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Under the Knife

*How about we start off the new year with a new story?! I hope you all enjoy!*

The pre-op bay was quiet as our surgical center prepared for its morning elective cases. Jenna Hayes sat propped against thin pillows on the table, her blonde hair pulled back in a loose ponytail, hazel eyes fixed on her phone screen. At 6’1, even reclined she had quite a presence-defined shoulders visible above the pale blue hospital gown, an athletic build, and long legs stretched out beneath the white blanket. Her left knee, today’s troublemaker, was wrapped in a light compression sleeve.

She swiped through her camera roll, reviewing the selfie she just took. Head tilted, slight smirk, and a peace sign thrown up with her right hand. The fluorescent lighting wasn’t doing her any favors, but it would have to do. Her thumb hovered over the caption box. “Minor setback for a major comeback 💪 See y’all in a few months.”

Perfect. She hit post and tossed the phone beside her.

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Under the Knife

*How about we start off the new year with a new story?! I hope you all enjoy!*

Perfect. She hit post and tossed the phone beside her.

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Mallory in the ER

The automatic doors of our emergency department burst open with a pneumatic hiss, and our team’s next patient was rushed in.

“Twenty-nine year old female, full arrest!” the lead paramedic shouted over the rhythmic chest compression thuds. Her partner maintained the steady pace atop the gurney, straddling the patient as they wheeled rapidly through the entrance, the wheels rattling against tile floor. “Found unconscious in her hotel room approximately twenty-five minutes ago. Roommate called 911. Patient was in severe respiratory distress, then became unresponsive. We intubated on scene- 7.0 ET tube, good placement confirmed. Started CPR approximately eighteen minutes ago.”

Dr Lindsay appeared immediately, her white coat trailing as she matched pace with the incoming gurney. Nurse Nancy was beside her, and Nurse Heather emerged from Trauma Bay 2, holding the door open.

“Initial rhythm?” Dr Lindsay asked, her eyes already assessing the patient.

“Started as PEA,” the paramedic replied, breathing hard. “Converted to v-fib en route. We shocked her twice at 200 joules-no conversion. Gave two rounds of epi, one atropine. Got an 18-gauge in her right AC. She’s been down basically the whole time, no ROSC.”

The young woman on the gurney was a study in contrasts. Even in the midst of full cardiac arrest, evidence of her careful attention to detail was visible. Her dark brown hair- long, nearly black, with bangs, was pulled back but messy now, loose strands falling across the backboard. Her nails were perfectly manicured in a neutral shade, matching the pedicure visible on her bare feet. A delicate silver anklet encircled her left ankle. She wore dark gray work pants, but her upper body had been stripped completely bare by the paramedics, her fair skin pale against the orange backboard. Defibrillator pads were affixed to her chest: one below her right collarbone, one just below her left breast. EKG electrodes dotted her torso, wires trailing off to the portable monitor. An endotracheal tube protruded from between pale lips, secured with white tape across her cheeks. Her eyes were wide open, green and striking even on the verge of death, but glazed and unseeing, staring at nothing.

She looked young. She looked like she should be anywhere but here, not fighting for her life on a gurney.

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Mallory in the ER

The automatic doors of our emergency department burst open with a pneumatic hiss, and our team’s next patient was rushed in.

Dr Lindsay appeared immediately, her white coat trailing as she matched pace with the incoming gurney. Nurse Nancy was beside her, and Nurse Heather emerged from Trauma Bay 2, holding the door open.

“Initial rhythm?” Dr Lindsay asked, her eyes already assessing the patient.

She looked young. She looked like she should be anywhere but here, not fighting for her life on a gurney.

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Dr Jen’s Seizure

*Good evening everyone! I'd like to try something a little different tonight by utilizing one of my other recurring characters as a patient for once. Hopefully you enjoy the story!*

First year ER resident Dr Jen Zhang didn’t stand out at first glance. Petite and soft-spoken, she moved through the emergency department like a whisper rather than with a commanding presence. Her scrubs were always clean and tidy, ID badge perfectly aligned, shoes quiet against the tile floors, her shoulder length hair with bangs always neat. She was the kind of resident who apologized before asking a question, who triple-checked dosages before administering even the most routine medication, and who still looked slightly startled every time someone referred to her as “Doctor.”

Jen had grown up in a household where excellence wasn’t praised- it was the expectation. The daughter of strict, uptight parents, she had been raised in the narrow corridor between high performance and quiet obedience. Straight A’s were the baseline. Anything less was unacceptable. There was no teenage rebellion, no school dances, no late-night parties or messy breakups. At twenty-six, she had never been kissed. Never dated. Never broken the rules. She carried herself like someone who was still waiting for permission to take up space.

Despite her quiet demeanor, Jen was sharp, quick-witted, intuitive, and deeply compassionate. The attendings had noticed it early. Dr Lindsay saw it in the way Jen handled a combative trauma patient without flinching; Dr Sarah saw it in her notes, which were meticulous and thorough. She learned fast, worked hard, and rarely complained. Her hands trembled the first time she inserted a central line, but she got it done on the first try. Lindsay had told her afterward, “You’re better than you think you are”, to which Jen had blushed so deeply that even her ears turned red.

Jen idolized her seniors- watched the way Lindsay barked orders during a code, the way Nurse Heather moved with practiced efficiency, the way Nurse Nancy had an answer for everything, and the way Sarah never seemed to second-guess herself. Jen admired them all, but she carried a low-grade fear of disappointing them. Even praise made her uneasy, as though she hadn’t truly earned it.

On most nights, she stayed late. Not because anyone asked her to, but because she couldn’t bear the idea of not knowing enough or missing something. She studied protocols between patients. Replayed procedures in her head on the ride home. She didn’t go out much. Her apartment was small, quiet, and filled with color-coded flashcards and half-finished cups of herbal tea. She told herself she’d catch up on life eventually. There was time.

The emergency department was often a blend of urgency, bright lights, blood, and noise, but Jen found meaning and fulfillment in the chaos. There was something sacred in stitching a wound, intubating a crashing patient, or holding pressure on a bleeding artery. She didn’t need to be the loudest voice in the room. She just wanted to be useful, steady, and a part of something.

She was all potential. A careful, quiet light not yet fully aware of its own brilliance.

And perhaps that’s why it felt so strange the way that light would go out. Not with ceremony. Not with warning. Just like flipping a switch. As if some unseen cord had ripped, and all that promise had nowhere left to go.

There had been nothing unusual about that particular night.

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Renee’s Respiratory Distress

It’s a slow weekday in our emergency department just around lunchtime. The ER is relatively quiet, and most of the trauma bays and exam rooms are open. Our team chats casually amongst themselves, sipping coffee, reviewing charts, and checking their phones.

The calm is interrupted when the automatic doors slide open, EMS wheeling in a stretcher. Dr Lindsay’s head snaps up at the sudden motion, her easy conversation with Nurse Nancy cut short. On the gurney sits a barefoot woman in loose black slacks, her blouse removed in the ambulance. EKG electrodes dot her fair skinned chest, wires trailing from the portable monitor. The woman is gasping, her lips tinged faintly blue. Her straight, shoulder length red hair is a tangled mess, strands clinging to the sweat on her temples. Sharp, bright blue eyes flick frantically between the faces around her, wide with terror and uncertainty. There’s a slight crease between her brows, as if she’s trying to keep control but failing. The paramedic at her side keeps a firm grip on her trembling shoulder.

Nancy is already moving, stepping toward the stretcher. “What do we got?” Lindsay asks, following Nancy, voice stern but professional. The lead EMT fires off a rapid report as they push through the hallway: “This is Renee. 38 year old female, sudden onset of severe shortness of breath and chest pain at work. Hypoxic, tachycardic, hypotensive. Maybe a PE? No signs of trauma. No history of asthma or respiratory issues.”

In a breathy, winded tone, Renee speaks. “I… c-can’t… breathe…” she struggles tremendously to get each word out. Nancy places a steadying hand on Renee’s shoulder. “You’re okay, hunny. We’ve got you. We’re gonna take a good look at you, ok?” Nancy reassures. “it… it… hurts… w-when… I… breathe…” Renee tries to respond, barely getting enough air. “it’s ok sweetie, we’re gonna make you feel better.” Nancy soothes.

Once Renee is wheeled into trauma one, Dr Sarah and Nurse Heather follow close behind. Monitors beep incessantly as the team transfers the redheaded woman from the EMS gurney onto the trauma room table. Nancy moves quickly but gently, adjusting the oxygen mask and checking the IV lines already in place.

The 38 year old sits upright on the trauma room table, her chest rising and falling quickly, taking shallow, uneven gasps. Her anxiety is visible, her blue eyes darting around the room. Dr Lindsay steps in first. “Renee, I’m Dr Lindsay. You’re in the ER. Can you tell me what’s going on?” asks the doctor. Renee shakes her head weakly, her chest heaving. She grips tightly at her sternum, fingers pressing against her ribs as if trying to hold herself together. “W-what’s… happening… to… me?…” she mumbles, the words barely escaping her lips. “You’re safe, hun. We’re figuring this out, okay?” Nurse Nancy intervenes.

Dr Sarah and Nurse Heather work in tandem. A d-dimer is drawn for clot detection. An ABG is taken to better check the patient’s oxygen saturation. A bolus of IV fluids are started to counteract her hypotension. A portable echocardiogram is performed by Dr Sarah, which displays evidence of right heart strain.

Even after these interventions and tests, Renee’s heart rate is climbing into the 150s, her systolic BP is in the 80s, and her O2 saturation is in the 70s.

Renee sucks in another dramatic, broken breath, her hand weakly grasping Nancy’s scrub sleeve. Her fingertips are cold and clammy. “my… my… chest…” she gasps, feeling as if there are a million tiny, razor sharp bits of glass inside her lungs. “Stay with me, sweetheart. You’re doing great. Just focus on breathing, okay?” Nancy tightens her grip on the patient’s hand. Renee’s eyes flicker to the monitor, taking in the blaring alarms and the flashing red numbers. She knows something’s wrong. Her gaze shifts to Lindsay, pleading silently for reassurance. “We’ve got you, Renee, you’re doing good.” Lindsay tells her. But behind Dr Lindsay’s composed face is a subtle sense of worry, and Renee picks up on it.

Over the coming minutes, Renee starts experiencing rapid, terrifying deterioration in quick succession. Initially, her heart rate spikes significantly, shooting into the 160s as her body struggles with severe respiratory distress. She gasps desperately for breath, struggling to draw in air, as her lungs and heart begin to fail under the weight of whatever’s happening to her body. It’s almost suffocating. Renee’s breathing becomes more and more labored and erratic, the sound of agonal gasps filling the room. Her chest heaves violently with each frantic gasp, but each inhalation is shallow and desperate. Her skin becomes pale, lips bluish, and there’s an almost grayish hue around her face as hypoxia sets in. This isn’t just the cold medical stuff, it’s visually disturbing to the staff and to the patient herself, who is acutely aware of her body failing on her. Her heart rate spikes dramatically- 160s, 170s, 170s, and the EKG starts to show signs of v-tach.

Despite the chaos, Renee’s mental clarity remains fully intact as she slowly realizes that something much more serious is happening to her. She’s not just experiencing a panic attack. She’s aware that she’s rapidly losing control. She gasps in a panicked voice, choking on her breaths: “Am… I… dying…?” Her voice is frantic, each word more strained than the last. There’s no crying, but her face is contorted in terror, her eyes wide and glassy. Her hands clutch the edge of the table in a desperate bid to hang on. “we’re gonna make sure that doesn’t happen hunny. Just try to relax for me and take slow, deep breaths, ok?” Nancy answers.

Our team’s urgency builds as her condition continues to deteriorate. While they’re still moving with clinical precision, the panic is very palpable. Nancy, despite the mounting tension, tries to keep the redheaded woman calm with quiet, reassuring words: “You’re going to be ok, Renee. Just stay with me, ok?” But even Nancy’s voice wavers as the minutes tick by, and it’s clear that things are slipping away.

In the coming minutes, Renee’s eyes widen In pure terror, as if understanding that the end is near. Her body quivers for a moment- one last desperate attempt to breathe. Then, her body goes limp, her eyes flicker once more before glazing over. A moment of silence hangs in the air as the team processes the sudden, brutal reality: she’s in pulseless v-tach!

The room erupts into a flurry of motion, but there’s an undercurrent of precision and expertise to every action. Dr Lindsay stands at the end of the bed, her hands steady despite the growing urgency. “Vitals are crashing, let’s move fast. Heather, on her chest, let’s go!” Lindsay commands. Nurse Heather lowers the table and gets on the patient’s chest, beginning compressions, her hands pressing down hard and fast on Renee’s sternum. Dr Lindsay looks at the monitor, confirming v-tach. “Hey Linds, I need to intubate now. 7.0 ET please.” Informs Dr Sarah. Sarah wastes no time. She stands at the head of the bed, positioning the intubation tube with practiced ease, and quickly slides it into the redhead’s airway, securing it with some surgical tape. Nurse Nancy connects the ambu bag, squeezing much needed oxygen into Renee’s lungs. Lindsay turns to Dr Sarah, who is putting the defib pads on her chest. “Let’s go with epi first. 1 mg IV push.” Dr Lindsay orders. Sarah administers the meds intravenously while Heather pumps away at Renee’s bare, skinny chest. The redhead’s chest caves in, her belly ripples out from the force of Heather’s chest compressions.

After a minute or so, the patient remains in pulseless v-tach despite intubation, 1mg epi, and a few CPR cycles. Lindsay decides it’s a good time to shock Renee. “ok, let’s charge to 200. Everyone… CLEAR!” Dr Lindsay calls out. KA-THUNK!!! There’s a pause after the shock, and all eyes are on the monitor, hoping and praying for ROSC. “No change. Resume compressions, Heather. Sarah, push 300 mg of amiodarone.” Orders Dr Lindsay. Another round of epinephrine is administered in swift silence. Heather completes two cycles of compressions after the second dose of epi is administered. At that point, the defibrillator charges again, the team holding their breath as they await the jolt. “Ok, recharging to 300. Everyone… CLEAR!” Barks Dr Lindsay. The electricity rips through Renee’s petite body, her chest heaving with the force of it. The monitor briefly catches a moment of regular rhythm, only for it to plummet into v-fib. “Crap! She’s in v-fib. Let’s push another milligram of epi, then shock again.” Dr Lindsay says, her tone a mix of frustration and determination. The team is relentless. Dr Sarah prepares the IV meds, while Dr Lindsay keeps a watchful eye on the monitor. The drugs flow through Renee’s veins, but still, the monitor remains unforgiving. “Ok, meds in. Let’s shock again at 360. Everyone… CLEAR!” The defibrillator charges for the third time, and the cute redhead’s body tenses up again, shoulders shrugging forward, eyes wide open, but the result is the same: nothing. Lindsay sighs following the shock. “She’s not responding. Let’s go for another 150 milligrams of amiodarone and shock her at 360.”

