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<blockquote data-quote="Jason Freeland" data-source="post: 4338299" data-attributes="member: 45827"><p>Was working a code in the ER one night with a GSW to the chest and they had cracked his chest open to see what was going on and do direct cardiac compressions. So me at the head of the bed using my manual resuscitator (ambu bag) and ventilating between compressions and the guy was squirting blood all over the place every time I bagged (pulmonary artery got cut). All the while I'm kind of watching this and watching the lungs inflate and thinking that at least our tube was in good position (and that this guy was a goner). We had been unable to get an oxygen saturation reading out of the guy the whole time we were working and the doc turns to me and asks "are you sure were in"? This being the breathing tube position he was referring to and I look at him and just said "yes were in". Mind you I had been watching the left lung inflate the whole time, so I knew our tube was good and the problem with his saturation was one of perfusion. Half or more of his blood volume was on the floor of the trauma bay, we had a dam made of towels to keep it out of the hall. I should have said "I could put the oximeter on the floor, that's where his blood is", but I had been to stunned by the question to give any other answer. Needless to say we called it not long after that. The doc was a good doc, but had a bit of tunnel vision on that one.</p><p></p><p>For something a bit different, twice I have had patients come back to life after the code was called. Both times I was walking away from the bed and something made me look back to see bounding carotid pulses on both patients (one adult, one baby). Near as I can tell in both cases, the epinephrine we had given didn't have enough contact time with the heart cells, during compressions. It wasn't until we stopped compressions and let it sit for a minute that it worked. Neither patient survived the ordeal much after that, but it's always disconcerting to have to call the code team back to the bedside and say that the patient is not as dead as we thought.</p><p></p><p>The next one I can talk about since it was featured on the TV show Critical Hour. The patient was riding his motorcycle and managed to scrape a retaining wall at speed, on the interstate. It ground off both hands and amputated a foot and the guy came in TALKING to us! Floored us that he was conscious after a wreck like that, but he was. We got him tubed and ready for surgery in near record time and were taking him to the door out of the ER, when I realized he was naked as a jaybird. I'm manually ventilating the patient so all I can do is yell "sheet, sheet". The nurse we were with said "just put the foot on it!" So without thinking I used my free hand to pick up the patient belonging bag we had his foot in and I placed it on his crotch. I suddenly realized after I had done it that the Critical Hour crew had filmed the entire thing and I said "I can't believe I just did that on camera." Everyone starts busting a gut laughing and we get him upstairs and into surgery without further incident. Fortunately the producers cut that part out of the show. I sweated bullets until they actually released the show.</p></blockquote><p></p>
[QUOTE="Jason Freeland, post: 4338299, member: 45827"] Was working a code in the ER one night with a GSW to the chest and they had cracked his chest open to see what was going on and do direct cardiac compressions. So me at the head of the bed using my manual resuscitator (ambu bag) and ventilating between compressions and the guy was squirting blood all over the place every time I bagged (pulmonary artery got cut). All the while I'm kind of watching this and watching the lungs inflate and thinking that at least our tube was in good position (and that this guy was a goner). We had been unable to get an oxygen saturation reading out of the guy the whole time we were working and the doc turns to me and asks "are you sure were in"? This being the breathing tube position he was referring to and I look at him and just said "yes were in". Mind you I had been watching the left lung inflate the whole time, so I knew our tube was good and the problem with his saturation was one of perfusion. Half or more of his blood volume was on the floor of the trauma bay, we had a dam made of towels to keep it out of the hall. I should have said "I could put the oximeter on the floor, that's where his blood is", but I had been to stunned by the question to give any other answer. Needless to say we called it not long after that. The doc was a good doc, but had a bit of tunnel vision on that one. For something a bit different, twice I have had patients come back to life after the code was called. Both times I was walking away from the bed and something made me look back to see bounding carotid pulses on both patients (one adult, one baby). Near as I can tell in both cases, the epinephrine we had given didn't have enough contact time with the heart cells, during compressions. It wasn't until we stopped compressions and let it sit for a minute that it worked. Neither patient survived the ordeal much after that, but it's always disconcerting to have to call the code team back to the bedside and say that the patient is not as dead as we thought. The next one I can talk about since it was featured on the TV show Critical Hour. The patient was riding his motorcycle and managed to scrape a retaining wall at speed, on the interstate. It ground off both hands and amputated a foot and the guy came in TALKING to us! Floored us that he was conscious after a wreck like that, but he was. We got him tubed and ready for surgery in near record time and were taking him to the door out of the ER, when I realized he was naked as a jaybird. I'm manually ventilating the patient so all I can do is yell "sheet, sheet". The nurse we were with said "just put the foot on it!" So without thinking I used my free hand to pick up the patient belonging bag we had his foot in and I placed it on his crotch. I suddenly realized after I had done it that the Critical Hour crew had filmed the entire thing and I said "I can't believe I just did that on camera." Everyone starts busting a gut laughing and we get him upstairs and into surgery without further incident. Fortunately the producers cut that part out of the show. I sweated bullets until they actually released the show. [/QUOTE]
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