Tempus Fugit

Time Flies…

   Apr 17

An Arresting Performance

Well.

I’ve been to cardiac arrests before. I’ve jumped on chests. I’ve uttered the words “charging to 200 joules….stand clear”.

In fact, it’s refreshing to go to a real MET (Medical Emergency Team) call instead of the usual “I can’t believe this is not a MET call!”.

I have to admit though, I’ve never RUN a cardiac arrest before, but given my chosen specialty it was bound to happen sooner or later.

I’ve given up RUNNING TO MET calls because 9/10 times times they’re not really MET calls and, let’s face it, if it’s a real one, an extra 30 seconds isn’t usually going to make a difference.

This evening, I was bemused when there was a MET call in the Crit. Care Unit today – only minutes after I’d left the unit in search of food.

I wandered back up (steak sandwich in hand) to see it was in fact a real “Bona Fide” heart-has-stopped arrest.

Well actually when I got there, the heart was still beating.

Not for long.

Looking briefly at irregular rhythm on the monitor and saggggggggggging S-T segments, it was pretty clear the heart was complaining bitterly about a lack of oxygen. (screw you guys, this piece of ischaemic myocardium ain’t gonna take no more of this “thrombosis stealin’ muh air shit”….this little ticker is bustin’ its troponin-leaking myofibrils outta here!)

Now, usually it is the job of the med-reg to run METs. I’m quite happy to do my job – that is to say, I’m the airway guy. You need an airway, I’m there. I’m quite happy doing my bagging and masking and occasional tubing.

Today however, airway management just wasn’t enough. There was a Med Reg and an ED Reg running around like blue-arsed flies effectively achieving nothing other than stirring up the chaos and making a difficult task appear impossible.

The patient in question had decided to enter a peri-arrest state whilst on the commode. He had since been relocated to the floor….with his head in the corner of the CCU.

Bagging and masking, let alone intubation is not an easy task on the floor. Trying to do it squished in a corner was even more challenging (not to mention the aspiration of the dinner consumed moments before).

So with chaos abounding, defib pads flying everywhere and an awful lot of nothing happening fast, I took the opportunity to run my first cardiac arrest.

I was amused how cliched it sounded barking orders for adrenaline and atropine STAT! and muttering things about not having shockable rhythms whilst asking a nurse to get me intubation equipment. Simultaneously another nurse is cracking ribs with a pretty good CPR pace and the two other regs try to get IV access (why does the cannula always tissue just before an arrest).

When sipping delicious caffeine in Melbourne yesterday, suctioning vomitus from a peri-terminal patient’s oropharynx was not something that crossed my mind, and yet, as my steak sandwich sat cooling it’s tasty heels on the nurses’-station bench, I was down on my hands and knees sucking out chunks of custard from this poor gentleman’s lungs.

It’s amazing how easy time can distort. In the frenetic pace of an arrest, time simultaneously stands still and passes instantly. The time it takes to get an IV in seems interminable. A few minijets of adrenaline & atropine later accompanied by a disappointing asystolic “flatline” with it’s accompanying blood-chilling asystole alarm signals 15 minutes of futile advanced life-support. It seems like milliseconds have passed.

It’s amazing how strange it is to be the one person to call the arrest….that is to say to everyone, this is a futile effort, and then, with that, the compressions stop, the flesh turns a greyer shade of blue, and the fixed and dilated pupils stare emptily up at you as you momentarily glance at the clock…..

…time of death 1817hrs.

Requiem aeternum Joe Bloggs.

The asystole alarm continues to announce to the world the terrible event that has occurred. The staff look around at each other in an exhausted manner – physically, mentally and emotionally exhausting.

I go back to my (now cold) steak sandwich.

An in-hospital cardiac arrest is not a dignified way to go. Statistically there is about a 1 in 20 chance of surviving an unwitnessed in hospital cardiac arrest. I think if patients and their families knew what actually goes on at an arrest – and the dismal outcomes that happen more often than not….they would be more willing to accept an NFR status – that is “Not For Resuscitation”.

An NFR is like a “get out of medical jail free” card. Free from the undignified futile last attempt at keeping a soul on earth for as long as we possibly can. When your number is called, if the cards are stacked against you in the age and medical morbidity stakes….take the easy option – leave with dignity and speed.

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5 Comments

  1. Jim says:

    I fixed a bug yesterday, and some typos…

  2. Paradox says:

    Hmm, sounds like every shift I have lately. I’m sick of resus situations!!! Very prosaic description though – buggar about the steak sanga. Hope all is good with you – catch up soon hopefully.

  3. Chris says:

    Dude, you’ve got one tough job there. Like Jim says, I dug out some corporate non-compliance equivalent to a bug (didn’t even fix it) and wrote a few of my own typos…

  4. Emma says:

    SO jealous.

    Isn’t nothing that looks like a steak sandwich at Ipswich.

  5. Jillian says:

    So will you now accept rellies at cardiac arrests so they can learn and acknowledge that everything possible was done for their relly?

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