The next amiodarone dose is halved, and Dr Sarah administers the medication with a calmness that contrasts the panic in the room. The defibrillator makes a rising, high pitched hum as it charges, and once again, sends a quick jolt through Renee’s chest. Her hands make loose fists, and the upper half of her body shivers for a second or two. Nothing. The 38 year old’s heart doesn’t budge. “Still nothing. We’re not giving up.” Dr Lindsay directs Nurse Nancy to ensure the ambu bag is being squeezed at full capacity. Heather resumes chest compressions. The team remains laser focused, and administers another 360 joule shock when Heather finishes her cycle of CPR. The jolt, more violent than the others, leaves the room holding its breath. Renee’s feet kick up at the far end of the table, slamming back down hard half a second later, showing off the soft, smooth soles of her size 6 feet. Even after this shock, v-fib persists.

The team continues their efforts, almost on autopilot at this point. CPR, ambu bagging, and another 1mg push of epi, but v-fib remains. Lindsay then orders the team to shock the patient for a sixth time. “Charging to 360. Everyone… CLEAR!” Lindsay calls out. Renee’s chest shoots up, her back arches dramatically, and her body plops back down on the table ungracefully a second later. All eyes shift back to the monitors. “Still in v-fib, Linds.” Sarah shakes her head.

Dr Lindsay takes a breath, steps back, folding her arms, looking at the team, her face unreadable. “She’s in refractory v-fib, we’re gonna have to call time of death.” Lindsay explains to the team, succinct and to the point. “heather, hold compressions.” Lindsay continues. Heather stops, and steps back from the table, away from the patient. Nancy detaches the ambu bag from the ET tube, a small amount of air hissing out. “Alright. Time of death, 12:37pm.” Announces Lindsay, her bluish gray eyes looking at the clock in the lefthand corner of the room, pulling off the latex gloves on her hands.

The room becomes eerily quiet, the frantic chaos of the code blue replaced by an unsettling calm. Dr Lindsay stands back, looking down at Renee, her eyes still WIDE open and unblinking, face still pale and distorted in terror, detached ET tube sitting between her pale, cyanotic lips. The heart monitor that still displays the jagged waveforms of v-fib is turned off. Nancy stays at the head of the bed, taking a moment to look down at Renee’s face. Her eyes are wide open, frozen in a moment of sheer terror. Nancy swallows, her throat tight, before reaching forward to gently close the redhead’s eyes for the final time. “I’m so sorry, hunny.” Nancy whispers under her breath, her hands lingering just a moment too long.

The rest of the team methodically moves through the motions, detaching the EKG wires and removing the IV lines with almost robotic efficiency. Defibrillator pads are peeled off of Renee’s battered chest, the adhesive strips coming away with a slight tug, leaving a red imprint on her skin where the pads had been.

Dr Lindsay fills out the toe tag, her movements deliberate and almost ritualistic. The tag, printed with Renee’s name, age, and the official time of death, dangles from her left big toe, brushing against the soft, smooth soles of her feet. Nurse Nancy places a sheet over her body, her hands trembling slightly as she covers the redhead’s lifeless form.

Lindsay glances over to Dr Sarah and then to Nurse Heather, the weight of the moment settling into their collective silence. Finally, she turns her attention to Nurse Nancy. “I’m going to request an autopsy.” Lindsay says, her voice clinical but with a slight edge of concern. “We never confirmed the PE. It might help us piece everything together.” Continues Dr Lindsay. Nancy nods silently, her face still pale, her eyes lingering on the covered body. She takes a deep breath and steps back, looking at Renee one last time. “What a shame. She went down so fast…” she mutters, her voice thick with emotion.

The room stands still for a moment, the weight of what just happened hanging heavily in the air. A life taken too soon. A woman who had been alive, pleading for her life just minutes ago, is now toe tagged and under a sheet. A nameless, faceless statistic in a death report. The rest of the team turns and leaves the room, each of them silently processing the brief but intense encounter.

Later on, Renee’s autopsy report and labs came back. It was determined that her cause of death was a massive, acute saddle PE. These types of blood clots can sneak up rather quickly and unexpectedly, leading to a deadly progression of events. When Renee woke up this morning, she never in a million years would’ve expected she’d have her time of death called in our ED. But just like that, Renee became the latest beauty to pass away in our emergency department.

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Ella’s OD

The fluorescent lights in Trauma Room One buzzed faintly, casting a glow on our usual team of medical professionals who stood like statues, their faces unreadable. Dr Lindsay stood at the head of the exam table, arms folded, her sharp eyes flicking towards the doorway. Nurse Nancy adjusted her gloves, the faint snap breaking the silence, while Nurse Heather prepared the crash cart nearby, her hands steady despite the silent tension in the room.

In an instant, the stillness shattered as the trauma bay doors flung open with a loud thud. A gurney barreled through, along with two paramedics. One was perched on top of the stretcher, rhythmically compressing the chest of a young lady. “22 year old female!” the paramedic started, breathless but focused, pumping away at the patient’s chest. “Suspected overdose, cardiac arrest for 15 minutes. She’s intubated- no response to multiple doses of Narcan. Seven shocks, two doses of epi on board!” the medic continued.

Twenty two year old Ella’s bare chest caved in hard, her small perky breasts with pierced nipples jiggling slightly in sync with each individual compression. Her fair skin had taken on a ghastly pallor, her colorful tattoo sleeves a stark contrast to her otherwise lifeless appearance. Her green eyes, wide open, stared into nothing, frozen in a gaze of terror that sent a chill through the room. The breathing tube taped firmly in place peeked between her pale lips, and the hiss of the ambu bag punctuated the chaos.

“Let’s transfer her on my count!” Dr Lindsay commanded, stepping towards the gurney. The team moved as one. “One… two… THREE!” With a coordinated heave, they transferred Ella onto the trauma room table. “Nancy, get me a rhythm check!” Dr Lindsay ordered as Nurse Heather connected the defibrillator pads to Ella’s chest. The monitor let out a shrill alarm as it revealed a chaotic ventricular fibrillation pattern. “She’s in v-fib, Linds” Nancy announced, her voice steady despite the grim reading. “Charge to 200!” Lindsay called out, snapping her latex gloves into place. “Everyone… CLEAR!” The team took a step back as Lindsay delivered a shock. Ella’s body was thrown around dramatically by the jolt of electricity, her green eyes still locked in that haunting gaze. “Ok, no change. Heather, resume compressions!” Lindsay barked, her voice sharp. Nancy jumped in without hesitation, her hands working Ella’s fragile frame as the room became a cacophony of beeping monitors, barking orders, and the rhythmic thud of chest compressions.

As the EMS team hurried out, their job done, the doors swung shut behind them, leaving the trauma team to take over the fight for Ella’s life. Nurse Heather stood at Ella’s side, her hands interlocked and pumping firmly on the young woman’s bare chest. The compressions sent tremors through Ella’s thin frame, her green eyes still frozen open, giving the room an eerie, haunting feel. “Charging to 300!” Dr Lindsay announced, her voice cutting through the noise. Her gloved hand hovered over the defibrillator controls as the machine emitted its rising electrical whine. “CLEAR!” she called, stepping back as Heather lifted her hands, and the team momentarily froze. The shock surged through Ella’s torso, causing her body to jerk violently before collapsing ungracefully back onto the table. The heart monitor beeped erratically, showing no change, still in ventricular fibrillation. “Resume compressions!” Lindsay barked without missing a beat. Heather immediately resumed, her palms pressing down rhythmically. Sweat glistened on her brow, but she didn’t falter. At the head of the bed, Nurse Nancy ambu bagged. “Come on sweetie, come on…” Nancy leaned in a little, whispering to the patient, gently stroking Ella’s short, jet black hair with bangs.

The door to the trauma room swung open again, with Dr Sarah and brand new, first year resident Dr Jen entering briskly, both already in yellow gowns and gloves, ready to dive into the chaos. “What do we have?” Dr. Sarah asked, her sharp gaze scanning the room. “22 year old female, suspected overdose.” Lindsay replied quickly, not breaking stride. “She’s been down for 18 minutes and counting, no response to Narcan, nine shocks, three rounds of epi. Still in v-fib.” Relayed Dr Lindsay. Dr. Jen moved to the head of the table, assessing Ella’s pale, motionless face. She adjusted the ambu bag, delivering a few firm breaths through the endotracheal tube. “Good tube placement.” she confirmed, her tone clipped but professional. “Any signs of underlying trauma?” Sarah asked as she grabbed the ultrasound probe from the cart. “None reported by EMS.” Nurse Nancy chimed in as she adjusted the IV line, prepping another dose of epinephrine. “All signs point to an overdose.” Lindsay added. “Let’s confirm in a minute. I’m going to see what her heart’s doing.” Sarah muttered, sliding the ultrasound probe across Ella’s chest. The ultrasound screen displayed a fluttering, twitching heart, no organized contractions. “Damn it.” Sarah shook her head. “Push another round of epi and hit her again at 360. We need to get her out of this rhythm now.” Lindsay ordered, her voice firm. Nancy moved swiftly, injecting the dose into Ella’s IV line as the defibrillator began to charge again. The team exchanged a brief, nervous glance before focusing back on their patient.

Heather’s gloved hands pressed down on Ella’s bare chest with rhythmic precision, each compression forcing her sternum to cave and recoil as it fought against the unnatural motion. The force of Heather’s efforts sent subtle ripples through Ella’s body, making her head bob gently in sync. Her short jet-black hair clung to her pale forehead. At the end of the table, Ella’s bare feet, marked with ink from scattered tattoos, bounced lightly with each downward motion. The movement was unnervingly rhythmic, almost like a puppet on strings. The high pitched whine of the defibrillator charging filled the room, growing louder as the next shock prepared to fire. Nurse Nancy, standing by with the ambu bag, occasionally squeezed it to deliver air into Ella’s lungs, though it felt futile against the relentless tide of chaos. Dr Sarah’s voice cut through the background noise. “Charging to 360!” Heather paused her compressions, lifting her gloved hands and stepping back as Dr Lindsay called out, “Clear!” The shock hit Ella’s chest like a thunderclap, her chest shooting up, her back arching before collapsing back, motionless. Her head lolled to the side, her green eyes staring into the void, still wide open, as though bearing silent witness to the battle raging around her. “No change, still in v-fib.” Dr Jen quickly checked the monitor, seeing the same disorganized rhythm. “Resume compressions” Dr Lindsay ordered, her voice sharp but controlled. Heather immediately resumed, her movements unwavering despite the sweat dripping from her temples. Ella’s head began to bob again, her feet tapping softly against the end of the table, the eerie rhythm matching the relentless beeping of the heart monitor. Dr Sarah exhaled sharply, wiping her brow. “We need to break this rhythm. Let’s prep for amiodarone. Nancy, 300 milligrams IV push.” Nancy nodded, grabbing the vial and syringe from the cart. Meanwhile, Dr Jen leaned over Ella, her voice soft but firm as though addressing the patient directly. “Come on, Ella. Don’t give up on us!”

The room was a whirlwind of controlled chaos as the minutes ticked on. Heather’s hands moved without pause, the rhythmic pressure of her compressions forcing Ella’s chest to yield, each pump a desperate attempt to restart the fragile heart beneath. Nancy prepared the amiodarone, her hands steady despite the mounting pressure. She pulled the syringe from the vial, the liquid gleaming under the harsh lights. “Amiodarone, 300 milligrams.” Dr Lindsay confirmed as Nancy injected the drug into the IV line, her movements swift. Dr Sarah glanced at the monitor, noting the continued, disordered chaos of Ella’s rhythm. “We’ve got to break this.” Sarah shook her head. “resuming compressions…” Heather panted, already positioning herself. “Go ahead.” Lindsay said, her eyes scanning the room for any hint of a shift in the young woman’s condition. With each downward push, Heather’s palms met Ella’s sternum with brutal force, her movements unrelenting. The sound of compressions echoed through the trauma room, filling the space with a macabre rhythm. As the cycle of compressions finished, the defibrillator was recharged once again. The air in the room thickened as everyone held their breath, waiting for the next shock. “Charging to 360.” Dr Lindsay called out. “Everyone… CLEAR!” The shock ripped through the room, the sound of Ella’s body being practically thrown off the table a sharp reminder of how tenuous the battle for her life truly was. Still no change. The monitor continued to display the erratic waves of v-fib, mocking their every attempt. Lindsay’s gaze turned to Nancy. “How long has she been down?” asked the doctor. Nancy’s eyes flicked to the clock on the wall, and her voice wavered slightly as she spoke. “Twenty six minutes Linds.” Answered Nancy. “We need to make a decision. She’s not responding to anything.” Dr. Jen inhaled sharply, her gaze briefly meeting Dr Sarah’s. “Push another epi.” Lindsay said, her tone sharp, eyes never leaving the monitor. Nancy quickly prepared the next round of epinephrine. The team had already been through so much, and they were running out of time. Their movements, while practiced, were also beginning to show the strain of prolonged, relentless effort. Heather resumed compressions as the drugs were delivered.

Dr Jen, her eyes focused on the monitor, took a step to the head of the bed. She moved slowly, her gaze drawn down to Ella’s face. Ella’s green eyes remained unnervingly wide open, staring helplessly at the ceiling. The glazed, lifeless death stare made her appear more like a forgotten doll than a beautiful young woman in the throes of a desperate fight for survival. The vacant gaze was cold, unblinking, locked in place as if her body had already accepted what her mind could not. Jen swallowed hard, her throat tight with a mixture of professional detachment and the raw sting of helplessness. She leaned in, pulling a penlight from her scrub pocket and shining it into Ella’s wide open eyes. The light flicked across her pupils, but they didn’t react. The glow of the light reflected back with the cold, indifferent stare of a body already slipping further away. “Pupils fixed and dilated…” Dr Jen observed, her voice barely audible, a heavy sigh escaping her lips. She took a step back, a troubled frown crossing her face as she shook her head, unable to hide the quiet disbelief. It wasn’t just the absence of any reaction to the light- it was the utter lack of life in Ella’s expression, as though her soul had already departed. Dr Sarah looked up from the monitor, meeting Jen’s eyes for a brief moment. The wordless exchange spoke volumes- their collective knowledge of what they were likely facing now. “She’s gone, isn’t she?” the resident asked. Lindsay’s eyes were cold, calculating. She didn’t want to say it, didn’t want to admit it- but the signs were impossible to ignore. She didn’t answer Jen immediately, focusing instead on the monitor as another cycle of compressions was completed. The v-fib was still there- persistent, chaotic, and now undeniably futile. “She’s not gone yet.” Lindsay finally said, her voice unwavering, though her words carried the bitter edge of disbelief. Jen nodded, though her expression remained pained. There was a subtle shift in her posture, the weight of the decision sinking in. They were pushing past the point of reason now- fighting for a life that might have already slipped through their fingers.

