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[thedailydefib]

You bring her back for a few minutes. Enough time to get her into the ER. Upon arrival to the emergency room Jane Doe slips away again.  A nurse calls out she can no longer find a pulse. Now the team is working on her and will not give up. You are in charge. Will you save her and figure out who she is? 

https://player.vimeo.com/video/180790328

[eyesfixedanddilated]

Heather’s Heart Attack

Me and Heather had been married since college. Now we were both late thirties and now had a family. After 15 years of marriage we both were comfortable with each other’s desires and love to experiment with our sexual pleasures. Tonight was a occasion when the kids were going to be gone so I could expect some adult minded fun.

After dinner we adjourned our selves to our upstairs deck to relax after a stressful week.

Heather had been really stressed, she was ICU nurse and was forced to cover several extra shifts. During the week she had to work several cardiac arrests and all cases the patients dead. To make matters worse they had been middle aged women and she was the charge nurse which meant she had to tell the families their loved one had dead. I had noticed she was more fidgety and was smoking more. A couple nights, when she got home, she had to taken a sedative to sleep. I also noticed her rubbing her left arm and saying it hurt some. It worried me because I knew she hadn’t been taking her blood pressure meds. I also knew that she was on birth control which wasn’t a good combination for her health.

Now we were both relaxing and she suggested that I video her smoking. She knew her smoking was a turn on and that my video would really get me going. We sat and I did just that; she could smoke in such a sensual way. After she had finished a couple of cigarettes and a beer I went inside to prepare her special treat involving hand cuffs, candles, and massage supplies. After I finished she hadn’t came in so I went to the doorway to find her laying on the deck. She had collapsed and now I found her unresponsive. I shook her and all I got was a gurgling noise. I knew what that was and quickly rolled her on her back noticing her eyes were open. I checked and found no sign of life left in her. I then did what I had done so many times; started CPR accept this time I was doing it to my 37 year old wife.I first pulled back the black satin robe and noticed how wrinkled her nipples were and how gray her chest was. As I pushed down on her chest I felt her ribs dislocating. After 30 compressions, I performed mouth to mouth on Heather.

As I look back now I recall the coolness of her lips against mine and her breath. After a couple of minutes I called 911 and continued with Heather noticing she was not recovering at all. The only hopeful sign was the gray complexion of her skin was more pink. After what seemed an eternity the help arrived and they took over her care.

The medic in charge asked me her history as he began the chest pumping. I said with my training “37 year old female no know cardiac history, unwitnessed arrest down 10 minutes, she’s had some left arm pain, chest pains, she has hypertension, and takes oral contraceptives.” At that moment I realized that I had missed the warning signs and felt guilty. Of course she knew all that too but was to busy I guess to noticed.

The medics did all they could and I watched them shock her, causing her body to jerk uncontrollably. I noticed once as they did the shock she wetted herself and I could smell the stench that was her last bowel movement. After some minutes they stopped CPR, they lift her torso up and slide the back of the auto pulse in place. They then laid her back down and connect the front of the device which attached to the back. The medic switched it on and the front would inflate and push Heathers chest down making her belly jiggle some. As the machine slide up and down the medic slide the long strait laryngoscope blade into Heathers wide stretched mouth. The medic quickly attempted to intubated and had to suction Heathers airway to see the trachea. He then inserted the tube and started squeezing the bag between pumps of the auto pulse. The other medic had been injecting the meds into the IV. They had gave Heather 3 epis, 2 bycarbs, 2 atropines, and 3 adenosines. The monitor only registered the wiggly line of terminal heart rhythm.

I rode up front in the ambulance and could here the auto pulse working as it compressed Heathers chest. I could hear the defib unit charge and shock. I could hear the artificial respirations be squeezed in her lungs. I also could hear the noise the air made, a wet barking noise like a seal.

As the they rolled Heather into the treatment room the staff was surprised. Heather was a friend, co worker, and colleague. Now she was a cardiac arrest victim on her way to be pronounced a victim of sudden cardiac death at the age of 37. They ER staff gave it their best shot drugs and shocks. After several minutes Heather finally converted into asystole and they tried pacing her. I’ll never forget the site of the auto pulse moving up and down and the pacer cause her arms and legs to twitch ever so slightly. After forty minutes and hospital resuscitation the only thing left was terminated the code. With a call of the time Heather became dead and now corpse.

The next time I saw her she was dressed and made up laying in her burial casket. She was so beautiful that dead she made a gorgeous corpse. To this day I think about her laying in that casket in the ground at the cemetery and wish I could see her uneven dead.

Heather’s autopsy report listed her death was due to a pulmonary embolism. It went on the disclose her use of oral contraceptives, tobacco, high blood pressure, and age older than 35 were contributing factors in her cardiac arrest.

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[eyesfixedanddilated]

Staci’s Sleep Study

1. Staci’s earlier evening sleep study showing the signs of obstructive sleep apnea. 2. This is a picture taken by Staci and posted on social media of Missy holding the leads which were hooked up to Staci. 3. The CareAssist Hospital Bed with “Instant CPR” release lever includes a dampened descent, gently lowering the patient and reducing caregiver back strain. It also is equipped with the removable CPR resuscitation head board. 4. The crash cart used on Staci with Phillips heart monitor, defibrillator, and pacer. 5. The drawer of the cart with the cardiac meds used on Staci. 6. ECG strip showing asystole. 7. Strip printed with pacing show no capture and persistent asystole. 8. Staci’s picture taken a year before her death. 9. Staci’s picture taken post resuscitation with the ET tube still in place.

Staci’s Sleep Study

Staci sat in her CRV nervously smoke a cigarette as she waited to check in for her sleep study. The sleep center didn’t take patients until after 7pm and she was running early. She looked down at her watch and saw it was 6:45. She realized she had enough time a smoke another cigarette before she went in. She flipped open the top of the long box and slide a long white cigarette out, without effort she had the filter tip between her lips firming it and bringing up her lighter had it lite. She inhaled slow and deep filling her lungs. Holding the exhalation then pushing the smoke out of her mouth and nose. She repeated until she had finished smoking it and as she exited her car dropped the butt on the ground and with that the last cigarette she would ever smoke.

