My crew yesterday included a paramedic who is actually a fairly good medic, but he has less than 2 years as a medic. There was also a new EMT and an excellent EMT who has been getting pushed by me to attend medic school.
We arrived at the home of a 90 year old woman for a reported fall. It seems that her neighbors stopped in for a visit and found her on the living room floor, and the victim stated that she had fallen, and her back was hurting. She also said it was difficult to breathe. She was on the floor, and was pale and diaphoretic. She has no radial pulses. Her BP was 86/p, pulse was 40. Out in the truck, the monitor shows:
(If you look closely, you can see where we were preparing to pace)An IV is established, a 12 lead EKG is established, and the Pacer pads are placed on the patient. Pacing was begun, and we got capture at 50mA. Three minutes later, she became apneic and went into PEA. We started chest compressions, and gave her a 500ml fluid bolus. Pulses returned.
When we arrived at the hospital, the same doctor from last week did not believe us, and felt that our rapid return of pulses indicated that the patient could not have coded, and we were mistaken. It went like this:
Dr: Why did you start CPR? What made you think it was PEA?
DM: She did not have a pulse.
Dr: Why did you stop CPR?
DM: We did one minute of CPR, and got ROSC.
Dr: How did you know that?
DM: She started moving her arms.
Dr: So you were doing CPR on a woman who was moving?
DM: No.
(In the background, the nurses have removed the pacer, per the Dr's orders- the patient has now gone into cardiac arrest again)
A code is called, and they get pulses back. I left. That Doctor is going to kill someone.