The defibrillator charged with a menacing hum, the quiet tension in the room palpable. “CLEAR!” Dr Sarah’s voice rang out, and in a single, tense moment, the shock hit Ella’s body with a violent jolt. Ella’s slender frame jerked sharply on the table, the electricity coursing through her body with an uncontrollable force. Her back arched slightly before slamming back down, her feet lifting briefly once more before crashing to the table. For just a split second, the brief twitch of her muscles seemed almost… human. But it was fleeting, just as everything else had been. Once again, the chaos on the monitor didn’t subside. V-fib persisted, a constant visual reminder that no matter how many times they shocked her, her heart refused to resume a proper rhythm. Heather, ever steady, resumed chest compressions immediately, the crunch of each compression reverberating in the room. Her movements were practiced and deliberate, a well oiled machine in sync with the others. But before long, Dr Lindsay held up a hand, halting the cycle. “Stop…” she said quietly, but with an undeniable finality. Heather paused, her hands still hovering over Ella’s bruised, battered chest as she looked up, waiting for the next instruction. Lindsay’s gaze remained fixed on the monitor, her eyes narrowing at the stubborn, erratic lines of v-fib. Her lips pressed into a thin line, the weight of the situation getting to her. Finally, she sighed, closing her eyes for a brief moment, before speaking the words that everyone in the room had been dreading. “She’s gone. Time of death… 21:55.” Lindsay shook her head. She turned away from the table, her frustration spilling out in a short, sharp exhale. The decision to call the time of death was never easy, but there was something particularly brutal about this moment. The countless attempts, the shock after shock, the tireless effort- it all meant nothing in the face of this. The team stood motionless for a moment, the weight of the loss settling over them. The room that had been filled with the chaos of resuscitation now felt oppressive in its silence. Heather slowly pulled her hands away from Ella’s chest, her face hard to read as she stood up, stepping back.

The room was still, except for the soft rustle of movements as the team shifted into the next phase of their task. Nancy moved first, her hands shaking slightly as she detached the ambu bag from Ella’s ET tube. Next, Dr Lindsay reached over and turned off the heart monitor. The beeping- once erratic and frantic, now just a slow, steady buzz of failure- came to a sudden stop. Nurse Heather moved to the other side of the bed, her gloved fingers working methodically as she disconnected the EKG wires from Ella’s torso. The defib pads were peeled off, their sticky residue a faint reminder of the futile attempts to bring Ella back to life. With a small, practiced tug, Heather pulled the wires free, coiling them neatly as she set them aside, careful to avoid disturbing the fragile quiet that had settled over the room. Then, as if in slow motion, Dr Sarah stepped forward, her eyes looking down at Ella. She retrieved the toe tag from the corner of the room, the heavy paper crinkling in her hands. Her pen hovered for a brief moment over the space for time of death. It was already etched In her mind, a number that had haunted her since the moment they’d called it. With a steady hand, Dr Sarah filled out the rest of the tag. Afterwards, she glanced one final time at the patient- no longer a person they were fighting to save, but simply a body now- and placed the tag on the big toe of Ella’s left foot. The tag dangled gently against the wrinkled soles of Ella’s feet. Dr Jen stepped forward, her face a mask of quiet resolve. She moved to the side of the bed, pulling a cover from a nearby cart. With careful hands, she draped the cover over Ella’s body. The sheet covered everything except her toe tagged feet. The team stood back, an unspoken respect filling the air as they took one last look at the lifeless form before them. The sheet settled over Ella’s face, and with it, the last remnants of her terrified, vacant stare were hidden from view- concealed forever beneath the sterile fabric. “Let’s move her to the morgue…” Dr Lindsay said, her voice unexpectedly soft, almost apologetic. The words broke the silence like a whispered command. Without another word, the team began the quiet, methodical process of preparing Ella’s body for transport. Just like that, Ella became the latest beauty to find herself toe tagged and under a sheet in our emergency department.

kk095

Xmas in the ER

*Hello there everyone, and merry Christmas to those who celebrate! As promised, here's my latest story. I hope you all enjoy the story as much as I do, and feel free to shoot me a message, comment, or leave me asks if you have any questions! I will also be posting another story sometime on New Year's Eve.*

As the old saying goes, Christmas is the most wonderful time of the year. The holiday is a great opportunity to spend time with loved ones, exchange gifts, and make lifelong memories. But for Dr Lindsay, this year’s Christmas was just another Wednesday where she was tasked with holding down the 7pm to 7am overnight shift in our ER. Naturally, Lindsay was bummed out about the idea of having to work on Christmas, but the emergency department is a 24/7 operation! Little did she know, she’d still have a holiday she’d never forget!

That night, the weather was awful. It was dark, freezing cold, and snowing heavily. Visibility was limited, and the roads were covered in a fresh coat of snow and ice. “Jeez… I bet we’ll have a couple of MVCs tonight.” Lindsay thought to herself shortly after she started driving, trying her best to carefully make her way to work through the frozen, wintery landscape. Fortunately for Lindsay, the roads were mostly empty, most people in the area opting to stay indoors. Even though the roads were empty, the conditions were less than ideal, so she felt the best move was to drive slowly.

Despite Lindsay doing everything in her power to arrive safely at the emergency department, fate had other plans for the cute, sporty tomboy doctor! On the highway about 10 minutes or so from her destination, Lindsay’s car slipped on a patch of ice on the road. The car almost immediately lost control, redirecting the doctor’s vehicle towards a cement barrier in the median of the highway. Lindsay’s heart raced as she white-knuckled the steering wheel, frantically attempting to regain control of the errant vehicle. But it all happened so fast! There was only so much Lindsay could do in those few seconds. Lindsay was unable to stop or change the trajectory of her car and slammed head on into the cement median.

CRUNCH! The windshield shattered, glass fragments flying everywhere inside the vehicle acting almost as little bits of shrapnel. Lindsay raised one arm to attempt to cover her face from the glass shards, but a few nicked her face and neck. The steering column was forced inwards, slamming Lindsay in her chest with tremendous force before being blown back a second or so later when the airbag deployed. “AHHH!” Dr Lindsay yelped, feeling something pop inside her chest. Even with the vehicle stopped after the impact, the momentum generated from the accident caused Lindsay to be thrown around a bit. Just like that, the roles were reversed, and now Lindsay found herself in need of assistance in the ER.

Upon arrival at the emergency department, Lindsay was awake, alert, and doing anything and everything she could to fight through the pain. While being wheeled in through the main entryway of the ER, she was laid out on a backboard atop a gurney with a c-collar around her neck. Lindsay was stripped barefoot, down to just her black sports bra and scrub pants. EKG electrodes and wires were stuck onto her torso, while IV lines were set up in each arm. A blood pressure cuff was wrapped around her left bicep, and a pulse oximeter was on her left index finger. The ER doc’s body was in relatively good shape, but she had some cuts and scrapes on her face and neck from the glass shards.

While being wheeled in, Dr Lindsay was experiencing a weird déjà vu of sorts. She’s walked through those same entryway doors more times than she could count, but she never saw the emergency department from that angle. She couldn’t wrap her mind around the idea of being brought in as a patient. Her pretty blue eyes scanned her surroundings, attempting to make sense of the nonsense. “33 year old female, blunt chest trauma, single car MVC. BP 60 over palp, heart rate’s 140 and climbing, pulse ox down to 90. Got IVs going on scene and started fluids, but her vitals aren’t looking too good.” Lindsay heard a female medic rattle off while wheeling the stretcher down the hall towards trauma room one. “Ok, thank you. Let’s get her over to trauma one. I’m gonna start her on the MTP and get a chest x ray.” A familiar voice replied to the medic. “who is that?” Lindsay thought to herself. “Dr Sarah maybe? I know she was supposed to work the day shift today.” Lindsay answered, still thinking to herself.

The gurney was still being wheeled towards the trauma bay. Dr Sarah leaned over, coming into Lindsay’s line of sight and lowered a stethoscope onto her chest. Sarah didn’t look down at Lindsay’s face, so she didn’t immediately realize who her next patient was. “Diminished breath sounds on the left side, we might need a chest tube.” Sarah observed, pulling her stethoscope away after a brief listen. Dr Sarah then looked down at the gurney, her eyes locking with Lindsay’s. Sarah’s eyes could be seen widening behind her glasses, absolutely stunned at what she was looking at. Sarah gasped, unable to get a word out. “Sarah….?” Lindsay whimpered, her voice weak and breathy. “OHMYGOD, Linds?! What happened?” Marveled Dr Sarah, still processing the concept of Dr Lindsay- a friend and coworker, being her next patient. Lindsay’s lip quivered, her eyes started to moisten. “my car… it just slipped… I don’t know what happened…” Lindsay explained to Sarah, her voice wobbly, now on the verge of tears. “It’s ok Linds, it’s gonna be ok! We’re gonna take a good look at you!” Consoled Sarah, gently grabbing Lindsay’s right hand, her voice a bit panicked.

Once in the trauma room, the stretcher was lined up parallel to the table, where Nurses Heather and Nancy waited. “LINDSAY?!” Heather exclaimed the instant she recognized who the patient was. “Hunny?! What happened?!” Nurse Nancy chimed in, equally surprised. Lindsay didn’t answer, but the familiar voices certainly comforted her through the terrifying uncertainty she was experiencing. “Let’s get her on the table on my count! One… Two… THREE!” Sarah barked out. The trio of beautiful ladies picked up the backboard and carefully moved their coworker onto the table while the paramedics took their stretcher back and exited the room. “Ah….” Winced Lindsay, feeling some pain inside her chest while being placed down on the table. Dr Lindsay squinted, the bright, fluorescent overhead light practically blinding her. “BPs 60 over palp and dropping. Hang 4 units of O-neg and prep Lindsay for a chest tube.” Ordered Dr Sarah, her voice urgent. “Linds? I have to put in a left chest tube. You know how bad they hurt, but be strong for me, ok? I promise I’ll be fast.” Dr Sarah kept Lindsay in the loop about her treatment. Lindsay hesitated for a moment, trying to mentally prepare for the pain she was about to endure. But the logical, doctor side of her took over, realizing that the brutal, painful procedure had to be done. Dr Lindsay’s eyes looked up at Sarah, and she nodded. “Go ahead.” Permitted Lindsay, giving Sarah the green light to begin chest tube placement.

Lindsay laid on the table in the supine position, her left arm raised above along her head. The normally calm and collected Dr Lindsay had a nervous expression on her face. The doctor turned patient’s lips were pinched tight, her forehead puckered, her icy blue-grey eyes looking in the direction of her left ribcage where the tube was to be inserted. She watched Dr Sarah insert a needle full of lidocaine to numb the skin. Lindsay felt a quick pinch, but nothing too worrisome. Sarah then sterilized the incision area with an alcohol wipe. “Ok Linds… Here we go…” The cute, nerdy redhead doctor told Lindsay, reaching for a 10 blade scalpel that sat on an equipment tray beside the trauma room table. Sarah took the scalpel and made a 1 inch cut at the intersection of the 4th intercostal space and anterior axillary line. Lindsay could feel the cold, sharp blade’s every move as it effortlessly slashed her skin apart. Lindsay saw stars, her eyes rolling back in pain. After the cut was made, Sarah attached a Kelly clamp to the proximal end of the chest tube, then bluntly inserted it into Lindsay’s chest cavity. “YAHHH!!!!” Yelped Lindsay, her eyes shooting wide open. Dr Sarah continued the procedure, guiding the tube further into Lindsay’s chest cavity into the pleural space. “AHHHH!!!” Lindsay let out a blood curdling scream, in absolute agony, her eyes tearing up, both her hands making tight fists, feeling the plastic tube forcing its way deeper inside her chest. There was a hiss of air once the tube reached the correct location from trapped air vacating Lindsay’s chest cavity. Lindsay gasped loudly and dramatically, then attempted to sit up. “whoawhoawhoa!” Nurse Heather stepped in, gently laying Lindsay back down on the table. “Stay still for us Linds. So far so good hunny.” Nancy chimed in, gently stroking Lindsay’s hair. Sarah lowered her stethoscope onto Lindsay’s chest and had a listen. “Tube’s in.” Sarah nodded.

Although Lindsay’s breathing improved following the chest tube placement, her vital signs continued to drop. Dr Sarah started another round of blood products and upped Lindsay’s meds, but that didn’t seem to be doing the trick. Lindsay began to shiver dramatically. Her long legs trembled and shook, and at the far end of the bed, her toes were scrunched up hard, showing off the white and red candy cane themed nail polish on her toes, along with the thin, wavy, prominent wrinkles that permeated the soles of the big, size 12 feet Lindsay was always so self conscious of. “Mmmmm…” Lindsay moaned. Dr Lindsay began taking rapid, shallow breaths, continuing to moan. “Shhh. It’s ok Linds. Hang in there a little longer for me…” Nurse Nancy’s calm, soothing voice told Lindsay. “I…I…” Lindsay babbled. “You what sweetie?” asked Nancy. “I just… I can’t believe I’m gonna die on Christmas…” Replied Lindsay, an impending sense of doom consuming her. The trio of caretakers in the room stood there frozen for a second, taken aback by Lindsay’s response. Nobody could believe that words like that were coming from Lindsay’s mouth. “You’re not dying hunny! We need you here New Year’s Eve! You know how we get slammed every year!” Nancy tried to encourage, her tone of voice upbeat and positive. “New Year’s Eve? Pshhh…” Lindsay scoffed, continuing to shiver. “I’m gonna be toe tagged and under a sheet in a little while…. Forget New year’s…” continued Lindsay. “No hunny, don’t say that! We’re gonna fix you up!” Nancy reassured, her voice getting a bit wobbly, upset by how Lindsay was talking about her own fate.

Before Lindsay could even answer, she started gasping loudly, taking deep, dramatic gasps. The heart monitors began beeping louder and faster, playing an almost ominous tone. “She’s crashing…” Heather announced. “linds? Stay with us hunny!” Nurse Nancy said to Lindsay, holding her right hand for a second. Again, Lindsay didn’t answer. Her frantic hyperventilating continued, her eyes WIDE open. “We need to intubate. 8.0 ET and a laryngoscope!.” Ordered Sarah, her voice roaring through the room. “Lindsay? I’m gonna intubate you, ok?” Sarah told Lindsay, moving to the head of the bed. Dr Lindsay looked up at Dr Sarah, their eyes locking for a moment. Lindsay looked like she was trying to mouth something, but couldn’t get the words out. “What’s up Linds?” asked Sarah. Lindsay didn’t answer. Her eyes shifted away from Sarah’s. Lindsay’s eyes remained wide open, but became locked at the ceiling. It was like a switch was flipped. Lindsay’s shivering and gasping came to an abrupt stop. The monitors began to alarm at that point. “V-fib! Starting compressions!!!” Nurse Heather shouted out. Heather immediately began chest compressions, pushing down on Lindsay’s chest hard and fast. Nancy swooped in, snipping off Lindsay’s sports bra, exposing her small breasts and hard nipples. At the head of the bed, Sarah got right to it, beginning rapid sequence intubation. The nerdy redheaded doctor carefully navigated the flexible plastic tube into her friend’s airway. Lindsay’s head bobbed and lolled around from the residual force of Heather’s hearty compressions, creating a moving target for Sarah- nothing that Sarah couldn’t handle! The breathing tube was navigated further into Lindsay’s airway, ending up in the correct depth and location in a matter of seconds. “I’m in!” Sarah confidently announced, taping the tube in place.