She entered the hospital and went to the 4th floor walked off the elevator proceeding to the sleep center. She stepped up to the admitting window and was greeted by Missy who was one of the tech’s on duty that night. “Well we’re glad you made it since your our only patient tonight” Missy said. “Now your Staci right”? Staci nervously smiled and said “Yes”. Missy handed Staci the standard forms and Stacy began filling out. After Staci completed the papers she handed them to Missy who opened the door and let Staci pass through. Missy asked Staci to fellow her to a room. Missy pushed open a door to a room and turned on the light which showing as the standard hospital room. “Let’s go over your paperwork” Missy responded. Staci sat on the hospital bed. Missy asked Staci “ok your 43”? “Yes” “ok” Missy looked up and “your a smoker”? Staci said “Yes” “ok how many cigarettes a day”? Missy asked. Staci looked at her quietly saying “about 40”. “Ok you have high blood pressure”? To which Staci said “yes”. They continued the history until completed. “Staci I’m going to step out and let you change into this hospital gown” as Missy left the room. Staci pulled off blouse and unclipped her bra releasing her double D’s. Staci’s breasts had nursed two baby’s and after the years showed quite a bit of sag. The nipples were large and the night chill had caused them to harden. She then sat on the edge of the bed and slipped off her shoes. Then she stood and pushed down her knit pants. Now only clad she went ahead and pulled down her panties exposing her brown pubic hair. She put on the gown and nervously sat down on the bed. She had just completed the last time she would undress in her 43 years.

Missy went out the station and Randy had arrived for his shift. “Missy how many we got?” She grinned and said “1”. “Great then maybe we can get some alone time” Randy flirted back. Staci had changed and Missy came back in carrying a arm full of wires and radio telemetry unit. “Ok let’s getting you in bed” Missy greeted Staci. “First let’s check your weight” Missy mannerly pointed to the scales. Staci stepped up and the scales read 285lbs. Missy nodded and Staci stepped out. Missy began sticky the wires all over different points on Staci’s obese body. Several on her head and face then chest even on her arms and legs. “Ok we’ve got you wired for sound Staci"Missy said. Randy walked in “This is Randy he’ll be assisting tonight with your study”. Staci settled in the bed. Randy rolled the BP/Pulse unit over and placed the cuff on Staci’s arm. “160/104, 105, 26, with a pulse ox of 92” Randy spoke out. “Your a little nervous tonight?” Randy said to Staci. “Do you have any history of COPD?” Randy questioned the patient. Staci confusingly responded “not that I know of why?” “Well your pulse ox is low.” Missy said.“Well you might need to follow up with your doctor. "Staci your all set” as the techs left the home.

Staci had fell asleep and the tech could tell that Staci was showing all the signs of obstructive sleep apnea. Missy and Randy watched the telemetry monitor as it recorded the data from Staci. About 11:30 Randy convinced Missy to go with him to one of the empty rooms. They proceeded with they blissful love making at the work place. While they were doing this in the next room their obese patients life was ending in her sleep.

11:40 Staci’s monitor was reading an episode of apnea but this time she didn’t recover. First sign of trouble was Staci’s breathing stopped for almost a minute. The subsequent dropped in the blood oxygen which had finally stressed her heart enough it began to beat irregular. First she started in vtach and after several minutes her heart degraded into Course V fib which was recorded as she began to seize in the hospital bed. This fatal heart rhythm went into Fine V-Fib as the seizing slowed. As Staci’s heart slowed until the last rhythm recorded was asystole, a flatline traced across the screen. As her heart went through these stages of of death the EEG showed her brain activity first increase through the seizure then the waves flattened. Staci’s brain activity slowed enough she wetted herself and then defecated the final time. She had been chain stoke breathing which meant she breathed real fast then paused for seconds then her pauses lasted longer and the breath got shallower. Her lower jaw dropped and at this point all life signs had ended and Staci was dead.

