Safety-Just in Time

It was the kind of game you love to watch. Two conference rivals, battering one another, trading leads througout the game. We get a field goal, they get a touchdown, we get a touchdown, they get another, finally we score again. There are less than three minutes left in the game when we sack their quarterback in the end zone…Safety! Two more points, further sealing the pending victory by the good guys.

I’m hiding in an empty patient room, watching the last two minutes of a great game, most of which I’ve missed because I’ve been seeing patients in the ED, and it’s been busy. THen I hear overhead, “Adult code team, emergency department…adult code team, emergency department.” The first thought that comes to mind isn’t “GREAT, another life to save!”, but instead, “CRAP, I’m going to miss the end of the game…I’ve only gotten to see one play”

Moments later, an ambulance rolls in the door with a man in his 60s, found down by local police. Paramedics responded, cut his clothes off, put pads on his chest and found him in ventricular fibrillation. He got shocked 3 times, got some drugs, loaded in the ambulance and arrived at our door. Before he even got off the stretcher onto our bed, he got shocked again. My collegues and me are doing what we’ve been trained to do! He’s back in a narrow complex rhythm after the fourth shock, we hang an antiarrythmic drip, get a 12 lead EKG and a chest x-ray. IV access isn’t working so we put in a femoral line. Everything seems to be running smoothly. He’s intubated, he’s got a blood pressure (albiet low), his heart is beating, he’s not having an acute MI based on the EKG, we’ve shocked him four times and he’s in a narrow complex rhythm. The resuscitation bay starts to spin its wheels. Can somebody get me a …, where’s the …, are we ready to …, it gradually becomes more chaotic and disorganized when it had been running so well. What’s wrong? What’s happening?

The problem was, what we did worked! We performed a resuscitation for man found in cardiac arrest, and now he’s breathing and his heart is beating again…none of teh ACLS courses teach you what to do next. We all scratched our heads and decided the best next move was to transfer him to the ICU. Our job here was done.

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