Post-intubation, the trauma team decided to shock Lindsay. The defibrillator paddles were charged to 200 joules, gelled, and pressed up against Lindsay’s bare, flat chest. “Alright! Everyone…CLEAR!” Sarah shouted, sending the first shock into the patient once everyone backed away. “MMMPH!” Lindsay moaned, as if she felt the shock. The first defibrillation didn’t do the trick, onto the second one! The defibs were recharged to 250 joules, and shock #2 was promptly delivered. “Mmm….” Moaned Lindsay, again, almost as if she knew what was being done to her. Shocks one and two didn’t do the trick, but third time’s the charm, right? The paddles were charged up to 300, and Lindsay was shocked. Her chest shot up and her back arched. She held that position for a second or two before plopping down onto the orange backboard. “Damn it, no change! Shocking again at 360. Everyone… CLEAR!” Barked Dr Sarah. KA-THUNK! Lindsay’s 6’1 frame was tossed around effortlessly by the stronger shock, but like before, v-fib persisted. With the paddles still pressed up against Lindsay’s bare chest, Sarah shocked Dr Lindsay again at 360 joules. At the far end of the table, Lindsay’s feet kicked up, slamming back down hard half a second later, wrinkling the soles of her big feet once again.

Following the fifth shock, the trauma team switched gears, giving CPR and ambu bagging another try. Heather placed the heel of her gloved hand on the middle of Lindsay’s chest and began pumping away hard and fast. Lindsay’s chest caved in, and her toned belly with abs rippled and jiggled out from the sheer force of the chest compressions. Heather felt Lindsay’s ribs break, but nonetheless, she kept up her life saving efforts. At the head of the bed, Nurse Nancy attached the ambu bag to the ET tube, puffing the light blue bag every few seconds or so, sending critically needed oxygen directly into the coding doctor’s lungs. Dr Sarah stood off to the side of the table injecting the first doses of epinephrine and atropine into Lindsay’s IV line in hopes of stimulating positive cardiac activity. While waiting for the meds to kick in, Heather kept at it, brutally going to town on her coworker (now patient’s) chest. Heather looked down at Lindsay’s face while continuing CPR. Lindsay’s head bobbed and bounced around in sync with each individual compression. Her eyes were WIDE open, her face locked in a full-blown death stare. The ET tube hung out the side of Lindsay’s mouth, taped in place, hugging her pale lips. Heather couldn’t believe a familiar face was in such dire shape. “The ones with their eyes open never make it…” Heather thought to herself. Back at the head of the table, Nancy continued ambu bagging. “You’ve got a long life ahead of you… We all love you and need you here Linds…” Nancy whispered into Lindsay’s ear, as if she was trying to convince Lindsay to not die.

Over the coming minutes, Lindsay’s chest began to take an absolute beating. A nasty bruise started to form in the center of her chest on top of the breastbone. Mid code, Lindsay’s chest tube began to drain a substantial amount of blood seemingly out of nowhere. “What the hell?...” A surprised Dr Sarah thought out loud. In the blink of an eye, a couple liters of blood drained through the tube. “She’s bleeding somewhere in her chest. Maybe a cardiac chamber or great vessel injury.” Speculated Sarah, trying to explain away what she was seeing. “I’m gonna do an echo. Let’s see what her heart’s doing. Maybe that’ll give me something to work with.” Sarah went on. With CPR ongoing, Sarah squirted a little bit of clear, conductive ultrasound gel onto Lindsay’s bare chest. She turned on the ultrasound monitor screen and lowered the wand onto the portion of Lindsay’s chest where the gel was and began moving it around for a second or two to spread it out a bit. Sarah then moved the ultrasound wand over Lindsay’s heart and eyes the monitor screen. “….oh Lord…what a mess in there…” Uttered Sarah. “Hmm?” Heather overheard. “Massive tamponade.” Sarah shook her head. “Pericardiocentesis?” asked Heather, wondering what the next step was. “I don’t think that’ll do the trick. We need to crack her chest and see what’s really going on in there. I’m gonna set up a thoracotomy tray.” Sarah explained to Nurse Heather. Nurse Heather’s eyes went wide once she heard the word “thoracotomy.” That was a last ditch effort, hail Mary procedure used in the most critical patients. Heather has seen many patients get their chest cracked during her time as a nurse in our ER, but the idea of a friend, coworker, and familiar face being the recipient of such a procedure really bothered Heather at a deeper level.

Betadine was splashed across the left half of Lindsay’s chest. The strong, chemical scent of antiseptic hit everyone’s nostrils in less than a second. Sarah picked up the scalpel, making a crude, but decisive incision. The cut started just to the left of Lindsay’s sternum, extended laterally across her chest, underneath her left nipple, and concluding just shy of her left armpit. Heather halted CPR while Sarah worked to separate the underlying tissue and muscle to make way for the rib spreader. With an adequate space created, the metal rib retractor was placed, and Lindsay’s chest was forcefully pried open. A loud popping and cracking sound echoed around the room while Sarah turned the knobs on the spreader. Upon entry to Lindsay’s chest cavity, there was a massive rush of blood. “Suction! SUCTION!” Shouted Sarah, packing handfuls of surgical sponges into the fresh incision area. Heather lowered a suction tube into Lindsay’s chest cavity and began removing the excess blood to create a good line of sight for Sarah. The suction tube made a wet slurping sound as it removed the blood. Meanwhile, Sarah incised the fibrous lining of the pericardium to relieve the tamponade and placed a vascular clamp on the descending aorta in order to redirect blood flow and quell any arterial bleeding- at least temporarily. Heather continued to apply suction every few seconds or so, the line of sight clogging up with blood like clockwork. “Starting cardiac massage.” Announced Sarah, reaching into Lindsay’s chest, beginning to vigorously massage away at Lindsay’s strong, athletic heart. Sarah’s gloved hands were wrapped firmly around the beautiful tomboy doctor’s heart, squeezing much needed blood to the rest of her body. A wet, rhythmic squishing sound was produced from Dr Sarah’s internal resus efforts. “Come on… come on Linds…” uttered Sarah under her breath.

Sarah squeezed and squeezed, but her multiple cycles of cardiac massage failed to restart Dr Lindsay’s heart. Next up, the team opted to give the internal paddles a try. The internal paddles were charged to 20 joules and lowered into Lindsay’s chest around her erratically twitching heart. THWACK! Lindsay’s heart tensed up for a second before going right back to v-fib. Sarah sighed. “No change, going again at 30. Everyone… CLEAR!” Sarah shocked again. Lindsay’s torso jolted sharply in response to the shock, but v-fib remained. “Hitting her again at 40!..... CLEAR!” Sarah’s voice surged. “Mmm….” Lindsay moaned in reaction to the shock. “she’s still in v-fib, let’s go again…. CLEAR!” Sarah yelled out passionately. A dull, wet thump was heard, however, Lindsay’s heart still couldn’t be shocked out of v-fib. “AGAIN!... CLEAR!” Yelled Sarah, lowering the blood soaked internal paddles back onto Lindsay’s cracked open chest. “Still nothing. Recharging the internal paddles to 40!” Sarah announced, her tone of voice growing more and panicked. The high pitched, electrical whirring sound of the paddles recharging bounced around the room. “Ok…. CLEAR!” Sarah defibbed Lindsay again. Almost instantly after the shock, the heart monitors flatlined. Lindsay’s heart sat completely motionless in plain sight. Dr Sarah removed the large, spoon shaped paddles and gently set them back on the crash cart. Sarah began removing her gloves and eyeing the clock on the wall. “It’s over. Time of death, 19:35.” Sarah called out, abruptly terminating the code.

The trio of caretakers stood there shell shocked for a moment while the high pitched hum of the flatlined monitors droned around the room. Nancy removed the ambu bag, a small amount of air quietly hissing out. Heather switched off the monitors, making the once loud, chaotic room eerily silent. Nobody said a word, but knew exactly what to do next. The IV lines were taken out of each arm. The EKG electrodes were disconnected. The BP cuff was taken off Lindsay’s left bicep. The pulse oximeter was taken off her left index finger. A blue surgical drape was hastily tossed on top of the thoracotomy site. Lindsay’s eyes remained wide open as her body was covered, appearing as if she watched the sheet get pulled over her head. Last but not least, a toe tag was filled out and placed on the big toe of Lindsay’s left foot. The tag dangled in front of Lindsay’s hot, wrinkly soles, serving as a harsh reminder that no Christmas miracles would be taking place that night. In this alternate reality, Lindsay was now the latest beauty who found herself toe tagged and under a sheet in our emergency department.

The Next Morning

..................................

The fluorescent lights in the emergency room buzzed softly overhead, casting a harsh glow over the sterile space. Sarah sat with her best friend, Emma, her arm wrapped tightly around her. They had been out drinking the night before, but something was wrong. Emma wasn’t just hungover; her skin was pale, and her body seemed to be shutting down. Sarah couldn’t shake the feeling that something was terribly off.

"I don’t feel right," Emma had whispered earlier, wincing from the pain in her head. "This isn’t a normal hangover."

Sarah’s heart raced as she explained to the triage nurse what had happened, pleading for her to take Emma seriously. "She’s really not feeling well. We were out drinking, but this isn’t normal. She can barely sit up, and she keeps saying her head is splitting."

#cpr #resus #resuscitation #defib #defibrillator #defibrillation

Curiosity

In the dimly lit room of the Intensive Care Unit (ICU), monitors beeped rhythmically, casting an eerie glow over the scene. Tubes and wires snaked around the bed, connecting the unconscious patient to various machines, a testament to the intricate dance of modern medicine. Amidst this symphony of medical intervention lay Sarah, a 28-year-old mother of one, her chest rising and falling with the aid of a mechanical ventilator.

Sarah's journey to this sterile environment had been nothing short of harrowing. It began like any other day, with the sun rising gently over the horizon, promising another day of routine and responsibilities. Little did she know that fate had other plans in store.

As Sarah went about her duties at work, a sudden wave of dizziness washed over her, her vision blurring at the edges. Ignoring the warning signs, she soldiered on, determined to fulfill her obligations. But fate is relentless, and as Sarah reached for a file on her desk, her world went dark.

#cpr #resus #resuscitation #defib #defibrillator #hospital #female #resus writing #resus community

Simulation

In the bustling corridors of the underfunded hospital, a faded flyer catches the eye of passersby, its corners curling with age. "Volunteers Needed for Trauma Training Exercise," it boldly proclaims, beckoning those with a sense of adventure or altruism to step forward and lend their aid.

Among those drawn to the call is a 24-year-old woman, her determination evident in the set of her jaw as she approaches the hospital's trauma director. They exchange a brief but earnest conversation, the young volunteer expressing her willingness to participate in the training exercise while voicing her concerns about her comfort level with certain procedures.

"I'm eager to help in any way I can," she explains, her voice tinged with a mix of nervousness and resolve. "But I'll admit, I'm a bit apprehensive about some of the more invasive procedures. I'm comfortable with basic first aid and CPR, but I'm not sure I'm ready for things like intubation or defibrillation."

The trauma director nods understandingly, his expression one of reassurance rather than judgment. "That's perfectly understandable," he replies, his tone gentle yet firm. "Your safety and comfort are our top priorities. We'll tailor the scenario to suit your preferences and ensure you're only asked to participate in tasks you feel comfortable with."

With a sense of relief washing over her, the young volunteer nods gratefully, grateful for the understanding and support offered by the trauma director. Together, they discuss her role in the upcoming training exercise, mapping out a scenario that challenges her skills without pushing her beyond her limits.

Preparing the volunteer for the trauma training exercise is a meticulous process, undertaken with care and attention to detail to ensure her safety and comfort throughout the simulation.

As she arrives at the hospital, the volunteer is greeted by a team of trained professionals who guide her through each step of the preparation process. They lead her to a private changing area, where a set of hospital scrubs awaits her. With gentle encouragement, they assist her in disrobing, providing her with disposable undergarments to wear beneath the scrubs for modesty and hygiene.

Once dressed, the volunteer takes a seat as a makeup artist meticulously applies special effects makeup to simulate the injuries she will portray during the exercise. With a steady hand and an artist's eye for detail, they create realistic bruises, lacerations, and abrasions, transforming the volunteer's appearance into that of a trauma patient in need of urgent medical attention.

As the makeup artist works their magic, other members of the preparation team gather the necessary equipment for the simulation. They retrieve a backboard from its storage location, laying it out on a nearby gurney in anticipation of the volunteer's arrival. Alongside the backboard, they arrange a cervical collar (C-collar) and an inflatable orange brace designed to stabilize her right leg.

With the makeup application complete, the volunteer is guided to the gurney, where she lies down with a sense of trepidation mingled with excitement. The preparation team surrounds her, their movements practiced and precise as they secure her to the backboard with straps, ensuring she remains stable and secure throughout the simulation.

Next, they carefully position the cervical collar around her neck, adjusting it to provide support without impeding her breathing or movement. With gentle yet firm hands, they slide the inflatable orange brace into place around her right leg, inflating it to the appropriate level to immobilize the limb and prevent further injury.

As the final touches are made, the volunteer takes a deep breath, steeling herself for the challenges that lie ahead. Though she may be nervous, she knows she is in capable hands, surrounded by a team of professionals dedicated to her well-being. With a nod of affirmation, she signals her readiness to begin, eager to play her part in the training exercise and contribute to the hospital's ongoing mission of saving lives.

The simulation begins with the trauma team gathered around the gurney, their expressions grave as they assess the condition of the patient lying before them. The young woman, named Emily, is 24 years old, her face drawn with pain as she struggles to maintain consciousness amidst the chaos of the emergency room.

Emily's injuries are extensive, the result of a harrowing car accident that left her trapped in the wreckage for hours before help arrived. She presents with multiple traumatic injuries, including a deep laceration on her forehead, contusions and bruising across her chest and abdomen, and a visibly deformed right leg.

As the medical team conducts their initial assessment, Emily groans softly, her voice barely above a whisper as she describes the events leading up to the accident. She recalls the screech of tires and the sickening crunch of metal as her car careened off the road, the world spinning in a dizzying blur before everything went dark.