12:04 the blissful lovers returned to their station. Missy looked at Staci’s telemetry showed all readings were flat. “Randy the telemetry has came unhooked” concerningly. Missy walked to Staci’s room and quietly entered. Before turning on the light she smelt the defecation which she found odorous to say the least. Missy walked over to Staci’s bed noticing now Staci’s chest wasn’t rising and her mouth was open with a little stream of foam running down her cheek. She also noticed Staci’s gray complexion and knew. “Randy”!!! Missy scared. As she checked Staci for a pulse on her cold calmly neck. Randy leisurely walked in “What is wrong”? “Randy she’s dead”! Missy announced in mortal terror. “What do you mean dead”? “Oh no she is” as Randy looked at Staci laying in the hospital bed. “What should we do? We should have caught this before now Randy”? “Well let’s go head push code blue and after the code team gets done I’ll delete the telemetry” purposed Randy as he pushed the code blue button above Staci’s bed. The hospital intercom announced “Code Blue 4th Floor Sleep Center” Missy ran out and grabbed the crash cart while Randy pushed the Instant CPR bar on Staci’s hospital bed. The head of the bed eased flat and Randy pulled off the front of Staci’s gown. Missy came over pushing the crash cart and got on the opposite side of the bed to Randy. They both slide one arm under each of Staci’s sweaty smelly arm pits and lifted her torso up and then with their other arms slide the head board on the bed sheet. They then laid Staci back down so her upper back was on the board. This board made Staci’s flabby breast and chest high and her head and neck extend lower. Randy positioned himself over Staci’s chest crossed his hands and pushed them against her chest between the breasts. He began pushing as I had been trained hard and fast. Staci’s breasts bounced in the rhythm of each compression her arms were extend strait out moved up and down. After Randy pushed down the thirtieth time he held as Missy squeezed the bag mask which was over Staci’s expressionless face. Staci’s chest rose and relaxed with each ventilation. Randy continued CPR as 3 nurses from ICU walked in and took over the code. Missy looked up nervously saying “Ah ah Staci 42 cardiac arrest” The charge nurse looked down and said “Ok so dose she have a cardiac history”?. “No that we’re aware of, ah she didn’t if she did” Missy responded giving the bag mask to one of the other nurses. Randy continued pushing Staci’s chest down her body positioned spread eagle. The charge nurse looked at all the electrodes hooked up to Staci and told the third nurse to apply the defib pads to Staci’s naked chest. The nurse had to pull a few of the leads off to get the Phillips pads on the right chest and below the left breast. The charge nurse flipped on the Phillips Heart Monitor which it’s screen traced a bright blue flatline. “Ok she’s in asystole” responded the charge nurse. Randy continued compressing Staci with her death already certain. The charge nurse looked for an I.V. And said “ok we need to push drugs.” “ I guess I’ll stick her” as she applied a tourniquet to Staci’s right arm. The nurse ventilating the patient asked Missy “did she just arrest with out any warning”? Missy said “Ah ah well she ah yes she just slowed down till ah it quit”. The nurses all thought it weird but didn’t say any more. By now the ER doctor arrived and the charge nurse gave him the report “Doctor we have a relatively healthy 43 year old female asymptotic cardiac arrest without a cardiac history. She was having a sleep study and they said just arrested to asystole”. “Well I’ve never had one of these before can somebody get her chart” answered the doctor. Missy left to retrieve Staci’s chart as the change nurse opened up the I.V. flow. The doctor looked at the monitor on the red crash cart studying what to do and ordered an Epi push. The charge nurse snapped the caps off a syringe and slide the needle into the port. A respiratory tech reported in the room and asked the doctor what he needed him to do. “7 ET tube please” the doctor ordered as the tech retrieved the laryngoscope and attached a strait blade. The tech step over Staci’s head extended the blade which switched on the light at the end and slide it in the her mouth. He then slide the 7 tube down the blade and retracted the scope. Then he inflated the cuffs securing the tube in Staci’s mouth. “Doctor her chart shows she’s got high blood pressure and an asthmatic. She also a smoker and weighs 280.” “Ok let’s presume she’s had a PE or an MI hold compressions and check her for a pulse and the rhythm on the monitor.” “She’s still asystolic push another epi and start a dopamine drip.” The nurses followed those orders and Randy excused himself as an EMT took over the compressions. The EMT had big hands covered with purple gloves that pushed Staci’s chest deep and fast as he had done hundreds of times before tonight. “Ok hold please; she’s still flatline. Nurse push a bicarbonate and atropine and see what that will do”. The nurse opened the box marked accordingly and from one pulled out the massive syringe snapping the caps and attaching the parts. She then flushed the syringe making a stream shoot from the needle. She injected it and then pushed the atropine next. As the code continued Staci laid lifeless, chest on the board arms stretched out, and face still empty of expression. Actual the only thing that had changed was that Staci had a tube coming out of her mouth. The doctor again asked that the compressions be held to check rhythm and as the EMT eased his heads off of Staci’s chest they all watched the wavy line on the heart monitor seize and fade to the flatline as before. “Guys were not getting anywhere with her; let’s try another round of drugs and start pacing her.” The staff continued preforming as they had and Staci’s condition did the same. The charge nurse pushed an epi, then an atropine, and bicarbonate. “Doctor she’s maxed out on atropine” the charge nurse reported. The doctor set the pacer on the Phillips unit and switched on the EMT paused CPR as the procedure started. Now the flow of electrons traveled through the wires into the large white foam pads. From them through Staci’s chest and into her dead heart. The only detectable reaction was the impulse being detected on the monitor and Staci’s hands and arms twitching gently. Randy had returned back into the room after completing the cover up of of his and Missy’s indiscretions. The doctor looked at him saying “She hooked up to an EEG what is her brain activity?” Randy replied “it’s flat on all points”. After a minute of this the doctor looked up at the clock. “Ok anybody got any objections to calling her”? Silence filled the room. “Ok time of death 12:35”. Give me the chart and I’ll make the call. With that the charge nurse flipped the Phillips unit to off and Staci return to her deathly stillness. After the respiratory tech turn the wall mount O2, contacted to the bag mask, a deathly silence returned. Staci with her arms still outstretched appeared gray and quit for good.

As he called from the nurses station phone the staff prepped Staci.

“Is this Jim” “ok well Staci’s suffered a serious cardiac emergency and we need you to come to the hospital”. He never tells the family over the phone. He didn’t even sign the death certificate until the family gets to the hospital. The nurses commenced to unhooking the mess of wires from what was now the corpse that had been Staci. They left the electrode pads dotting her body and the ET tube as was hospital policy. A couple of the nurse raised the dead body up off the head board and removed the board. Then they gently laid the obese torso back down on the sheet. They then removed the gown so now the corpse that had been Staci lay nude and pale gray on the white sheet. The charge nurse spread the legs apart and wipe the fecal material and urine from them. The nurses then rolled the body carefully side to side removed and replaced the bed sheet. After this and having Staci’s dead body clean they then draped a clean gown it. Then they pulled a sheets over the body concealing the toe tag and placed the arms on top of the sheet and at the sides. Once they finished; Staci if alive would have looked like she was napping with the except of the ET tube. The ET had replaced the place between her lips where she had placed several hundred thousand cigarettes over the years.

By now Jim arrived and stepped off the elevator. He was met by the ER doctor and charge nurse. “Jim your wife suffered a sudden cardiac arrest and we were unable to resuscitate her. I’m sorry but she’s dead. We did everything we could do but the damage to her heart was so bad that her condition was just irreversible.”

[eyesfixedanddilated]

Dawn’s Dying Day

Pictures and story of Dawn’s death in ICU

1. Last shallow breath. 2. CPR and Bag mask ventilations. 3. More chest compressions and bagging. 4.&5. First and second defib at 300 joules conversion to asystole. 6. More CPR. 7. Final shock at 360j. With same outcome. 8. Dead long shot. 9. Dawn death close up.

Dawn had been admitted to ICU for post cardiac arrest care and observation. She had suffered a myocardial infarction which was in fact probably had been a STEMI. It Couldn’t be diagnosed because she was admitted to the ED in cardiac arrest. She had been clinically dead for thirty minutes. We had treated her post arrest with hypothermic therapy to decease the amount of hypoxic brain injury but she had been found apnic and had probably been that way for several minutes.

