“You were quick!” says the very pale looking man who answered the door. He looked like the person that we were calling to see – a male in his 70’s who is complaining of shortness of breath with hemoptysis, hence the small amount of blood on his top lip coming from his nose and mouth.
I manage to get him sat down quickly and try to take his pulse at his wrist while finding out his name and how long he has been feeling unwell. I find out that he has been short of breath for two weeks and is being treated with steroids by his GP. He looks very pale, he seems short of breath, but his breathing isn’t very noisy (which is normally a good sign), he has poor circulation in his finger tips and our oxygen saturations probe is telling me that he is only getting 72% oxygen saturation on air. Is this a true reading though as he is peripherally shutting down!
My colleague has already noticed the signs and has the high flow oxygen ready to put onto the patient, he is also trying to find a pulse and can’t find one. I quickly get on the phone and request backup from a Paramedic, luckily I know there is one nearby who is working with two fire-fighters on a fire service 4×4.
As soon as I have put the phone down the patient goes rigid in his chair and stops breathing. We instinctively get him on to the floor and lie him on his back, we put a oropharyngeal airway in and start ventilating the patient with a bag valve and mask. my crew mate runs back to the ambulance to get our defibrillator whilst I ventilate the patient, try to find a carotid (neck) pulse and then call control to update the Paramedic that we now have a Cardiac arrest.
No pulse found, patient isn’t breathing, I have seen him collapse, I punch him hard in the chest (precordial thump) and start full Cardiopulmonary Resuscitation. The Laryngeal Mask Airway just won’t seat properly and I keep getting too much air escaping despite trying to re-site it twice. The ECG is showing Pulseless Electrical Activity which means that we can’t defibrillate him.
Thankfully the Paramedic comes in, he takes over the compressions and I continue to maintain the airway whilst I give my handover and tell him what has happened so far. He then hands over to a fire-fighter to carry on with compressions whilst he intubates the patient as we know we will need to move him. I get a cannula into his external jugular vein and now we can start getting drugs into him. Despite the good CPR and the addition of drugs we still se no change in his ECG – not good!
The helicopter has now been scrambled to us, we have a fire service 4×4 outside and the Police are now on route to help close any roads that the helicopter may want to land on. The helicopter pilot decides to put down on a nearby playing field which means that we have to carry our poor man over the snow and ice to the back of our ambulance and then drive gingerly to the playing field, we quickly load him on to the helicopter and handover to the two Paramedics and Doctor on the aircraft who then whisk him off to an Emergency Department somewhere.
The job went well. Its unusually luck to go into Cardiac Arrest in front of medically trained people who can help to get you back. Its unusual to get good CPR, a defibrillator and then Paramedic intervention so quickly, but equally its unusual for a patient to not be in a shockable rhythm so soon after their heart stopping.
Its even more unusual for the patient to meet you at the door, fully conscious and smiling, to leave you via helicopter unconscious not breathing and no heart beating….