Her breathing is shallow and labored, punctuated by gasps of pain as she struggles to draw air into her damaged lungs. A rapid pulse races beneath her clammy skin, a testament to the body's instinctive response to trauma as it fights to stay alive against overwhelming odds.

The trauma team works quickly and methodically, their movements a synchronized dance of urgency and precision as they address each of Emily's injuries in turn. They apply pressure to the gaping wound on her forehead, staunching the flow of blood with sterile dressings and medical tape.

Meanwhile, others attend to her chest and abdomen, palpating for signs of internal injury while monitoring her vital signs for any indication of deterioration. X-rays are ordered to assess the extent of her injuries, with the medical team bracing themselves for the possibility of life-threatening complications hidden beneath the surface.

Throughout the simulation, Emily remains conscious but disoriented, her grip on reality tenuous as she grapples with the enormity of what has happened. She reaches out for reassurance, her eyes searching the faces of the medical team for a glimmer of hope in the midst of her darkest hour.

As the simulation progresses, the trauma team springs into action with renewed determination, their focus unwavering as they fight to stabilize Emily's condition and save her life. Though the road ahead may be long and fraught with uncertainty, they refuse to give up hope, drawing strength from their collective commitment to excellence in the face of adversity.

As the simulation progresses, the trauma director approaches Emily with solemnity, his voice gentle yet firm as he explains the next phase of the exercise. "Emily," he begins, his tone tinged with empathy, "in just a moment, we'll be simulating a critical event. We'll need to simulate your heart stopping. We'll need to cut open your shirt to begin chest compressions, and we'll place an ambu bag over your mouth and nose. You should remain still and 'lifeless' during this process. You may choose to close your eyes or keep them open."

Emily nods in understanding, her heart pounding in her chest as she braces herself for what's to come. With a deep breath, she closes her eyes, surrendering herself to the immersive experience of the simulation.

The trauma team springs into action with practiced efficiency, their movements choreographed to perfection as they simulate the onset of cardiac arrest. With a swift motion, they cut open Emily's shirt, exposing her chest to the harsh glare of the overhead lights. A sense of vulnerability washes over her, but she remains steadfast in her commitment to the exercise.

Chest compressions begin in earnest, the rhythmic thud echoing through the trauma room as the medical team works tirelessly to restore circulation to Emily's failing heart. An ambu bag is placed over her mouth and nose, delivering precious oxygen to her struggling lungs with each squeeze of the bag.

Amidst the chaos, Emily lies perfectly still, her body limp and unresponsive as she embraces the role of a patient in cardiac arrest. Though her mind races with adrenaline-fueled anticipation, she remains focused on maintaining the illusion of lifelessness, drawing upon her training and instincts to convey the gravity of the situation.

As the simulation unfolds, Emily finds herself enveloped in a surreal sense of suspended animation, her senses heightened as she navigates the fine line between reality and simulation. With each passing moment, she grows more deeply immersed in the role, her commitment unwavering as she plays her part in the collective effort to save lives and improve patient outcomes.

In the tense silence of the trauma room, Emily waits with bated breath, her entire being poised on the precipice of uncertainty. Though the outcome remains uncertain, she knows she is surrounded by a team of dedicated professionals committed to her well-being, ready to spring into action at a moment's notice to ensure her safety and success in the simulation.

As the simulation progresses and Emily remains in her role, the trauma director approaches her once more, his demeanor compassionate yet resolute. "Emily," he says softly, "we need to simulate defibrillation and the removal of the rest of your clothing. Are you okay with that?"

Emily meets the trauma director's gaze with a steady nod, her determination shining through the mask of simulated injuries. "Yes," she replies, her voice steady despite the rising tide of nerves coursing through her veins. "I'm ready."

With Emily's consent secured, the trauma team prepares to take the simulation to the next level. The room hums with a sense of purpose as equipment is brought forth, including the defibrillator paddles and a privacy screen to shield Emily from prying eyes.

With practiced hands, the trauma team carefully removes the remainder of Emily's clothing, revealing her body in its entirety to the stark fluorescent lights of the trauma room. Emily feels a pang of vulnerability wash over her, but she remains steadfast in her commitment to the exercise, drawing strength from the knowledge that she is surrounded by a team of professionals dedicated to her well-being.

As the final pieces of clothing are set aside, the trauma director approaches Emily once more, his expression one of reassurance as he prepares her for the next phase of the simulation. "Emily," he says, his voice gentle yet authoritative, "we're going to simulate defibrillation now. You'll feel a brief shock, but it's perfectly safe. Are you ready?"

Emily nods, her heart racing with a mixture of anticipation and apprehension. "I'm ready," she affirms, her voice a whisper in the stillness of the trauma room.

With a sense of purpose, the trauma team positions the defibrillator paddles against Emily's bare chest, their gloved hands steady as they prepare to deliver the simulated shock. A hush falls over the room as the trauma director counts down, his voice a steady cadence in the tense silence.

"Clear," he calls out, his command echoing through the trauma room.

In the next instant, Emily feels a jolt of electricity course through her body, sending a shiver down her spine as her muscles twitch in response to the simulated shock. Though the sensation is fleeting, it leaves her breathless with adrenaline, her senses heightened as she remains poised on the brink of uncertainty.

As the simulation continues, Emily finds herself drawn deeper into the immersive experience, her commitment unwavering as she navigates the challenges presented by the training exercise. Though the road ahead may be fraught with obstacles, she knows she is surrounded by a team of dedicated professionals ready to guide her every step of the way, ensuring her safety and success in the simulation.

As the simulation progresses, the trauma team continues their relentless efforts to resuscitate Emily, their movements a blur of urgency as they alternate between chest compressions, defibrillations, and the administration of resuscitation drugs.

With each compression, Emily feels the pressure against her chest, a rhythmic reminder of the tireless dedication of the medical team fighting to bring her back from the brink. The defibrillator paddles crackle with energy as they deliver simulated shocks, each one sending a jolt of electricity coursing through her body in a desperate bid to restart her faltering heart.

Amidst the chaos, the trauma director calls out the duration of Emily's cardiac arrest, his voice a steady anchor in the storm of uncertainty. "Five minutes," he intones, his words a stark reminder of the precious seconds slipping away with each passing moment.

The medical team works with practiced efficiency, their movements synchronized as they administer resuscitation drugs in a last-ditch effort to revive Emily's failing heart. The air is thick with tension as they watch for any signs of response, their collective gaze fixed on the monitor displaying Emily's vital signs.

Minutes stretch into eternity as the trauma team refuses to yield to despair, their determination unwavering in the face of overwhelming odds. With each passing moment, Emily feels herself drawn deeper into the immersive experience of the simulation, her senses attuned to the ebb and flow of life and death unfolding around her.

Though the outcome remains uncertain, Emily knows she is in capable hands, surrounded by a team of dedicated professionals committed to her well-being. As she lies in the midst of the simulated cardiac arrest, she draws upon her training and instincts to convey the gravity of the situation, embracing her role with a sense of purpose and determination that belies the simulated injuries adorning her body.

In the stillness of the trauma room, Emily waits with bated breath, her entire being poised on the razor's edge of uncertainty. Though the road ahead may be fraught with obstacles, she remains steadfast in her commitment to the simulation, ready to face whatever challenges lie in store with courage and resilience.

As the simulation intensifies, a sense of unease washes over Emily, a peculiar sensation prickling at the edges of her consciousness. Though she tries to push aside the feeling, dismissing it as a product of the immersive experience, a growing sense of dread gnaws at the pit of her stomach.

Unbeknownst to Emily or the trauma team, a medical student, eager to prove themselves in their new environment, has made a critical error. In their haste to assist with the simulation, they mistakenly administered a vial of real epinephrine instead of the simulated medication, a grave oversight that goes unnoticed amidst the chaos of the trauma room.

As the potent drug courses through Emily's veins, she feels a surge of adrenaline flood her system, her heart racing with an intensity that surpasses the bounds of the simulation. A sense of disorientation washes over her, her senses overwhelmed by the sudden onslaught of physiological responses triggered by the real medication.

Despite the mounting alarm bells ringing in her mind, Emily says nothing, her voice lost amidst the cacophony of the trauma room as the medical team continues their efforts to resuscitate her. With each passing moment, her condition deteriorates, her heartbeat growing erratic as she teeters on the brink of true cardiac arrest.

In a cruel twist of fate, Emily's worst fears are realized as she plunges into the depths of a genuine cardiac arrest, her body succumbing to the deadly grip of arrhythmia. The trauma team, unaware of the unfolding crisis, presses on with their simulated interventions, their attention focused solely on the task at hand.

As Emily's consciousness fades into darkness, she realizes with a sinking heart that she is no longer a participant in a training exercise but a patient in desperate need of salvation. Though the realization comes too late to alter the course of events, she clings to a flicker of hope, praying for a miracle to save her from the abyss of death that looms ever closer with each passing second.

As the trauma director attempts to speak to Emily, a sense of urgency grips him as he notices her lack of response. His brow furrows with concern as he leans in closer, his voice tinged with desperation as he calls out her name. "Emily, can you hear me? Emily?"

There is no response, no flicker of recognition in Emily's glassy eyes as they stare blankly ahead. Panic begins to rise within the trauma director's chest as he realizes something is terribly wrong. With trembling hands, he reaches for Emily's wrist, his fingers searching for the reassuring throb of a pulse beneath her skin.

His heart sinks as he feels nothing but stillness, his worst fears confirmed in the absence of the vital sign he had hoped to find. In a state of shock, he checks for a pulse again, this time beneath the cervical collar, but the result remains the same—Emily is in cardiac arrest.

A sense of urgency washes over the trauma director as he springs into action, his training kicking in as he directs the medical team to shift their focus from simulation to reality. "She's in cardiac arrest!" he declares, his voice cutting through the chaos of the trauma room. "Start chest compressions, now!"

With practiced efficiency, the trauma team pivots to the new reality before them, their movements swift and sure as they initiate CPR in a desperate bid to revive Emily's failing heart. Each compression is a prayer whispered into the void, a plea for a miracle to breathe life back into the stillness that surrounds them.

As the trauma room buzzes with frenetic energy, the trauma director's mind races with a million questions, each one more pressing than the last. How could this have happened? What went wrong? But amidst the chaos, there is no time for answers, only action as they fight to save Emily's life against overwhelming odds.

In the midst of the turmoil, Emily lies motionless, her body a canvas for the frantic efforts of the medical team as they work tirelessly to bring her back from the brink. Though the road ahead may be fraught with uncertainty, they refuse to give up hope, drawing upon their training and expertise to navigate the stormy seas of cardiac arrest and guide Emily safely back to shore.

As the resuscitation attempts continue, the trauma room pulses with urgency, the rhythm of chest compressions driving the frantic tempo of the medical team's efforts to revive Emily. With each compression, her body sways from side to side, the force of the compressions causing her breasts to shake in a stark reminder of the gravity of the situation.

Amidst the chaos, the trauma team remains undeterred, their focus unwavering as they prepare to escalate their interventions in a desperate bid to save Emily's life. With a sense of grim determination, they gel the paddles and charge them with electricity, the anticipation hanging heavy in the air as they prepare to deliver a shock to Emily's bare chest.

In a moment fraught with tension, the paddles are placed on Emily's skin, their cold metal surface a stark contrast to the warmth of her flesh. With a silent prayer on their lips, the medical team braces themselves as they prepare to unleash the full force of the defibrillator in a last-ditch effort to restart Emily's faltering heart.

A heartbeat later, the trauma room is awash with blinding light and crackling energy as the paddles deliver their shock, coursing through Emily's body in a desperate bid to jolt her heart back into rhythm. The room holds its breath as the monitor displays the outcome, the fate of Emily's life hanging in the balance with each passing moment.

But despite their best efforts, the monitor remains stubbornly flatline, a grim testament to the stubbornness of death in the face of human intervention. With a heavy heart, the trauma team presses on, their resolve unshaken as they refuse to yield to despair.

In a final act of desperation, the medical team moves to intubate Emily, their hands steady as they guide the endotracheal tube into her airway, securing her breathing and allowing for the administration of life-saving medications

As the resuscitation efforts persist, the passage of time weighs heavily on the trauma room, each minute stretching into eternity as the medical team fights desperately to revive Emily. Over thirty agonizing minutes tick by, marked by the relentless rhythm of chest compressions and the mechanical whir of life-saving equipment.

Despite their tireless efforts, Emily's condition continues to deteriorate before their eyes. Her once rosy complexion fades to a pallid shade of gray, her skin growing cold to the touch as the chill of death creeps inexorably into the room. The gel from the defibrillator paddles glistens on her bare chest, a stark reminder of the futile battle being waged against the icy grip of mortality.

A bruise blossoms between Emily's breasts, a grim testament to the force of the chest compressions that have been administered in a desperate bid to restore her failing circulation. Her eyes remain wide open, staring blankly into the void as if searching for answers that will never come.

Sensing the gravity of the situation, the trauma team pauses momentarily, their hands hovering over Emily's motionless form as they perform a vital signs check. With a heavy heart, they prepare to confirm what they already fear to be true—that Emily is beyond saving, her journey on this mortal coil drawing to a tragic and untimely end.

A cardiac ultrasound reveals the harsh reality of Emily's condition, the images on the monitor painting a bleak portrait of irreversible cardiac damage. Her heart lies still within her chest, a silent sentinel to the finality of death's embrace.

#cpr #resus #resuscitation #defib #defibrillator #hospital

Runner Down

I have decided to try and get back into writing. I found this request from a while back that I decided to flesh out. A little bit different from some previous stuff. I hope you enjoy!

Caleb is a nineteen year old college student standing at five foot eight with blonde hair and blue eyes. Caleb always made sure to take care of his body and had a strict diet and exercise regimen. Since the weather was starting to warm up he decided to hit up a heavily wooded trail near school to go on a run. He parked in the lot and began his pre-run stretches. He was in shorts and running shoes and decided that since it was so nice outside that he would go on the run without a shirt. His fit and tone torso was already begining to sweat slightly due to the heat. The first half mile went well but Caleb forgot to drink enough water and developed a cramp in his left leg. He slowed down slightly in attempt to not put as much pressure on it but continued with the run. A short while later he was almost a mile into his three mile run when he developed a sharp pain in his left arm. The pain caused him to slow to a walk and attempt to catch his breath. He could feel his heart pounding in his chest and found it hard to breathe. He began wheezing as he attempted to breathe but panic began to set in. He reached for his phone in his pocket but as he pulled it out he collapsed onto the ground. He landed face down in the dirt and felt himself losing consciousness. Before he could call for help he went unconscious as his heart rate slowed and he was wheezing face down in the dirt.. Due to the location there was no one around and it wasn't until almost three minutes later that another runner found Caleb in the middle of the path. The runner was 23 year old Amy who went to the same college and recognized Caleb from all the times they had passed on their runs. "Oh my god Caleb" Amy yelled as she rushed over to him. When she rolled him onto his back he was barely breathing. She reached for her phone and called 911. "I need an ambulance my friend is unconscious and barely breathing." she pleaded with the 911 operator. She gave the name of the path and an approximation of how far into the woods they were. The operator asked Amy to monitor Caleb. While she was doing so Caleb stopped breathing. The operator walked Amy through how to check for a pulse. "I... I don't feel anything" Amy said in a panic. The operator instructed her to start CPR and walked her through how to do it. She put the phone on speaker and followed each of the steps. She placed her small hands in-between his nipples and interlocked her fingers. She began to push down into her chest and had to give the full weight of her body to give the compressions. After giving thirty compressions she was instructed on how to give mouth to mouth. After giving the two breaths she went back to the compressions. She was instructed to continue this cycle until the ambulance arrived.

