January 19, 2011

The odds.

A firend of mine that lives in Canada is on the town. He is also a Paramedic and he enjoys the Mexican EMS system because of the diversity of the patients that you can come across. I told him to ride with us that day.

It was past midnight when we got a call.
A 80 year old lady has fell.

We made more or less 8 minnutes to the scene. When we arrived and entered the room it was obvious dispatch had it all wrong. She was in cardiac arrest.
(Of course she fell but is different falling because you tripped rather tha falling because your heart stopped. You suck dispatch!)

My friend got her on the ground of the 3 x 3 room and started the CPR. I hooked up the cardiac monitor to see what was going on with her heart. Two minutes later the CPR stopped so we could see the electrical activity that her heart was having.... she didn´t had any. She was in asystole. In the world of cardiac resusctation that is closer to being in the grave than anything else. Its a very long shot, i tought, but well, lets give it a shot, every one deserves an opportunity.

We carried on, my friend switched with another parter for CPR, he placed a tube on her throat, i placed an i.v. in her arm. The meds went in. I pushed a couple of times epinephrine while my partners switched positions a couple of time so better CPR is performed by someone who is not tired.

6 minutes went by, cpr stopped for the 3rd time so we could see what was going on with her electrical activity (EKG). Everything just froze, everyone looked at the cardiac monitor. Then we saw it. We heard a "beep", YES!, thats it, an organized beat. We got our fingers on her neck to see if there was a pulse....

There was none.

Well, we are making some progress, lets give her another 2 minutes of CPR and more epi.

2 minutes later everyones attention was again on the cardiac monitor. When the cpr stopped we looked at the screen and it was clear as normal saline. She had a very good rythm. Again our fingers went for the neck. And there it was; A pulse!!. Not normal, a little weak, but a pulse.

After a couple of more medications and a switch to a transport ventilator we got her out of there and into the hospital. The way out was not easy, it has a very small house. But with a little help from another unit we could manage to get out of there smooth and safe. We arrived at the hospital.

Out of the hospital return of spontaneous circulation in the USA is very low. Imagine here in Mexico, where no witness CPR is performed, where no instructions are given over the phone, where only one of every 10 ambulances has a cardiac monitor and sometimes the "paramedics" don´t know how to use it.

But still, there we were, we gave her an opportunity, she took it.

I wish with all my heart that you can make it out of the intensive care unit and give a hug to that son of yours that got out of the way the fridge with one push when we asked him if he could make some room for the stretcher.

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