The first thing me and the other nurse assigned to Dawn’s care was to bath her. I removed the same gown that Dawn was wearing when she arrived from the ED 24 hours earlier. I took the damped cloth and wiped off her torso. I wiped under and on her large flabby breast which were crowned large nipples. It was hard not to notice the 2 triangular pink sunburnt like marks from the pads which had repeatedly defibrillated her. One above the right breast and the other to the side of the left breast. Equally hard not to see was the large bruise between Dawn’s breasts over her breast bone undoubtedly from chest compressions. I cleaned the folds of skin between Dawn’s fat rolls as she laid there in her unresponsive condition. I continued by moving her arms and wiping her arm pits which had a faint odor. The other female nurse cleaned Dawn’s groin and genitals which also had some odor. She made sure the folely catheter was secured properly and functioning. Then she wiped off Dawn’s legs and feet. We then rolled Dawn on her side and wiped down her back and buttocks. We then placed a clean hospital gown on Dawn and elevated her head. The other nurse went to the foot of Dawn’s bed and weighed her. Dawn weighed 385 lbs. which was a 5 lb. increase in 24 hrs. The nurse also measure our Dawn’s feet which had swelled more; to the point of weeping fluid. In fact Dawn’s feet had swelled so much her toes were cold and turning purple. I listened to Dawn’s lung sounds which I noticed gurgling as the ventilator pushed air into her lungs. It sounded like pulmonary edema which was another sign Dawn was developing severe congestive heart failure. The other nurse drain the catheter bag which had dark urine which was a sign of kidney failure. I walked up to the heart monitor over the ICU bed and printed off a ECG strip noting that Dawn’s heart rhythm was third degree heart block with multi focal PVC’s which wasn’t a very good rhythm and another sign of massive ischemic cardiac death. Her pulse was 45-50, O2 saturation was 85 and blood pressure was 100/40. The other nurse reattached the pneumatic stockings which in helped prevent deep vein thrombosis. I began my examination of Dawn at her head. I shined my pin light in her eyes noting that they were bilaterally equal, fixed, and dilated fully. I opened her mouth and shine my light noticing Dawn’s teeth were slitty yellowed and her gums were some what inflamed. I looked around the tube as it traveled through the back of her throat making sure it was secure and in place. The other nurse check the reflexes noting that each were missing. She then pinched the extremities and I preformed a sternal rub checking for responsiveness Dawn appeared to us both to be in a deep coma caused by the hypoxia during her cardiac arrest.

The neurologist came in and we told him what we had found. He examined Dawn and I reviewed the patient history. According to her chart Dawn was a morbidly obese 50 year old. She had a history of hypertension, COPD, Obstructive Sleep Apnea and Type II diabetes . She had complained to her family of have chest pains days prior to the cardiac arrest. Her family reported that Dawn was a pack a day smoker since her mid teens and got winded walking from the car to the house or up a flight of steps. She also was being treated for degenerative knee’s and was needing both replaced. She had been treated for depression and fibromyalgia. The most interesting information on the chart was the fact she had been found unresponsive in a hotel bed, nude and alone. The ED had preformed a rape examination which was positive for sperm but their were no signs of trauma. The report said that a male had called 911 reporting a lady was having a heart attack but was gone before help arrived. The neurologist concluded his exam. He reviewed a brain scan and EEG from earlier and told us he felt she was brain dead.

We all went to the waiting room to tell the family. The doctor showed them the EEG and Brain Scan and told them that when Dawn had the heart attack she had been without oxygen to long. That if CPR had been start she might have made it. It was apparent that the husband didn’t know why she was at a hotel. The doctor told them that Dawn was certainly brain dead, she was in a chronic vegetative state requiring life support for the rest of her life. He then requested they sign the papers to terminate the life support so Dawn could die with peace. They were relay reluctant saying she said if something like this happened to her to keep her on the machines. They finally relented with us agreeing to code her after we took her off the vent. With her heart in the shape it was in we knew that once it stopped that it wasn’t going to start again.

We proceeded to Dawn’s room and prepared her for the termination of life support. The doctor told us that we would only code Dawn a couple minutes to ease the family and that we would do nothing more than bag mask, CPR, and Defib’s. He made it clear we were not going to retube or push cardiac drugs. It wasn’t hard to take some body off of life support. I turned the vent off, Dawn’s was breathing about 6 breaths a minute at first. I deflated the ET tube tracheal cuff and released the strap which secured it in Dawn’s mouth. I then slide the tube, strap attached out of her mouth. I then placed a non rebreather mask over her face and set it to flown 15 LPM’s. The other nurse place Defib pads on Dawn’s chest. After she did that she then turned off the I.V. Pumps which cut off the flow of Lidocaine and Dopamine. I then went out and got the family so they could say their good bye’s. I sat her daughter’s so they could hold her hands and me and her husband stood. Dawn’s breathing began to speed up and grew more shallow. I told the family that would happen and Dawn’s heart would become erratic and slowed till she passed. Dawn’s heart rate was down to 30 with her respiration rate the same. Over the next 10 minutes both remained the same. Then she began breathing faster more like a pant which grew more shallow. The pulse became more erratic it would beat twice and pulse for several seconds. Then her panting faded not drawing any air at all. The heart monitor showed fainted to a flat line. The monitor showed no pulse, O2 sat of 30, Blood Pressure 00/00. A couple of irregular complexes and then the screen only display a flat line again. I silenced the alarms and felt for a carotid pulse. Feeling none I listen for a heart beat with my stethoscope and heard nothing. The husband insisted again we code her so I pushed the code blue call button on the wall. The code team arrive and we prepared Dawn for resuscitation. Although normally we would do a lot more in this case the doctor only wanted enough to keep the family happy. So we began with CPR after a couple cycles Dawn’s heart began a fine fibrillation which we shock back to asystole after repeating this twice the husband told us to stop and since she was dead we did.