As Amy continued the CPR cycle, her mind raced with worry for Caleb's well-being. She could feel the urgency in the dispatcher's voice guiding her through the life-saving procedure. With each compression, she focused all her strength, willing Caleb's heart to respond. She knew that every second counted in this critical situation. Despite her fear and panic, Amy maintained her composure, determined to do everything in her power to keep Caleb alive until help arrived. With each breath, she hoped to see a sign of life returning to him. Time seemed to stretch endlessly as she performed the CPR, her heart pounding in sync with each compression. In the midst of the crisis, Amy's training as a lifeguard kicked in, guiding her actions with precision. She concentrated on the task at hand, shutting out the chaos around her as she followed the dispatcher's instructions to the letter. As she continued the compressions and rescue breaths, Amy couldn't help but think about Caleb's family and friends, wondering how they would react to this sudden turn of events. She silently prayed for his recovery, willing him to hold on and fight for his life. Finally, after what felt like an eternity, the distant sound of sirens pierced the air, signaling the arrival of the ambulance. With a surge of relief, Amy redoubled her efforts, knowing that help was now just moments away. She kept up the CPR until the paramedics arrived, ready to take over.

As Caleb was rushed into the back of the ambulance, the paramedics wasted no time springing into action. With practiced efficiency, they swiftly assessed his condition, confirming that he was still in cardiac arrest. Without hesitation, they began the process of intubating him to secure his airway and ensure he received the oxygen he desperately needed. The ambulance interior was a whirlwind of activity as the paramedics worked tirelessly to stabilize Caleb's condition. Amidst the chaos, Amy stood by, feeling a mixture of anxiety and helplessness as she watched the medical team fight to save Caleb's life. With each passing moment, the urgency of the situation weighed heavily on everyone in the ambulance. The paramedics continued their efforts, administering medications, and performing chest compressions in a desperate bid to restart Caleb's heart. As the paramedics worked, they quickly and efficiently removed Caleb's clothing to better assess his condition and provide necessary medical interventions. Amy averted her gaze out of respect for Caleb's privacy, her heart aching for him and his loved ones as she prayed for a miracle. Despite their best efforts, the minutes ticked by with no sign of improvement in Caleb's condition. The paramedics remained focused and determined, refusing to give up on him even as the odds seemed stacked against them.

As the ambulance screeched to a halt outside the hospital, the paramedics wasted no time in rushing Caleb into the trauma room. The medical team waiting there sprang into action, seamlessly taking over CPR as they wheeled him through the doors. With a sense of urgency, the team worked in synchronized harmony, performing continuous chest compressions and delivering defibrillations in rapid succession. Despite their best efforts, Caleb's heart stubbornly refused to respond, remaining silent and still despite the onslaught of interventions. Time seemed to stand still as the medical team fought tirelessly to revive Caleb, their faces etched with determination and grim resolve. With each passing moment, the chances of success grew increasingly slim, but they refused to give up hope, clinging to the belief that miracles could still happen. Amy stood by, her heart heavy with fear and sorrow as she watched the chaotic scene unfold before her. She had done everything she could to help Caleb, but now it was out of her hands. All she could do was pray and hope for a miracle, willing Caleb to defy the odds and come back to life. As the minutes stretched into eternity, the reality of the situation began to sink in. Despite their heroic efforts, Caleb's condition continued to deteriorate, his chances of survival slipping away with each passing moment. As Amy stood on the sidelines, her heart heavy with grief, she watched as the medical team continued their relentless efforts to revive Caleb. Despite multiple rounds of defibrillation, Caleb's heart remained stubbornly silent, refusing to respond to the shocks. Each attempt seemed more desperate than the last, the tension in the room palpable as the medical team fought against the odds, refusing to give up on Caleb despite the grim reality of his condition. With each failed attempt, Amy's hope dwindled, replaced by a deepening sense of despair. She felt helpless, unable to do anything but watch as the life slowly slipped away from her friend. The sound of the defibrillator charging echoed through the room, a stark reminder of the high stakes and the dire situation they faced. With each shock, Amy held her breath, praying for a miracle that never came. As the minutes ticked by, the medical team's efforts became increasingly frantic, their faces etched with frustration and sorrow. Despite their expertise and determination, they were powerless to save Caleb from the grip of death. Finally, after what felt like an eternity, the lead physician called a halt to the resuscitation efforts, his voice heavy with regret. The room fell silent as the reality of Caleb's passing sank in, a somber reminder of the fragility of life and the cruel randomness of fate. Amy felt a wave of grief wash over her as she struggled to come to terms with the loss of her friend. Tears welled up in her eyes as she mourned the life that had been cut short far too soon. In the aftermath of the failed resuscitation, Amy found herself grappling with a whirlwind of emotions. Anger, sorrow, and disbelief warred within her as she tried to make sense of what had just happened.

#cpr #resus #resuscitation #defib #defibrillator

kk095

Gabby’s Cardioversion

*hey everyone! I came up with a new story and wanted to try something different. Hope you all like it!*

On a chilly fall evening, an ambulance arrives at our emergency department where our usual team waits in the trauma room. In come Tracy and Stephanie with the next patient. “37 year old female, fainting episode but regained consciousness. Patient is complaining of chest pains, palpitations, and dizziness. EKG abnormal, tachy at 140bpm.” Stephanie rattles off. On that gurney was Gabby, the 37 year old basketball coach at the local college. She had fainted during practice that evening and one of her players called 911. Gabby was a tall glass of water, standing at 6’3, with a slim but toned, athletic build. She had blonde hair that was usually in a ponytail, beautiful bluish gray eyes, and had a cute tomboy appearance. Gabby was sitting in the upright position on the gurney when she was brought in, stripped down to just her purple sports bra and matching underwear (the team’s primary color of course). She had EKG electrodes stuck onto her chest, had IVs going in both arms, and had a nasal cannula in her nostrils. Coach Gabby was visibly uncomfortable, clenching her chest with one hand, groaning every so often.

Gabby was transferred onto the table, where she still sat in the upright position. “My chest…” Gabby says to herself, still clenching her chest, taking a few breaths. Dr Sarah lowers her stethoscope onto the coach’s chest for a listen. It sounded like Gabby’s heart was going to leap right out of her chest, but at the same time, there were no abnormal heart sounds, and her lungs were clear. “lets get labs going. Let’s do a CBC, BMP, tox screen, cardiac enzyme test, and a d-dimer. We gotta know what we’re up against.” Said Lindsay, taking some initiative in the situation. The team asked Gabby a handful of questions: “has anything like this happened before?” “any history of heart problems?” “any drug use?” “any other health problems that need to be disclosed?” But the answer to all these questions remained consistent- no!

“I wonder if I’m just stressed out. We haven’t had the best season, and rumor has it they’re gonna get rid of me if the season doesn’t turn around.” Gabby said, trying to take a stab as to why she was in our emergency department. The team continued to wait on labs, so the doctors decided to do a chest x ray and an echocardiogram to see if that could shed any light on the coach’s issues. The chest x ray showed completely normal anatomy, as did the echocardiogram- back to the drawing board. Since the ER team couldn’t find an obvious cause for the coach’s ailment, they decided to treat the symptoms and see if that helped. Gabby was given meds via IV to calm her heart down, and to help with her chest discomfort.

The evening droned on and coach Gabby only appeared to be getting worse. Her heart rate was still high, and her was EKG definitely off. “Something’s off with the QT interval. I know it might be subtle, but something just doesn’t look right there.” Said Lindsay, taking a long, detailed look at Gabby’s EKG. “she’s tall, so I wonder if she has undiagnosed Marfan syndrome or EDS?” Sarah suggested. “Yeah, but wouldn’t there have been a structural heart issue or something else we could work with on either chest x ray or the echo?” Lindsay rebutted. “Could be an electrical issue, but I wanna see what the labs end up saying. Is she on something? Are her electrolytes out of whack? Is there a blood clot or heart attack? There’s a lot consider.” Sarah countered. The two doctors respectfully disagreed with one another, unable to figure out what was wrong with the coach.

More time had passed, and coach Gabby’s vitals were starting to become worrisome. Her heart rate was through the roof, in the verge of v-tach. Gabby was leaning back with her eyes shut, holding her chest, moaning from the worsening pain she was experiencing. The monitors were chirping loud and fast, and only got faster. “I’ve got stable v-tach on the monitors.” Nurse Nancy tells the two doctors. At that point, Gabby’s bra was snipped off and the defibrillator pads were stuck onto her bare chest. “gabby? Your heart is in a dangerous rhythm. We have to give your heart a quick shock to make it all better, ok?” Dr Lindsay attempted to explain. “just make it stop…” coach Gabby replies, visibly uncomfortable. The doctors wanted to start Gabby off with a smaller jolt, so they went with 125j. The pads were charged up, and the first shock was delivered. Gabby’s body tensed up and her shoulders shrugged forwards. “AHH!” Gabby winced, feeling the electricity run through her. Post shock, the team looked at the monitor. “she’s still in stable v-tach. Let’s shock at 150.” Sarah decided. “Gabby? The first shock didn’t work, so we’re gonna do it 1 more time.” Lindsay explained. The defib pads were charged up to 150 joules, and the shock button was hit. Gabby jolted sharply, making strong fists with both her hands, letting out a yelp from the pain of the shock. Dr Lindsay lowered her stethoscope onto the coach’s bare chest and listened to her heart, and Sarah studied the monitors for a moment. “no change. Let’s go again at 175.” Said Sarah. The electrical whirring sound of the pads charging filled the room, followed by a weak thump when the shock was delivered. Her body tensed up and her toes scrunched up at the end of the table, showing off prominent, medium sized wrinkles in the soles of her size 14 feet. “pleaae… make it stop…” Gabby said in a worried tone, on the verge of tears. The rhythm wouldn’t go away, so it was decided to shock Gabby again at 200. Her long, slender body twitched sharply in reaction to the next shock. “am I gonna die? I don’t wanna die…” a terrified Gabby asked. “charge again to 225.” Sarah said. “no! Please…no more! No more!!!” coach gabby begged. Her chest shot forward and her back arched, but it didn’t look quite the same as the typical Hollywood style defibs since she was sitting in the upright position still. The next shock was at 250. The tall blonde winced in pain once more from the shock. She leaned back and her eyes opened wide, taking rapid, shallow breaths. She mouthed “I don’t wanna die” to Dr Lindsay, but didn’t have the energy to get the words out.

Suddenly, coach Gabby’s rapid breaths came to an abrupt stop. Her pretty blue eyes remained wide open, staring up above with an absolutely terrified expression on her face. “she’s in v-fib! Lower the bed and start compressions!” Dr Lindsay shouted urgently. The bed was lowered, and nurse Heather began going to town on Gabby’s chest. Her chest caved in, and her toned belly and abs bounced outwards. “I’m intubating. 8.0 ET and a laryngoscope.” Sarah called out. “pushing epi and atropine.” Lin announced. Heather continued pumping the coach’s chest, and Sarah got the breathing tube in, securing it with a blue tube holder. Once she was intubated and the meds were in, it was decided to switch over to the defib paddles. The pads were quickly peeled off, and the paddles were gelled, charged up to 250, and pressed up against the coach’s bare chest. Her chest was picked up and her arms flailed weakly towards the center of her body before falling limp again. “no change, charge to 300.” Lindsay ordered. KA-THUNK!!! The shock threw Gabby’s large, lanky body around on the table effortlessly, but didn’t restart her heart. ”360! Everyone….CLEAR!” Sarah called out, pressing the paddles back up against Gabby’s chest. Her feet leapt above the table, slamming back down a moment later, showing off coach Gabby’s hot wrinkly soles once more. “PEA, start compressions!” Lindsay yelled out. Nurse Jamie took over CPR this time, pumping the basketball coach’s rhythmically.

CPR, ambu bagging, and pushing meds went on for a bit. It took some time and hard work from the team, but Gabby converted back to v-fib around 17 minutes into the code. The defibs were gelled, charged to 360, and the next shock was delivered. Gabby’s body jolted violently from the controlled dose of electricity. Her eyes remained wide open, staring up above while the fight for her life went on. The team shocked Gabby another 2 times unsuccessfully, but v-fib looked like it was winning this battle. “should we crack her chest? Get better perfusion?” Lindsay asked. “I don’t know, I’m not feeling it here.” Replied Sarah. A few cycles of CPR and ambu bagging were performed, hoping to stimulate the tall blonde’s heart, but no change was noted. The team defibbed Gabby another 4 times, before flatlining after that last shock. Dr Sarah lowered her stethoscope onto the patient’s bare chest. “no heartbeat. No respirations.” Sarah stepped back, shaking her head. Lindsay did a quick bedside echocardiogram and looked over at the monitor. “no cardiac activity, down 27 minutes, pupils fixed and dilated.” Lindsay added. “it’s over. Time of death, 21:45.” Sarah said reluctantly, pulling the gloves off her hands.

The flatlined monitors were turned off and the ambu bag was detached from the ET tube while her pretty blue eyes stared up above helplessly. The EKG electrodes were plucked off Gabby’s chest, the defib gel was wiped off, and the IVs were taken out. Her body was covered with a sheet, and a toe tag was placed. The toe tag dangled in front of her big, wrinkly, size 14 soles, bringing a sad, and seemingly surprising end to the case.

kk095

Hannah’s Head Injury

Hannah Dansby was a 28 year old web+app developer. She was the cute, shy, nerdy type who had shoulder length brown hair, green eyes, and stood at 5’6 with a slim build. Sadly, Ms Dansby was brought into our emergency department recently after sustaining blunt head trauma in a high speed collision.

The young lady laid on a backboard in a c-collar. She was intubated, had EKG electrodes on her chest, and IV lines going in both arms. She had a large seatbelt shaped bruise across the front of her chest, while there was a large laceration above her right eyebrow. On the side of her head above her right ear, you could see an accumulation of blood soaking her hair in that general area, with some blood droplets coming out of the right ear. Hannah’s eyes were wide open upon arrival even though she was intubated, and was actively convulsing while medics Stephanie and Tracy wheeled her into the trauma bay. Hannah’s toes scrunched at the other end of the gurney, showing off the fresh black nail polish and the cute, prominent wrinkles in the soles of her size 8 feet. “28 year old female, restrained driver in a high speed MVC. Intubated en route, vitals all over the place. Started seizing just as we pulled into here.” Medic Stephanie tells the trauma team, giving them a quick summary of what to expect. “ok, let’s transfer her on my count. One… two… THREE!” Dr Lindsay ordered.

