Right Before My Eyes

We were responding for an elderly female with breathing problems just before eight o'clock in the morning.  When we arrived we were led to a room in the back of the house where my patient was sitting in a chair unresponsive. She was moving her lips a little, drooling (her dentures were still on the dresser), and had pretty shallow respirations with no palpable radial pulse.  I asked the first obvious question of "Is she diabetic?" and was told by the family that yes she was.  Bingo, no problem. I quickly took a blood sugar reading and it came back well into the normal range. Oh, okay, time to start thinking and acting quickly. My firefighter had obtained vitals and had the patient on oxygen by this time. Her blood pressure was quite low and we weren't getting a very good reading off of the pulse oximeter (to read pulse and blood oxygen saturation).  She was completely unresponsive but was still breathing and had some purposeful movement. I checked her pupils which were smallish and not very reactive. The ambulance arrived and I gave them a quick rundown and suggested that we not muck around on scene getting the IV and 12 lead ekg but instead move straight to the ambulance and work there on the way to the hospital - I didn't like the way this was going. The ambulance crew went to ready the gurney and my firefighter and I picked the woman up and carried her outside to the waiting gurney and in so doing apparently killed her.

By 'we killed her' what I mean is, when we set her down on the gurney I noticed that she was no longer breathing and after a quick pulse check discovered that she was also pulseless.  She must have coded right in our arms. My firefighter had immediately headed back into the house to gather up our gear and clean up. I called after him to get the Lucas (CPR) Device but he didn't hear me. I sent the captain off to the rig to retrieve it while we started chest compressions and quickly loaded the gurney in the ambulance.

The captain and I climbed aboard the ambulance and put the Lucas on the patient and fired it up. At this point my firefighter arrived back from getting our gear and, not seeing us anywhere by the fire engine, popped his head in the open door of the ambulance. He of course had no idea that any of this was going on and was quite surprised to see that we were now working a full code in the back of the ambulance. He merely said, "Oh" and got to work helping us out. I wasn't able to get an IV so went quickly to the IO, easily screwing the needle into her tibia and got the line flowing. The ambulance medic got us a good ET tube and we were off to the races. I administered one round each of Epinephrine and Atropine and after circulating the drugs for a couple of minutes we stopped CPR for a rhythm check and found our patient to be in a sinus tachycardia (rapid heart rate) with a corresponding carotid pulse. A quick blood pressure check yielded results of almost 200 over 100 and her capnography (CO2) numbers were dead on - no pun intended. She still wasn't breathing on her own so we continued with the assisted ventilations but stopped the IV fluids and chest compressions. The hospital was only about five to ten minutes away so it was a pretty short trip. The ambulance had rung down the ER and told them what we had and the staff was waiting for us when we arrived.

When we moved the patient to the ER bed, the ambulance medic gave a rundown of the call, and before I left the room I heard the ER doctor saying something to the effect of "they did an excellent job" - rare praise from an ER doc. Five minutes later we were deconning our equipment outside by the ambulance when my captain came out and told us that our patient was now breathing on her own and had a BP of about 140 over 80.

This call definitely demonstrates the truth and importance of the Chain Of Survival:

This woman had no down time since she coded right in front of us, had immediate and proficient CPR, an advanced airway, IO access, and medications all within a matter of minutes after she coded.
I still don't know what the underlying cause was, although the ambulance medic said it sounded like she had fluid in her lungs, and I don't know if she will leave the hospital neurologically intact or if she will leave the hospital at all. But, leaving the scene with a dead patient and arriving at the hospital with a live one is a pretty good run for us.