Thursday, April 25, 2013

CPR, part 4 (Re-posted from "Switch 2 Plan B")


When we walked into the back bedroom, I was sure he was already dead.

Yup…Pretty sure.

See, I can’t remember really ever having to worry about it too much before. The paramedic squad would be right behind us, bring in their Zoll heart monitor, hook ‘em up, and most likely “call it.” But with the department’s recent reiteration of certain field protocols, the in-coming squad would be canceled if the on-scene firefighter/EMTs (emergency medical technicians) determined right then and there that the victim was dead.

So it was up to us.

As I’ve said before, there’s no point in working up an elderly person with extensive medical history who’s been down for a while. Chest compressions and all the drugs known to man just aren’t gonna help. So before we drag him in a tangle of blankets off his bed, ease him to the floor (best to do CPR on a hard surface), and start pumping on his chest, we can verify certain criteria.
Moments before, as we sped to the call, sirens and lights, our boot firefighter admitted he’d never been on a full arrest and had never used an AED (automatic external defibrillator) on an actual patient. Now I stood in a tiny bedroom with that same wide-eyed fireman waiting to follow my cues.

While our captain took the old man’s wife aside, we established that our victim was pulseless and apneic, and began checking for additional signs that would let us off the hook, in regards to initiating CPR.

Evidence of rigor mortis? I tugged gently on his lower jaw, and it did not seem to give readily. Post-mortem lividity? We rolled him slowly on his side, lifted his pajama shirt, and observed what appeared to be that purplish discoloration caused by pooling blood that can occur within 20 minutes of death.

The captain glanced up from his clipboard and looked at us expectantly. “Well?” the raised eyebrows seemed to ask. Are we going to cancel the medics and call it, or start CPR and continue them in?

Protocols also call for auscultating heart and lung sounds for at least 60 seconds, but as the rookie would later confess (and I remember all too well from my days as a new fireman), when you steady that stethoscope to the victim’s chest and listen intently, trying to block out all external distractions, you’re so nervous that you begin to second-guess whether the steady thrum you hear is indeed the pounding of your own heart and not the patient’s.

Nervous, because the next words out of your mouth had better be definitive.

Is he, or is he not, dead?

And even though that may be a foregone truth, it will be you, in fact, who acknowledges this reality for the first time—for the anxious wife, the concerned children, and the well-meaning friends all to hear.

And it will set off a chain of events.

A chain of “No.”

No, there will not be any life-saving measures…
No, there’s not going to be a paramedic squad coming in…
No heart monitors, no defibrillators, no ambu-bags…
No

And we have been told: When informing family members, do not use euphemisms such as “passed away” or “gone on,” or any other gentle yet gauzy terms you may be tempted to couch this hard truth in just to help sooth loved ones or ease your own conscience. The pronouncement must be unambiguous:

I’m very sorry

There is nothing more we can do

He is dead

…And so maybe I did pause, if just for moment. And in that split second, feel a dizzying kaleidoscope of sorrow and pain suddenly coalesce. Pulled back to those moments in my own life when someone I loved slipped away.

I’m very sorry

There is nothing more


2 comments:

angel gonzales said...

I think it is normal for people to help someone in the middle of a crisis situation. It is indeed difficult when you are in this kind of situation and you don't know if you should go on with the CPR or just cancel it. Damage may have been done but at least you did something to help this person.

- FrontlineHealth.com

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