Hannah was transferred onto the trauma room table underneath the large overhead light. “Push a unit of ativan, and run stat trauma labs. Page radiology, I’d like to get a head CT sooner rather than later.” Lindsay barked out to the members of her trauma team. Nurse Nancy pushed the dose of the anticonvulsants and drew the trauma labs. Dr Lindsay shined a pen light in Hannah’s eyes, revealing her pupils were fixed and dilated. “well, she’s already braindead. What a shame.” Dr Lindsay announced, shaking her head. “she might be a good organ donor. But don’t let transplant surgery know just yet. We don’t need them hovering over this poor girl like a vulture.” Dr Jose added. “amen to that.” Nurse Nancy replied in agreement.

The ativan took effect and stopped Hannah’s seizure. However, Hannah’s heart also stopped. “damn it, someone start compressions!” Dr Lindsay shouted while taking a look at the monitors. Hannah’s eyes remained wide open, staring expressionlessly across the room while Dr Jose started pumping away at her chest. His compressions were intense and forceful, causing Hannah’s chest to cave in and her belly to ripple out. Her small, perky breasts jiggled and one arm hung off the side of the table, bobbing and lolling around. Blood shot out of her right ear in sync with each individual compression. What happened was the temporal bone of her skull became partially displaced and slashed open the temporal artery within the subarachnoid space. A lot of blood in such a small space is always bad, so the pressure inside her skull built up rather quickly, squeezing her brain, causing her brain death, and the only way out for the excess blood was through the ear canal.

“Epi and atropine in Linds” nurse Heather called out. “ok, I’ve got v-fib on the monitors. Charge the paddles to 250” Dr Lindsay called out. The paddles were charged, gelled, and pressed up against Hannah’s bare chest, and a shock was delivered as soon as Jose stood clear. KA-THUNK. The young woman’s broken body tensed up and flopped for a moment. “no pulse, recharge to 300.” Dr Lindsay called out, placing 2 fingers on Hannah’s neck for a carotid pulse. The defibs were readied, and shock #2 was delivered. Hannah’s feet kicked around on the other end of the table in response to the shock, wrinkling the soles of her feet. “She’s still in v-fib. Charge to 360.” Dr Jose ordered, closely looking at the heart monitor. The third shock caused Hannah’s chest to shoot up and her back to arch, while her eyes remained wide open, looking almost as if she was watching the team as they coded her.

A fourth shock was delivered shortly after, sending Hannah into PEA. Nurse Heather took over chest compressions this time, and the next doses of epinephrine and atropine were pushed into the young lady’s IV line. Medics Stephanie and Tracy stood behind the yellow line in the trauma room still watching the code. “what a shame.” Stephanie says, knowing how this code is going to play out. “yeah, I hope they find the SOB that hit her. Someone on scene said it was a hit and run.” Tracy replies. Tracy and Stephanie’s conversation is interrupted for a moment. “excuse me, coming through.” A female voice said. Sure enough, it was Dr Amy, the hospital’s transplant surgeon. “hey, is this the head trauma patient? I need an A+ liver for a hemochromatosis patient and a kidney for a little girl.” Dr Amy says, forgoing any greetings or any social graces associated with conversation. “ugh. Amy. Can this girl just die in peace?” a frustrated Dr Lindsay replies. “I know you have your patients to look out for, but I have mine to look out for. This beautiful girl woke up this morning not knowing it was gonna be her last day, and I wanna at least try for her.” Dr Lindsay added, trying to reason with the transplant surgeon. “alright, just try to make it quick so I can get the ORs ready.” Dr Amy replied, more or less disregarding Dr Lindsay’s heartfelt reply before walking out of the trauma room. “wow what a bitch.” Medic Tracy said, surprised at the exchange that took place.

Hannah converted back to a shockable rhythm, so the paddles were charged to 360, gelled, and pressed back up against the patient’s bare chest. Hannah’s body jolted violently in response to the shock, but v-fib displayed on the monitors. “hit her again at 360. Everyone… CLEAR!” Dr Lindsay shouted, pressing the paddles onto Hannah’s bare chest. KA-THUNK. “no change, shocking again. Everyone stand clear!” Lindsay barked out. Hannah’s body thrashed around on the table for a brief moment before going limp again, but she was still in v-fib. Lindsay shocked her again, causing a quick, but violent reaction out of Hannah. This time, the monitors went completely flat. “asystole…” Dr Jose said in a defeated tone. Lindsay let out a sigh, and placed the defib paddles back on the crash cart. She started to peel her gloves off, making the dreaded announcement. “time of death, 4:07pm.”

The ambu bag was detached from the ET tube and the flatlined monitors were switched off. Nurse Nancy gently shut Hannah’s eyes for the last time, while nurse Heather started disconnecting the EKG electrodes. “let Amy know. I’m sure she’ll be thrilled…” an upset Dr Lindsay said, heading out of the room.

Hannah’s organs were able to be successfully extracted and were credited for saving 3 different lives. Unfortunately, the alleged hit and run driver that killed her has yet to be located by law enforcement. If you have any information regarding this incident, please reach out to the authorities.

tkresus

ice hockey friendly

The women’s ice hockey game between the United States and Canada was a thrilling display of skill and athleticism. The arena was filled with the sounds of skates cutting into the ice, sticks clashing against each other, and the roar of the passionate fans cheering on their respective teams.

The teams took to the ice in their distinctive uniforms, the United States in their traditional red, white, and blue jerseys, and Canada in their iconic red and white uniforms. As the game began, the tension was palpable, and both teams came out with a fierce determination to win.

The players flew down the ice, each one showcasing their incredible speed and agility as they maneuvered around their opponents. The American team was relentless, with their forwards launching a flurry of shots on the Canadian goaltender, who made an impressive save to keep the score level.

The Canadian team responded with their own offensive, utilizing their swift skating and puck-handling skills to try and break through the American defense. However, the American defense stood firm, and their goaltender made several acrobatic saves to keep the Canadian team at bay.

As the game progressed, the physicality increased, with players battling for every inch of ice. Body checks and collisions echoed throughout the arena as players fought for possession of the puck. The referees were kept busy, with several penalties being called for rough play.

The crowd was on the edge of their seats as the game approached the final minutes of play. With the score tied, both teams knew that a single mistake could cost them the game. The tension was thick in the air, and every shot on goal was met with a collective gasp from the crowd.

As the game wore on, the intensity increased, and the players pushed themselves to their limits. In a split second, a collision occurred between two players. It was an American player, Jade, and a Canadian player, Riley. The sound of their helmets cracking together echoed throughout the arena, and both players fell to the ice. Unfortunately, it happened so fast that three other players toppled on top of them, not being able to stop in time.

The crowd fell silent and everything seemed to pause. The other players on the ice were quick to help the injured up and were thankful that some got up fairly quickly. Unfortunately, two bodies remained on the ice. The initial players who ended up colliding remained sprawled on the floor.

“Riley. Riley. Look at me. You are okay.” Jennifer, her teammate says as she knelt down seeing her friend’s eyes darting around. “Are you hurt?”

Riley doesn’t seem like she heard her as she continues to look around before she sits up causing her to wince in pain.

“Hey, why don’t you lie back down?” Amber, another teammate who happens to be Riley’s girlfriend as well, says. “You took a hard hit.” Amber can clearly see that Riley is not with it at all. Usually, her girlfriend is quick to get up after a collision but this one leaves the woman in a daze of confusion.

“I’m fine. We need to get going.” Riley says wanting to stand up.

“Look at me, Riley.” Amber says grabbing the sides of Riley’s helmet before making eye contact with the woman seeing her eyes glazed over and not really being able to focus. “Oh, you definitely have a concussion.” She whispers. “The medical staff are coming to check you out, okay?”

“I’m fine. Just help me up.”

“I can’t do that, Riley. Let them check you out before getting up.” Amber and Jennifer try to keep Riley from moving too much as they can clearly see the woman in pain every time she moves.

The athletic trainers from both teams are quick to make their way to the ice and to their players. Tommy, the Canadian trainer goes to examine Riley but she waves his hands off.

“Listen, Tommy, it’s a little knock to the head. You can run your concussion protocol test but I don’t need to go to the hospital. I am fine.” Riley says, taking off her gloves and helmet, letting her blonde hair fall with the motion.

“Let me be the judge of that,” Tommy smirks. “I don’t remember you having a degree in any sort of medicine.”

“Ha ha, Tommy. Just do your thing.” As she tells him, he pulls out a pen light guiding her through different tests before taking his hands and palpating her head, neck, and clavicles.

“As of right now, I can say you have a concussion. You need to go to the hospital for a CT scan to make sure it isn’t worse and there is no internal bleeding in that thick head of yours.”

“I’m not going to the hospital right now. I want to shower and head to the hotel room to relax and get some things.”

“Riley, it’s not up for discussion.”

“Tommy, I said I am going just not right away. There is no problem with that. I will go once we head back as a team to the hotel.”

Knowing he is losing the argument, he accepts. With that, they all stand and help Riley to her feet before a wave of dizziness and nausea comes over her making her stumble and double over. Amber and Tommy stabilize her and ask her if she’s alright which of course she says yes to. They manage to get her off the ice and keep an eye on her as she heads to the locker room.

… … …

Simultaneously, back on the ice, the Americans are worried for their player, Jade. Jade is 65 inches tall with medium wavy black hair that contrasted her pale skin. She is the baby of her team, so imagine their worry as her teammates first by her side after the collision see her unconscious. They pull off her gloves wanting to hold her hand and not move her in case of spinal damage.

“Come on, Jade. We know you are a deep sleeper but this isn’t the time.” Sarah, the designated team mom says. “Jade, we need you to open your eyes sweetie.”

“She’s not waking up!” Fiona yells at the trainers making their way to them. And repeats herself as they come closer but more in shock than anything else.

When the lead trainer, Andrew, makes his way to Jade, he can already tell this wasn’t going to be good as her lips were already turning cyanotic. He talks into his radio, “I need the medics, Jose, and Samantha. Bring the AED.” He brings his attention back to the woman and starts giving out commands in the meantime. “Sarah, I need you to hold her neck like this as I remove the helmet.” He shows her how to guide her spread out fingers, getting a lot of surface area to hold the sides of Jade’s head. Sarah positions herself straddled over the young player so Andrew can easily slide the helmet off without her in the way. Once off, he checks for a pulse and breathing.

“GET OFF!” He says frustrated he just wasted time for c-spine precautions when the girl was obviously pulseless. A shocked Sarah hops off before Andrew kneels beside Jade and starts compressions. “One… Two… Three…”

“Four… Five… Six…” He keeps going, sweat pouring down his face, as he tries to save Jade’s life. He can hear the panicked whispers of her teammates behind him, but he can’t let himself be distracted. “Seven… Eight… Nine…” Andrew is determined to keep going until the medics arrive. He knows that every second counts when it comes to CPR, and he refuses to give up on Jade.

As Andrew counts the compressions, Fiona is on the phone with Jade’s family, updating them on the situation. Tears stream down her face as she tries to remain composed for them. The other teammates huddle close, praying and hoping for Jade to make it through. They form a circle around her and link arms wanting to give the woman privacy as they don’t want the public to have access to this vulnerable moment. Some watch as others have their backs turned to the resuscitation happening.

“She’s been pulseless for two minutes. Continuous compressions since I got to her side.” Andrew relays to the medics, Henry and Don. Don switches Andrew out for the compressions as Henry tells Andrew to strip the player’s jersey off and attach the AED pads. Using the scissors Henry gave him, he cut away working around Don. He attached the pads to the machine and peeled away the plastic film placing one sticky pad on top of Jade’s small right breast and another on her ribs below her left breast. He places his hands on the pads pushing down to secure them even more. As his hands are there, he can feel the damage Done is doing with the compressions.

Jade’s body sways under the forceful compressions and Don tries his best for his knees not to slip on the ice. His short stubby hands are placed accurately on her sternum. Little huffs leave Jade’s mouth every time he pushes deep into her chest.

“Hold compressions,” Henry calls out and quickly tilts the woman’s head back, her eyes thankfully closed when he looks at her face. He struggles to open her mouth at the same time as pushing the laryngoscope down because of her tiny mouth. Don takes his hands and lifts Jade’s neck up letting her head extend more but even with this movement, it’s not enough. Don tells Andrew to hold where he is holding before using his fingers to manually pry Jade’s mouth open. Don sticks his fingers into her mouth and pushes from her teeth getting a little bit of leeway.

“Now, Henry.” He says. “Try, now.” With the help of Don and Andrew, Henry places the metal device in her mouth before placing the 7.5 ET tube down her throat and inflating the balloon. Attaching the ambu bag, he takes his stethoscope and listens to breath sounds.

“We’re in. Continue compressions.” Henry tells Don. “Hey, I need you to squeeze this bag enough to see the chest rise and no more. Too much will over inflate her and might cause aspiration. Squeeze twice after Don does 30 compressions,” he tells Samantha, the athletic trainer assistant.

Her hands shake from adrenaline as she takes the bag. This frees up Henry to start attaching leads, an IV line, and push meds.

“Do not touch patient. Analyzing heart rhythm.” The AED calls out. The rescuing team remove their hands and clear anyone even remotely close to Jade.

“Keep bagging her every 5 seconds.” Henry tells Samantha who dropped the ambu bag and moved away. “You are the only exception in this case.”

“No shock advised. Continue CPR.” The machine calls out.

“I’ll take over compressions,” Henry says and places his fresh pair of arms over the red spot on Jade’s sternum that was made from the previous cycles of CPR. He is quick and allows for full recoil watching Jade’s chest cave under his hands. As he watches, he can see the bruising on her ribs. There must be bleeding around her heart causing the pressure to not let her heart actually beat.

“Andrew, do you have a team doctor?” Henry asks while keeping count of the compressions in his head.

“Yes, she’s in the locker room tending to the other player.”

“Radio her and tell her we need her HERE. Jade needs an emergency thoracotomy.” Andrew isn’t quite sure what that is and relays it over the radio.

“What the hell, Andrew.” Dr. Teddy replies back. “We are not in a sterile area or have the proper equipment to confirm we need one.”

“Medics say she needs one, Dr. Teddy. She has signs of blood build-up and she has yet to have a shockable rhythm.”

“I’m coming to check her out myself.”

“What’s her problem?” Henry huffs after hearing the conversation.

“God-complex,” Samatha replies and shakes her head knowing how the team doctor is.

“Tell your players to all turn around so their backs are towards us. I am going to give you guys two sheets to hold up. What is going to happen next isn’t something anyone should see.” Don explains to Andrew and Samantha.