After the family left the room I notified the funeral home they had requested. I then proceeded to remove Dawn’s gown. I then unsnapped the monitor leads. Then pulling off the foam monitor and defib pads. The other nurse removed the foley as I pulled out the I.V.s. We them logged rolled Dawn on her side so I could lay the body bag under her. We rolled her back flat and we each pulled the vinyl bag sides up. Dawn’s body made a gurgling noise as her lungs collapsed pushing the last air out in the death rattle. Before zipping body in the bag the other nurse tied the toe tag onto the Dawn’s right big toe. I wiped some mucusy discharge which came out of her mouth during the death rattle. Placed a strap over her chin and the top of her head which tightened to close her mouth. Then I tape her eyelids shut and zipped the bag closed. We proceeded to finish clean up and throwing away the used disposable medical supplies. By now the funeral home arrived. We helped them lift Dawn’s body onto their gurney. She was almost to big to fit. Her fat corpse hung over the sides of the cot. As they proceed down the back corridor that was the last time I saw Dawn.

[canuckcpr-deactivated20250427]

Lecturer’s arrest

This is Jeanette in the picture taken in her office during happier times, a couple months ago for her school.

(Disclaimer: The picture above I got off a website, and the story had nothing to do with this person. I made up the character on my own, thank you)

The story is from Jeanette point of view.

Hi, I am woman college professor who is 44 years old and 5 foot 7 inches but coming in at 280 pounds. I get tons of looks about my weight but I am proud of my weight. As I am the proud mother of two amazing children, a son who is 9 and a daughter who is 7. Not so proud of a smoker of 30 years, but it keeps me calm and gets me through a tough time. Like recently when I witnessed one of my students collapsing in class, not being able to revive him, and found out he got pronounced dead in the ER a short time later. My smoking habit has got me through this difficult time and not even told my family about it. Increased from one pack a day to two packs, the past couple of days. Now, the hardest thing for me, to face the class for the first time since the passing of one of their classmates.

The day came for me to address the class. It was a normal day, got to college, and held my office hours with my students. I was getting few chest pains throughout the morning, and just thought it was the nervous energy of the day. I make sure before the class, I went out to the courtyard to have a good smoke and the chest pains return, now I know they are from the nervous energy. After the smoke, I got myself together and headed to teach the class.

I entered the lecture hall as I normal with all the students staring or chatting with friends. As I can see, there is about half the normal amount in class, I am guessing many are grieving the loss of their classmate. I looked up and realize it is time to begin the lecture with my chest hurting. I began to address the class, “I know everyone is grieving in here from the recent loss, but I think it is best if we start class as usu…” As I was saying the last word I immediately collapsed in front of the class, and by the time I reached the floor, I have spilled my bowels.

Everyone in the class was shocked and could not believe it was happening again. Good news for me now, Erica, the nursing student showed up to class today. She immediately got to work on me, told someone to call 911 and for someone to go get the AED. She felt for a pulse on my neck, nothing and check my breathing, nothing. She then tilts my head and gave me mouth to mouth, and after two breaths, she starts giving me CPR. She was pushing my chest down and hard counting out loud to thirty, as she was doing my body was reacting to the compressions with belly movement. Then she gave me two more breaths, and she continues to do this until the AED showed up. She pulled out the AED, listen to the instructions, and she rip off my shirt and bra. She put the pads on my bare chest. When the machine told her to push the button, as she did this, you could see my big body reacting to shock with my big thighs jiggling and my belly jiggling. Once she gave me the shocks, she resumed the CPR and mouth to mouth.

Erica continued the AED shocks and CPR for three rounds before two young EMTs, Melissa and Brooklyn showed up. Erica told the EMTs, that I collapsed ten minutes ago and she gave me three shocks. The EMTs thanked her and got to work on me. Melissa hooked me up to the heart monitor which register I was in v-fib. Brooklyn prepared an epi and injected me with it, she also got the paddles ready. Melissa began deep compressions to try to revive me. Once the paddles were ready, Brooklyn gel the paddles, and charged them to 300J, yelled “CLEAR!” and shock me. Once the paddles were applied, u could see my obese body arches with my body crash down with my big belly jiggling and my big thighs jiggling. With no change on the monitor they gave me from air from an Ambu bag, and more compressions from Melissa. Brooklyn then placed the paddles back on me, charged them to 360J, yelled clear again, and she shocked. Again, my body arch in the air with my body crash back down with my belly and thighs juggling. When I hit the ground, the monitor registered a weak pulse. The two EMTs immediately loaded me onto the board and loaded me onto the stretcher that I barely fit. All my students were wondering why I was not waking up. The EMTs told them, that my body was not strong enough yet to open my eyes, and I am going to be okay. They continue to give me air through the Ambu bag as they roll me down the hallway towards the ambulance.

As they load my obese body into the back of the ambulance, Brooklyn jumped into the back and Melissa into the front. Brooklyn immediately unhooks the Ambu bag and put a mask on me, hooks me up to the monitor. The monitor still registers a weak pulse as the ambulance races towards the hospital. As I weakly opened my eyes; but before Brooklyn can say anything to me, I crash again to a v-fib. Brooklyn immediately begins deep compressions into my jumbo breasts. As she counts to thirty, telling me to come back to her. After the compressions, she immediately gels the paddles and charges them to 300J. Once they are charge she puts them on my obese chest. She yells “CLEAR!” I arch and crash back down with my big belly jiggling and my thighs with no change. She immediately recharged the paddles, and shocks me again and the same result. As we were arriving at the hospital, she shocks me one more time at 360J, this time my body arches, with me crashing back down with my whole body jiggling with no change. As they open doors to the ambulance.

