!!”

I decided not to disturb him, It is highly unlikely that he would remember Tim or I, and to be honest, it was enough to see him sitting up eating his food, not even on any oxygen.

As the title to this post states, ‘Simple Actions Save Lives’

The single most important thing that I did in this case was to move Richard from his position we found him in and open his airway. If that had been done earlier by a member of the public, he would never have been so close to death. What the medical team think happened, was that he had difficulty breathing with an exacerbation of his COPD which ultimately made him lose consciousness. Once this happened his position in the door way resulted in his neck flexing forward to the point that he obstructed his airway and effectively asphyxiated himself.

The action of opening an airway and breathing for him for a while was all that was needed to get him back from the precipice.

It may not be much, but it feels good!!

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Responses

  1. Oh my! Thanks for sharing that. As a newly qualified first aider, that’s really helpful to me, reinforces why I’m doing this, and why it’s the small things – airway, breathing, circulation – that are important.

  2. Blimey, that was incredible to watch! It’s almost miraculous the way he goes from being completely lifeless to breathing and opening his eyes in the space of a few seconds. A very, very lucky young man ๐Ÿ™‚

  3. Good BLS before ALS everytime.

  4. Some shameless promotion of something I really believe in http://www.callandpump.org – Continuous Compression CPR that really works well.

    I use it and I’m a believer.

  5. I’ve just been trained to use iGels, along with OP airs, as well ๐Ÿ˜€ look like a great bit of kit actually. How easily can you pop them in in a pre-hospital setting? Quite fun being able to give salbutamol as well :p

    The video was way more educational than you perhaps meant it to be – I’ve never actually seen CPR being done on a person before, so now I know how a person may act (although it was probably slightly rare for that one – the tongue movement surprised me), and what an AED will do to someone when you push the button to shock them.

    So not only have you saved a life, you might have helped save another indirectly someday ๐Ÿ™‚

  6. WELL DONE!!
    I can proudly say that I’ve worked with that man!!

    Hope your well

    regards,

    Eamonn

  7. Well done. If only they all ended like that.

  8. Part of me wants to see what an iGel is like properly, but that’d mean doing CPR on a real person! No Resuscianne for me! I assume that if they start to gag it out, it’s very noticeable?

    Also, if you fancy having me down to observe for a night let me know ๐Ÿ˜‰

  9. The British Heart Foundation runs a scheme to train laypeople in CPR. It’s called Heartstart UK, and it also deals with the recovery position, dealing with choking and treatment of severe bleeding.

    Originally designed for adults, the BHF realised they were missing a trick. They decided to catch ’em young and developed a scheme for schools.

    This scheme will take kids as young as 5 and teach them age-appropriate techniques (which may be as simple as getting Mrs Next Door to call an ambulance). Children 10 and above get the works, as a 10 yo can perform effective CPR on an adult.

    I’m currently arranging for the three secondary schools I work at to take the scheme – and I have provisional agreement in all of them. Within a year, we could have trained 3,000 kids in the techniques with another 500-600 trained every year thereafter.

    If you’re interested in the scheme, contact your Community Defibrillation Officer.

  10. Thanks for sharing this incident. Very aptly titled post.


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