To shock or not to shock, that is the question?

This is is the ECG strip from one of my patients last week. Heres the dilema, he was a 45 year old male weighing about 400 pounds and recently loosing 200 pounds. He was at the gym working out when BAM! he collapses. We get on scene and he is talking to us but dripping in sweat. When we hook him up on the monitor we only saw the rhythm for about 5 seconds and one of the stickers came off because of the sweat. Looking at it for only 5 seconds was more than enough to get our hearts racing. We needed to get him out of there immediately! This is a lethal rhythm that can lead to a very not so "and they lived happily ever after" moment. So heres the question? He is fully alert, talking to us, blood pressure is normal, and mentation is A0X4. However, he is cool, pale, and diaphoretic. Do we shock him or do we administer Amiodarone? I would have synchronized shocked him (200J *he's a big guy), however we decided to take the less risky route. Reason being his blood pressure was stable. I still wished we would have shocked him, a bit of an ornery man he was. He did not want to go to the hospital and he was swearing at us and being super combative. He even refused treatment from me because of the way my perfume smelled. Seriously? This went on for about 5 minutes until we told him, "sir if you do not come with us, you will die." Straight to the point, words no one wants to hear, but they sure do make one think twice. He finally was sane and came with us. His fussing stopped after that and was super cooperative. Knowing i was gonna die i would too. We ran him in "hot" and administered 150mg of Amiodarone over 10 minutes. Being in the Paramedic program we were programed more like branded into our heads to automatically set this up as an IV drip set, however my preceptor showed me a great tip. If we dont have the time to set of an IV drip, you can draw up your 150 mg of Amiodarone which is 3ml and add to 7ml of Normal Saline (NS) in a Syringe. This makes it into a diluted solution that can be monitored closely and administered at  1ml of fluid per minute to a total of 10 minutes, which is the rate you want it at.
So we did this and it did not work, he was still in V-tach. I was very impressed with the patient's vital signs, other than the heart rhythm all other signs were stable. When we got to the hospital the nursing staff was freaking out and one doctor was happy that we didn't shock him and the other was mad at us that we didn't. We ended up shocking him (200J *like i said, big guy) with out any sedation (ouch!) and his heart finally converted to a normal sinus rhythm. He was rushed to the Cath lab and we found out that his heart's refractory period was about 15% (its bad). This means his heart is using minimal force to beat, he could die of a weak heart. Poor guy, i never knew the out come, but i hope his heart fought to live. He was on the right path to becoming healthier, but i guess it was a bit too late. So what would you have done? To shock or not to shock?

First week, done and over!

This week was my first week doing my ride-alongs with EMSA in Oklahoma City. I got assigned and awesome preceptor (this is what you call a paramedic teacher). She is super nice, but you can definitely tell she's the type of person you do not want to get mad! My shift starts at 6:15 in the morning and runs for 12 hours straight. In between emergency calls you sit in an ambulance at a random location, usually gas stations and "post" (meaning that you wait for the next call). At times you wait as little as 5 minutes before you get the next call and at other times you can wait for as much as an hour to even 2 hours.

This week I ran probably a total of 20 calls from a range of basic patients complaining of really bad headaches to advanced cardiac arrest calls. Its funny to think that my first ride-along at BYU-I was on the day of  9/11 at the Idaho Falls Fire Department. I remember being super nervous and anxious and not knowing what to do. Well now its been a whole year and the process begins all over again. My first day of ride-alongs in Oklahoma happened to be on 9/11 again, and the nerves and anxiety are still there. However, now i know what to do and actually be helpful to my patients.

The first call I ran was a DOA (death on arrival), usually we get these calls early in the morning when people get up from bed and realize that their significant other or the person they take care for does not wake up. What we do as paramedics is we try to determine for how long they have been dead and connect them to the heart monitor to confirm the death. Its really sad, but i kinda have an awkward story to share. So we are at the scene of death and the family members are just heart broken. Well some one decides to let the dog in and all the dog wanted to do the whole time was to go into the deceased persons bedroom. So I am trying to run around the whole house trying to catch this dog so that that he doesn't do anything to the body, and the dog thinks its a game, so he runs away from me. So im running around like a crazy chicken,  and all this is happening while the family is in the other room mourning. Can i say AWKWARD! Finally i was able to grab him by the ear and put him in the bathroom. Oh man! *note to self, keep some dog treats in pocket, you never know when you need to chase a dog.

Later that week

I had, plenty of over-doses usually on narcotics or alcohol. Respiratory distress, patients. Falls at nursing homes and plenty of seizures. Seizures are very popular during this time of year here in OK. So question? How many personel does it take to take down a patient who is combative after a seizure?..................Answer: A whole lot!! (5 Firemen, 2 Paramedics, and and EMT). Story- After a person has a seizure this phase is called the postictal phase and they can be disoriented. Our patient was super combative and very, very strong. I literally had to sit on top of him so that he could stop flailing and kicking his legs. We where able to restrain him on a backboard after half an hour of struggling with him, which seemed like forever! But he finally started gaining consciousness with a treatment of Valium.

But the call of the week happened today, just a couple of hours ago! We were called to a fall at a nursing home and on our way there we got cancelled on that call and reassigned to a full cardiac arrest. So we drive "hot" (meaning full lights and sirens) there and get to a patient who has been in a-systole "flatline" for a while. We started doing CPR and in an a-systole heart rhythm as much as the movies have ingrained in our heads that we shock them, WE DO NOT SHOCK THEM! or else you will definitely kill the patient. So i was able to do chest compressions, bag the patient and drum roll please!...........INTUBATE them. Intubating means that you assist their breathing by inserting a tube down their trachea so that you can breathe for them. This is a paramedic's MOST shining moment. I was successful and we drove our patient "code" (CPR in progress)  to the hospital. I had to ride the stretcher doing CPR while we wheeled into to the hospital. That was pretty cool. We didn't think she would make it, but she got a spontaneous pulse return and currently she is in the ICU. Im crossing my fingers for her!

An example of what an intubation looks like

What running "code" means.

Overall this week was fun and exciting, i was able to put my skills in use and get the groove of how things work at EMSA. Hopefully by the end of this internship all of you will be able to understand paramedic lingo with a little bit of help from me. Till next week!

Medic Mania!

My name is Paola Cooper and I am on the road to becoming a brand new paramedic! I will be doing an internship in Oklahoma City, Oklahoma. Over the next 3 months I will be sharing to family and friends the thrilling new experiences that i am faced with on an ambulance. I will give you a sneak peak of what it is like to be in the shoes of a paramedic. For HIPPA purposes i cannot name the people in my stories but just give some few details. However, dont get too upset we are about to embark on a journey full of adrenaline and life or death situations.

(Me and my husband Brock at my Paramedic Pinning July 2011)

My best friends Melissa and Amanda

My Graduating Class of 2011

My mom at Graduation

And of course how could i forget these two, they taught me everything i know! Bro. Lewis and Bro. Holley