Doctor Cass waits for us to arrive at the er. Dr. Cass asks Melissa when she saw her what is the situation. Melissa responds with “Mid – forties obese female, who is a lecturer at the local college, she collapses at the beginning of lecturer, bystander worked on her for 10 minutes, then we were able to revive her on the scene after about ten minutes.” As Melissa is opening the door. Brooklyn continues, “On the way here, she arrests again to v-fib about 5 minutes ago, I have given her two shocks but no response.” Dr. Cass gather this info into her, “ok we need to get her to treatment room one, and try to save her”

They get me into treatment one where three nurses named Quinn, Alexandria, and Lisa are waiting and ready, as they burst me through the door. Dr. Cass says, “on the count of three we move her on to the table; 1,2,3” They lift me onto table taking all the strength to move me, they quickly get me hook up to the monitors which register a v-fib. Each nurse takes her role, with Quinn bagging me, Lisa doing compressions, and Alexandria strips me. EMTs wishing everyone luck. Dr. Cass yells “I need that crash cart and stat.” As I continue to register a v-fib as Alexandria gets my obese body fully naked. Alexandria and Cass look at each other; thinking another victim from that college.

The crash cart arrives, and Alexandria immediately charges the paddles to 300 joules while she gels them. As this was going on, Lisa was giving me hard deep compressions making my obese body jerk with the compressions, and shaking the table. Once the paddles were ready, Alexandria hands them to Dr. Cass. She tells everyone to back away, and yells “CLEAR!” The paddles hit me as I arch in the air come crashing down with my belly and thighs jiggling and no response. Dr. Cass then says, “Again at 360 joules,” the paddles are charged once again. She shocks me with me arching once again but crash down to no response. Before they shocked me again, Quinn gives me two breathes forcefully trying to get oxygen into my lungs. Cass then shock me once again, this time my whole obese body jumps a foot into the air, crashes down with my body jiggling; my head rolls to the side, as the monitor shows asystole.

“We need to intubate her now, if we want to save her, and get the epi-ready” Dr. Cass yells out. The get the intubation tray ready, as Quinn gets the epi needle. Lisa inserts the tube into me but struggles to get it down my throat, but she was able to. Lisa grabs the Ambu bag and connects it, as she forcefully tries to get air into my dying lungs. At the same time, Quinn injects the epi needle into my arm, and Alexandria begins compressions. All you can see and hear in trauma room for the next ten minutes is monitor beeping to the compressions, my naked obese body bounces to them as all the nurses apply very deep compressions, and begging for me to live. Whenever they tried to breathe for me, my lungs barely move. Dr. Cass then administers another epi after those ten minutes, this time directly to my heart. But to no avail, as nurses continue to fight for me, as my dying body lays naked on the table.

As the code continues, my face starts to lose its colour with my lips going blue, and my chest going gray. After passing the thirty-minute mark of being asystole, Dr. Cass administers the third epi again to my heart. Everyone in the room hoping it will work. It sorta does, as it gets me back to v-fib. Dr. Cass yells, “Charges the paddles, she is not dying today.” Alexandria gets paddles gel and my chest and charges them to 360 joules. She then says, “paddles ready,” and hands them to Cass. Cass yells “CLEAR,” as she shocks me. My fat obese body arch slightly and crash back down with everything jiggling. “No change,” Quinn says. “Going again, Clear,” as Cass shocks me again. My body again arches, crashes back down to no change. All the nurses are yelling at me, come on, and we cannot lose you, too, as Lisa tries to get air into me. Dr. Cass shocks me again. I arch into the air with my butt lifting and crashes back down to table with everything jiggling. Everyone turns to the monitor, it beeps twice, then goes to very loud asystole that seems to be louder than before.

All nurses immediately go back to try to save me, but Dr. Cass speaks up, she is gone. They double check before calling me, Lisa confirms eyes are fixed and dilated, Quinn confirms no pulse on the neck, Alexandria confirms no pulse on the wrist or femoral artery, and Dr. Cass confirms nothing coming from my chest. “We all tried all best, but we lost another one,” as Dr. Cass looks at the clock, “Time of death: 1:00 pm.” Dr. Cass tells the nurses to stay behind for the clean up as she goes to get my husband, Bob. They unhook the leads and disconnect the Ambu bag. They all say to each other, this does not get any easier to do. As they put a clean white sheet over my naked obese corpse.

Dr. Cass walks my husband into the room, and lift the sheet revealing my head and above my chest. He starts crying his eyes out, leaning over my body and hugs my corpse. He lets go, start saying, “Have no idea how going tell our kids, and told you to quit smoking.” Dr. Cass then says, “also this could have been from the additional stress of one of her students dying from a heart attack.” My husband just went into absolute shock. “She did not tell me, she said everything was fine, and before you ask she was fine this morning.” Dr. Cass then comforts him, telling him, “it is ok, and we have to leave her now” Dr. Cass covers me up and leaves with Bob to grieving room in the hospital.

The nurses after they leave, remove the sheet from me and get out the obese bag beside me. They roll me over struggling in the process but the bag below me, then roll me back in. Then Lisa puts the tog tag on my right toe, right before they zip me up. Then, they wheel me down the hall. Alexandria speaks up on way down the hall, “One of our former classmate, now one of our former lecturers both being called by us” They all nod, as they wheel me into the morgue where I will wait for my autopsy.

The next morning, it was revealed I did die of heart attack because of the clogged artery by my heart. But they also noted that my lungs were the worst they have ever seen. They decided to put me beside my student that died a few days ago. Of course, people are going to say his death was the cause of mine. But, it was because of my smoking. If I knew I would die so young, I might have had a second thought before lighting one up.

[kk095]

I know most of you aren’t into blood, internal compressions/paddles but I’m just going to do my thing and express myself! I hope you enjoy the story and feedback is appreciated!

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Rough day

Losing a patient is always a hard thing to deal with on multiple levels for the trauma team. You have to watch patients suffer a bit before they die and then the worst part is having to tell family or friends that they didn’t make it. It’s hard doing this once in a given day but imagine doing it twice! That’s the reality we face when working the ER night shift. You know what they say: nothing good happens after midnight! Before I ramble on and get off topic, let me start from the beginning of this particular shift.

It started last Friday night around 8pm. The first few hours of the shift were pretty uneventful; all minor cases, people attempting to use the ER as a walk in clinic, or attempting to get drugs from us because of “back problems.” However, we received our first major case around midnight. A young woman was hit by a car and was in pretty rough shape and the eta was 3 minutes. We got our gear on and prepped the next available trauma room for the patient’s arrival.

