One Hour
A story of heart break
As a paramedic, I run into all kinds of oddities, one of which being death. Sometimes it’s slow, dragging, needing. Other times it’s on you before you can say “wait.” The following is a pseudo technical report of a real patient I had early in my career. Some of the verbiage will make more sense to those more medically inclined, though I think it tracks without the deeper understanding. If something still doesn’t sit right, google it.
18:01.
ALS arrived as pt exited house under his own power with mild ataxia. Pt had refused assistance to be wheeled out to ambulance in stairchair. Pt was directed to stretcher on street where he was secured and loaded into ambulance by BLS. Monitor was applied as initial assessment was obtained. Pt is a 53 y/o male of Eastern European descent, approx. 120 kg. Pt complains of severe chest pain. CP described as 10/10 discomfort. Denied radiation to any other part of body. Pt presents alert and oriented and able to answer questions. Pt makes joke about his weight and mentions that his wife would meet him at the hospital. Skin is pale and grossly diaphoretic. Breathing is tachypneic though non-labored. Pt denies any other pain, dizziness, or nausea. Vitals are HR 93, BP 109/79, RR 24, BGL 192. Left sided 12 lead EKG shows normal sinus rhythm with widespread ST depression indicating ischemia though no noted elevations to indicate infarction. 18 gage IV placed in right forearm. Sudden and self limiting run of ventricular tachycardia on cardiac monitor. Defibrillation pads placed and prepared. Right sided 12 lead EKG performed with normal sinus rhythm and widespread ST depression. O2 placed on pt via non-rebreather at 15 liters per minute. Posterior EKG performed with same finding. ALS believed pt to be having significant myocardial infarction though had difficulty finding definitive signs on EKG. Pt given 324 mg of aspirin which he was able to chew and swallow. Pt given 90 mg of Brilinta by mouth which he was able to swallow. Second 18g IV established in left forearm. Pt c/o of nausea. 4 mg of Zofran administered IV. 150 mg of amiodarone administered via IV pump over 10 minutes to prevent further ventricular rhythms. Standard left sided 12 lead EKG repeated and noted significant ST segment elevation in leads II, III, and aVF indicating myocardial infarction of the inferior region of the heart. Pt becomes unresponsive. Monitor shows consistent ventricular tachycardia. Pt becomes pulseless. CPR started. Defibrillation delivered at 120 joules. Non-rebreather removed and manual ventilations given via bag-valve-mask. Oral airway placed to secure airway. No gag reflex noted. 1 mg epinephrine administered IV. Monitor shows ventricular tachycardia. Shock delivered at 200j. 1 mg epinephrine administered. Pt moves lower extremity by his own power. Pulses return. CPR ceased. Manual ventilations continue. Pt wheeled into hospital on stretcher. On entering hospital, monitor shows ventricular tachycardia. Pt loses pulses. Shock delivered. CPR resumed. 1 mg epinephrine administered IV. Shock delivered. CPR continued. Pt intubated. 300 mg amiodarone, IV. 100 mEq sodium bicarbonate, IV. Shock delivered. 1 mg epinephrine, IV. EKG shows asystole. CPR continued.
1 mg epinephrine, IV. CPR continued.
1 mg epinephrine, IV. CPR continued.
1 mg epinephrine, IV. CPR continued.
1 mg epinephrine, IV. CPR continued.
1 mg epinephrine, IV. CPR continued.
1 mg epinephrine, IV. CPR continued.
1 mg epinephrine, IV. CPR continued.
1 mg epinephrine, IV.
CPR continued…
Further efforts determined to be futile.
CPR terminated.
Pt declared dead.
18:59.
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