Those 3 minutes came and went quickly. The sound of the ambulance’s sirens could be heard as it showed up. Moments later, the EMT’s wheeled the patient into the trauma room. She was an Asian woman in her early to mid twenties, slim build, and somewhat tall. The EMT’s updated us on her condition: “24 year old female, blunt trauma to the abdomen, intubated at the scene, hemodynamically unstable, BP is low, heart rate is high, coded twice on the way here. We shocked her once and got her back during the first code and then we shocked her 4 times during the second code; she was down for about 5 minutes. We got her back just before we got here.”

After the EMT’s left the room, we lifted the patient onto the table. She wasn’t conscious but her eyes were half open, which gave all of us a creepy feeling. It’s as if she was somehow watching us.

I started barking orders: “get a chest x ray, CBC, tox screen, push FFP, start the massive transfusion protocol, get a surgical consult, get me an abdominal ultrasound, an echo, and tell CT we might be on the way over if we can get her stable!” I had my doubts that we could stabilize her before sending her off to surgery; her stats weren’t the best and she already coded twice.

I started examining the patient by palpating her abdomen. It felt tender and stiff, which didn’t totally surprise me because she was in hypovolemic shock and the EMT’s mentioned blunt abdominal trauma. Next, we performed the abdominal ultrasound. To be honest with you, it didn’t help THAT much. There was blood in her abdomen but we couldn’t determine the source. I didn’t think it was the inferior vena cava because she would’ve died long before she got here. Injuries to veins aren’t common but when they happen, they’re REALLY bad and patients often don’t survive. I mean, 95% of injuries to the inferior vena cava are fatal even if the patient makes it to the hospital.

I assumed her injuries were either an arterial bleed or an organ injury (or possibly both) but I didn’t know for sure and that really alarmed me.

Next, we did the chest x ray and echocardiogram. Her chest was fine despite a few broken ribs from the chest compressions she received earlier and her heart was fine; there wasn’t cardiac tampenade, pericardial effusion, or lacerations to the atria or ventricles. Based on that, it appeared her only issues were because of blunt abdominal trauma.

I kept up with the massive transfusion and I tried giving her drugs to increase her blood pressure but the effect appeared to be neutral: She wasn’t getting better or worse.

A few minutes later, the trauma surgeon arrived for the consult. The surgeon on call that night was Dr Rodgers. She’s a young, attractive, and intelligent woman but she’s arrogant and hard to deal with at times. She went to brown university and she has to let you know about it every chance she gets and that gets old really fast!

I updated her on the patient and she said “ok, let me do an abdominal ultrasound.” I tried to explain to her that I already did one but she didn’t seem to care about what I had to say. She started the ultrasound and said “hmm, there’s a lot of blood but I’m not sure where it’s coming from. I wonder if the abdominal aorta was lacerated?” I replied “blunt aortic injuries are uncommon. What if it’s her spleen?” She said “they’re uncommon but they still happen! Maybe her spleen is injured too, I don’t know for sure. What I do know is this is really bad and we need to do something ASAP.” I said “well, she isn’t stable enough for a CT scan and I doubt she’d make it through surgery in this condition so what do you suggest doing?” Rodgers replied “let’s increase her meds to regulate her BP and keep the transfusions going. I think we can buy her some time until we can get her to the OR. Let’s get a Neuro consult in here to rule out a brain bleed.”

Several minutes later, the neurologist showed up and did a brief consult because they had another patient to get to. They said “the patient doesn’t have a head injury. Her pupils are reactive and she doesn’t present any signs or symptoms of a head injury.”

It was now 12:35am and the patient was starting to deteriorate. Her BP was dropping and the bleed in her abdomen appeared to get worse; her abdomen was slightly distended. Rodgers said “ok, we gotta get her up to the OR. This is definitely an aortic injury!” Before we could wheel the young woman out of the trauma room, she coded! Chest compressions were started as the sound of the paddles being charged could be heard in the background. The paddles were placed on the woman’s chest and a shock was delivered. Her body jolted quickly and violently before returning to her previous position. She remained in V-Fib so the trauma team continued to deliver strong, rapid compressions as the paddles were recharging. Her small breasts bounced slightly during each compression. Her eyes were still half open staring up above in an eerily beautiful way.

The paddles were placed back on her chest and another shock was delivered. Her battered body arched violently and dramatically for a moment before slamming back down onto the table. She remained in V-Fib so chest compressions went on for 30 seconds or so until the paddles were ready again. Her body was thrown into the air as her arms and legs twitched slightly. Unfortunately, she became asystolic after this shock. We pushed epinephrine and continued chest compressions.

We continued chest compressions on her for several minutes but we couldn’t restore a shockable rhythm. I decided to make a drastic call since things didn’t appear to be heading in the right direction. “prep her for a thoracotomy!” I ordered. I bet you’re thinking “why would you crack her chest if it’s an abdominal injury?” The reasoning is: if it’s an injury to the aorta, I can clamp that off in her chest which would temporarily stop the bleeding in her abdomen, hit her with the internal paddles a few times, and send her off to the OR for a pretty straight forward repair.

Betadine was squirted onto the left side of her chest. As CPR continued, an incision was made in the 5th intercostal space just below her nipple. The cut started near her sternum and ended up near her mid axillary line. Once the incision was made, a rib spreader was placed into the cut. CPR still went on as we began to open her chest. Once we got her chest opened, I reached into her chest as external chest compressions were stopped. I began massaging her lifeless heart while Dr Rodgers dug around a bit to get the thoracic aorta. Once the clamp was placed, we pushed epi and continued internal compressions. At this point, all we could do is hope that we’d get a shockable rhythm back.

Her abdomen distension didn’t appear to get worse but even after 4 and a half minutes of internal compressions, the monitors still displayed no rhythm. Overall, she’s been down for about 10 minutes so things were starting to get a bit iffy. My plan didn’t seem to be working out as easily as I expected!

I continued pumping her heart manually. I looked down at the girl’s face and thought “come on, just start beating! That’s all you gotta do!“

I massaged her lifeless heart for another 2 minutes until we finally regained a shockable rhythm. The internal paddles were charged and placed into her chest. A dull thump was heard as her body twitched slightly. She remained in V-Fib so I continued internal compressions as the internal paddles were recharged. I could feel her heart quiver in my hands and I have to say, it’s an extremely unnatural feeling. It’s almost as if her heart was trying to say “GET OUT” despite our efforts to save her life.

The paddles were placed back into her chest and a shock was delivered. Her feet jolted slightly as the monitors went flat. I frantically reached back into her chest and started massaging her heart. “come on, just beat! That’s all you have to do!” I thought.

5 more minutes of internal compressions went on until a shockable rhythm was displayed on the monitor. Things were getting desperate because the patient has now been down for 18 minutes.

The internal paddles were placed and the patient was defibbed yet again. A dull thump was heard as her body twitched slightly. She remained in V-Fib so I massaged her heart some more. Her eyes were now closed. Her skin was pale and slightly cold to the touch and her lips were starting to turn a reddish purple color.

The next shock was delivered. Her body jumped quickly as the monitors continued to go crazy. She was in v-tach so we shocked her again a moment later. Her heart quivered for a few seconds and then came to an abrupt stop. The high pitched sound of the monitors going flat could be heard. At this point, we knew the patient wasn’t coming back. “time of death, 12:57am.” I said reluctantly.

The ambu bag was detached from the ET tube and the monitors were switched off. The EKG electrodes were disconnected from her lifeless body as the rib spreader was removed. A toe tag was placed on the big toe of her left foot. Her body was then covered up, only leaving the toe tag visible as it dangled in front of her soft, wrinkly soles.

I walked out of the trauma room feeling defeated. We did everything right and the patient still died! It felt like the patient just lost her will to live. What’s even worse is I don’t even know the woman’s name! How sad is that?!

After a half hour break, I was able to get my emotions under control and finish my shift.

Around 3:15am, another patient was brought in totally unannounced and under CPR. “22 year old female, multiple stab wounds to the neck and chest. Tracheotomy performed at the scene, defibbed twice, down for 3 minutes.”

The patient was an attractive light skinned black woman. She was about 5'6, average build, had straight black hair, and beautiful dark brown eyes, which were wide open and staring accusingly at us, as if she was saying "wtf just happened?! Do something!” Apparently she got into an argument with her boyfriend and the altercation became physical…and apparently deadly.

We lifted the patient onto the trauma room bed; the monitors went flat for a moment during the transfer. Chest compressions were resumed seconds later as I began to steth the patient. “I’m not getting any breath sounds on the left side. Let’s get a chest tube going. I wanna get a chest x ray and an echo if possible. Push FFP, start the MTP, and get a thoracotomy tray in here just in case!”

I squirted betadine on the patient’s left chest and quickly made an incision in between her ribs as CPR continued. Once the incision was made, I placed a chest tube into the pleural space and restored normal breath sounds and got a little bit of blood out of her chest cavity.

A moment later, she went into V-Fib. The orange pads were placed onto her chest as the paddles were charged.

Her body was thrown into the air as she was shocked. Her eyes stared lifelessly above as we frantically pounded her blood soaked chest. Her breasts bounced considerably due to the deep, rapid compressions she was receiving. The monitors displayed no change whatsoever so we defibbed the patient again to no avail. Then we pushed epi and continued the code.

5 minutes went by and the patient was still asystolic. Overall, she’s been down for just under 9 minutes. I decided to prep her chest for a left anterolateral thoracotomy, just like the last patient. She had penetrating injuries to the neck and chest so I felt that I had to control the hemorrhaging in her chest. Her neck wounds were noticeable but the carotid artery and jugular vein were missed; her trachea was compromised, which explains the tracheotomy.

The young woman’s chest was squirted with betadine. Her eyes stared emotionlessly as her chest was being pounded and cut into. I looked at her eyes as all of that was going on. I had a strange, seemingly metaphysical feeling that she was thinking “I’ve been cut enough today, just stop this and let me go.”

After a minute or so, the trauma team was able to get her chest opened up. External CPR stopped as I reached into her chest and began direct cardiac massage. Her chest cavity was a bloody mess despite the chest tube I placed earlier.

Blood was suctioned out of her chest as I massaged her heart relentlessly. Once I could actually see the structures inside of her chest, I noticed that there were several lacerations in the atria and ventricles. I decided to plug up the lacerations in her heart the best I could until we could get her to the OR. However, I needed to get her back in the next minute or so or she’d be gone. She was asystolic at that moment so we were all getting worried.

The wounds in her heart were plugged and after another minute of internal compressions, she had a shockable rhythm. The internal paddles were charged and a shock was administered. A dull thump was heard as her body twitched slightly; the monitors displayed no change. We decided to hit her with the internal paddles for a second time. Her feet jumped into the air just a few inches off the table and slammed back down in a matter of a second or two. The monitors displayed no change yet again so we shocked her a 3rd time. A dull thump was heard accompanied by the high pitched sound of the monitors going flat.

We stopped what we were doing and checked her pupils and for other signs of life.

She wasn’t breathing, her heart clearly wasn’t beating, her pupils were fixed and dilated, and she’s been down for 15 minutes. “time of death, 3:31am.” I said as the ambu bag was detached from the ET tube. We shut the monitors off and began the same process we did with the last deceased patient.

I left the trauma room because I just couldn’t watch them cover her body up. I lost 2 patients in one night and that made me feel like a total failure. It’s not like a mass casualty incident occurred, these were 2 random, unrelated patients who came into my ER and both died.

The last few hours of that shift dragged but I’m glad there weren’t any other major cases brought in because I felt totally burnt out and defeated. I felt totally relieved when I left the hospital at 8am. I was able to go home, get some sleep, and start fresh later on. Perhaps I’ll save the next trauma patient I get!

[bretcrawford-blog]

[cprlovers]

Warning:  Graphic Resus picture

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[graphicmedicalstuff]

Polish Tv Show “Szpital” Episode 141 (2) https://player.pl/seriale-online/szpital-odcinki,1171/odcinek-141,S03E141,24618

[medfantasies-deactivated2018121]