Andrew informs the players to not turn back no matter what and just pray. Don hands the sheets to Andrew before taking over bagging from Samantha. Both the trainers unfold their sheets and stand on opposite sides over Jade. With their backs turned away from the patient they spread their sheets blocking the public from viewing this disastrous moment.

A minute after she was requested, Dr. Teddy makes her way onto the ice with a med bag, breaking through the ring of players and kneeling down next to Jade.

“She’s been in cardiac arrest for six minutes and has yet to have a shockable rhythm. A dose of epi and atropine was pushed two minutes ago. She has bruising on her chest indicative of blood build-up which may be causing pressure in her heart. A thoracotomy is necessary.” Don relays. Dr. Teddy takes her stethoscope and places it on Jade’s chest. The cool air in the arena makes Jade feel cold to touch and her nipples hard. As Dr. Teddy listens and ultimately agrees with what the medics have mentioned.

“Okay, here’s the game plan… You two switch roles… He is getting tired… I am going to get everything ready and proceed to make an incision. There will be a lot of blood and I would usually also add a chest tube before this but circumstances limit me. Just continue regular CPR until I tell you otherwise.”

The medics nod and Dr. Teddy puts on a yellow protective gown, gloves, and glasses before grabbing Betadine from her bag and drenching Jade’s pale chest making it a rusty orange-brown color.

Dr. Teddy makes an incision on Jade’s left side, between her ribs, and carefully cuts through the intercostal muscles and pleura. She uses a rib spreader to open up the chest cavity. The cracks echo through the rink and everyone flinches at the crunching sound of the ribs. Samantha turns around instinctively from the noise and she wishes she didn’t. She suppresses a gag seeing the blood and Jade’s body mutilated from the procedure happening. She turns back around when Dr. Teddy uses a pair of scissors to cut through the pericardium.

As soon as the pericardium is open, Dr. Teddy sees the problem. Jade’s heart is lacerated, and blood is pouring from the wound. Without hesitation, she sticks her hand in the wound, feeling for the source of the bleeding. She quickly locates it and uses a clamp to stop the bleeding.

She looks up at Henry. “We need to cross-clamp the aorta. Get the vascular clamp from my bag, it’s labeled in a sterile bag.” Henry nods and searches for the clamp. In the meantime, Dr. Teddy thinks of different ways to make a makeshift chest tube. She knows now she really needs one to drain the blood and air from the pleural cavity.

When Henry retrieves the vascular clamp, Dr. Teddy carefully places it on the aorta, just above the diaphragm. She holds it in place, compressing the aorta to slow down the bleeding. Jade’s blood pressure starts to drop even with DOn’s rigorous compressions, and Dr. Teddy knows she needs to act fast.

“Okay, I am going to make a makeshift chest tube. I need an IV bag and a saline water bottle.” Henry doesn’t question her and grabs the additional supplies, handing them to her. She quickly does her thing and inserts it into Jade’s open chest. The blood oozes out on the ice and turns it into a crimson red as it is absorbed and spread beneath their legs.

“I need to repair the heart,” Dr. Teddy says, getting the suture kit and informing Don to hold off on compressions.

Dr. Teddy carefully removes the clamp, watching as the blood starts to flow freely again. She quickly places his hand back in the wound, feeling for the laceration. When she does, she starts to repair the wound, working quickly and efficiently.

As she sutures the wound, Dr. Teddy can feel Jade’s heart start to beat again, weakly at first, but getting stronger with each passing moment. As she finishes the repair and takes her hand out, she looks at the monitors.

“God-complex might have just saved her life,” Henry says, astonished by what just happened and Don agrees.

“Her pressure is holding and her heart is beating slowly but it’s something. Prep me 2 mg of epi.” She asks and is quick to be given it before guiding her fingers back into Jade’s wet and warm heart. The syringe is plunged directly into Jade’s heart and it takes effect quickly as her heart beats quicker. “There we go, Jade. Welcome back.”

Jade is transferred to a backboard and a sterile drape over her cracked-open chest. Instead of lifting the blackboard and risking slipping on the ice, the team decided to push it on the ice allowing for a smoother and safer ride over to the steady ground. Once there they lifted her and quickly moved her into the ambulance calling the hospital to tell them what was coming in.

The rest of the public was left in shock and tears streamed down their faces not knowing anything and coming to terrible conclusions at the amount of blood where Jade once lay. Her blood streaked across the rink and her teammates also were at a loss.

… … …

Back in the Canadian team’s locker room. The players can hear what has happened to Jade. They silently prayed for her while also staying around Riley knowing how lucky she got.

Riley sat on the bench, her head in her hands. Her teammates around her had concern etched on their faces. One of the veterans, Millie, put a hand on her shoulder. “You okay, kid?”

Riley shook her head, yes. “I-I’m fine. I just feel so dizzy.” Her head throbbing and her vision blurry. Her teammates were now hovering over her, babying her like she was a child which made her a bit irritated. She could hear their concerned voices, telling her she wasn’t okay and that she needed to go to the hospital.

“Riley, you really should get checked. Better sooner than later.”

“I’m fine,” Riley muttered, brushing off their concern. “I just need a minute to catch my breath. I will go once I clean off and change back at the hotel.” Everyone backed off a bit happy that the girl understood that she still had to go.

As they boarded the team bus back to the hotel, Riley’s frustration boiled over. She lashed out at her girlfriend Amber, who had been particularly insistent that she get checked out.

“I don’t need everyone babying me!” Riley shouted, tears streaming down her face. “I’m fine! I can take care of myself!”

Amber looked at her with concern, taking her hand and squeezing it gently. “I know you can, babe,” she said softly. “But we just want to make sure you’re okay. We care about you.”

Riley sniffled, wiping away her tears. “I know,” she said, her voice barely above a whisper. “I’m sorry. It’s just frustrating.” Riley wasn’t sure if it was the pain or frustration making her cry and be vulnerable on the bus ride back but she didn’t like it. It also was concerning to her teammates as she rarely shows this side of her.

Amber wrapped an arm around her, pulling her close. “I get it,” she said. “But we’re a team, Riley. We take care of each other, no matter what.”

Riley nodded, leaning into Amber’s embrace. She knew deep down that her teammates only had her best interests at heart, and that they were just trying to keep her safe. But it was hard to accept their help sometimes, especially when she wanted to prove herself as a tough, capable player.

When they get back to the hotel, Amber and Riley head to their room. Amber told Riley she could take a shower first. Riley accepted gratefully as she could wash off the hell of the day she had. She took a quick 10-minute shower before looking in the mirror and frowning as her headache got worse. She unsteadily came out of the bathroom with a towel wrapped around her and wet blonde hair sticking to her skin.

Amber furrowed her brow in concern, quickly getting up from the bed as she saw her girlfriend looking pale and unsteady. “Riley, are you feeling okay?” she asked, walking over to her.

“Yeah, I’m alright. Just feel off, nothing to be concerned with. I should be good for the game later.” Riley says confidently as she didn’t want to raise any flags so she can play later today.

Before Amber could respond, a few of their teammates came into the room, led by their captain, Millie, hoping to check on their youngest player. “Is everything okay here?” she asked, her eyes scanning over Riley.

“I don’t know,” Amber said, turning to the others. “She’s acting really strange talking about playing tonight.”

The other players gathered around, all looking at Riley with a mixture of confusion and concern.

“Riley, what game?” Millie asked gently, placing a hand on her shoulder.

Riley looked as if they all grew two heads. “Us vs the Americans. I know we said to not think about it but we shouldn’t completely ignore it either.”

Millie turns to her teammate, Celly. “You need to go get Tommy and tell him it’s urgent.” Celly rushes off to find the head of their athletic trainers.

The other players exchanged worried glances, and Millie leaned in closer. “Riley, we already played the game. It ended almost an hour ago. Don’t you remember?”

Riley’s head was fuzzy as she tried to recall but was having trouble. She based her answer on the faces around her, “Yeah, of course. I remember. Sorry.”

Amber can tell her girlfriend was lying. “It’s okay if you don’t remember, babe. You got hit pretty hard. You just wanted to get refreshed before heading to the hospital, which I think you might need to go right now and not wait any longer.”

The realization of how serious this was crossed everyone’s mind knowing cognitive damage is real in their profession. Even Riley who was adamant about being fine looked confused and nodded at the suggestion which was concerning as she usually waved concerns off.

Millie took it upon herself to get more questions answered seeing Riley open and vulnerable at this moment. “Do you have a headache? Are you feeling dizzy or nauseous?”

Riley nodded, feeling a throbbing pain in her head. “Yeah, I have a headache,” she said. “I also feel really groggy. I’m scared.”The other players exchanged a worried glance, but they didn’t push the issue any further. They knew that Riley could be stubborn sometimes, and they didn’t want to add to her fear.

Millie sighed, her gaze softening. “Riley, we’re your teammates,” she said. “We care about you and are here with you. We will make sure you are okay.”

“How about we help you get dressed?” Amber suggested knowing Riley hates sitting in a towel with her hair wet and also doesn’t want her naked when Tommy comes in.

“You think we are going to win the game tonight? The Americans have been doing good this season with the new players they drafted.” Riley asks again, making tears accumulate in Amber’s eyes. Millie sends another teammate to hurry up and search for any one of their athletic trainers at this point.

“She was just fine before the shower,” Amber says desperately to Millie. Millie and Jennifer try to comfort her while keeping an eye on Riley who now keeps dissociating as well. Jennifer pulls Amber to the side hoping to calm her down knowing if she gets worked up it might work up Riley which they don’t need.

“Okay, Riley, I got some shorts and a shirt for you to wear. Do you need help?” Millie asks, ready to intervene if needed. She kept her eyes on the girl knowing they’d all seen each other naked before as it comes with communal showers in locker rooms since joining the team.

Riley shook her head and took the shorts first. As she stood up from the bed, the floor moved under her feet causing her to sway significantly putting her arms out hoping to steady herself with the bed. “Woah, woah, I got you…. Easy, Riles… Easy.” Millie says, grabbing her shoulders steady. When she looks at Riley’s face, she can see the color draining. Before she can react, Riley gags and throws up. Millie thankfully jumps out of the way of the projectile vomit and pulls Riles’ hair out of the way. Once done, Riley’s body immediately weakens causing Millie to practically hold all of Riley’s weight. She decides to ease Riley down to the floor against her lap and away from the vomit.

“Talk to me, Riles. What’s going on? Are you in pain?” Millie shouts out questions feeling Riley shaking in her arms. The towel was already on the floor leaving Riley bare with only shorts on.

“I don’t feel good,” Riley whines and nobody recognizes this childlike side of her, making them worry.

“What do you feel, Riles?” Millie urges again and shakes the woman when she sees her eyes wanting to close shut. “Riles, you need to stay awake. What’s going on? Talk to me!”

Riley feels a warmth overcome her and she wants to succumb to the comfort but hands shake her awake and tell her to keep her eyes open. She moans and pushes away at the hands and voices. She isn’t sure if they let her be or if she fell asleep but she is brought to consciousness again when she feels a fist rub the middle of her chest making her groan in pain. She can see a lot of figures around her through her slightly parted eyes but nausea comes back as she gags not having the energy to avoid herself as it comes up. She starts choking on her vomit being laid flat on her back but the people around her are quick to shove and turn her over to her right side as content leaves her mouth.

Riley can feel the tiredness wanting to take over again but the fist is rubbed between her C-cup breasts as she is still on her side.

When she goes to groan, a weird grunt leaves instead and she feels her body tense up. Her muscles start to spasm and her limbs start to jerk uncontrollably, making her feel like a ragdoll. She hears voices talking but their words are muffled and she can’t comprehend them. Her eyes roll back and forth, and her breathing becomes shallow and erratic. She feels like she’s floating, weightless and dizzy. The spasms continue, and she feels like she’s being electrocuted from the inside out. Riley’s mind is a jumbled mess, and she can’t think straight. She can hear her heart pounding in her ears, and her vision becomes blurry. The voices around her start to fade away as she slips into a deep, dreamless sleep. The seizure has taken over her completely, and she can only hope that it will be over soon.

Tommy and Will arrived as the seizure was taking place and immediately dialed 911.

“What happened?” Tommy asks, seeing Riley’s half-naked body seizing next to a pile of what he assumed was her own vomit.

“She was lethargic and confused. She said she was feeling dizzy and threw up, practically collapsing in my arms. She kept going in and out of consciousness and I was giving her sternum rubs as I’ve seen on TV and it kept waking her up but she started having a seizure about 20 seconds ago.”

Will, hearing the conversation, told dispatch and gave the phone to Millie so he can help Tommy. Both of the trainers knew they couldn’t do much without medical drugs so they kept the seizing player on her side as she let out little grunts and gasps through her tightened jaw. Their hands stayed on her not wanting her limbs or head to accidentally thrash into the furniture or floor of the room.

Her olive skin was glistening with sweat despite the shower she just had and her body jerking caused her breasts to move as well in such an uncoordinated fashion. It was an ugly sight to see by her team who held their breaths wanting her to be okay. Amber remained held back by Jennifer and Millie moved to stay close enough to Riley without interfering in case an extra set of hands were needed.

Will took a moment to set up the portable oxygen tank and place a mask on Riley as she seized, knowing oxygen isn’t reaching her brain at the moment. As her body convulsed violently, foam started to build up in her mouth and would exit every time she let out an involuntary cry and moan.

“Get me a towel,” Tommy called out and one appeared seconds later. He removed Riley’s oxygen briefly to clear her face and mask before placing it back on. “She’s turning cyanotic! Where are the medics?”

“They are 4 minutes away.” Millie calls out. “Jennifer and Amber, go down to the lobby so you can guide them to us.” She tells them seeing Amber is on the verge of a breakdown watching her girlfriend practically suffocate. Jennifer pulls Amber out of the room while teammates gather in the hotel hallway watching their youngest player in a scary situation.

“If she doesn’t stop soon, this is very bad,” Will mentions. “This is why a team doctor should always be around and not just at games themselves.”

With Riley’s fingers and feet stiff and crunched in an unnatural way her limbs jerk around for another two minutes before she suddenly stops. Her body is limp with foaming now coming out her mouth in a steady stream as her jaw relaxes. Will removes the oxygen mask and takes the towel from Will to sweep the inside of her mouth getting all the saliva out of the way before she’s turned on her back. Once on her back, Tommy tilts her chin back and puts his fingers on her carotid, checking for breathing and pulse.

“She’s tachy but has agonal breath sounds.” He takes out a pocket mask from his bag and pops it open attaching the one-way valve and switching out the oxygen mask for it. “Will start attaching the AED. I will begin rescue breathing.”

Tommy readjusts Riley’s head position so he fully hyperextends her neck and takes a deep breath before exhaling in her mouth enough for her chest to rise. He gets into a quick rhythm breathing every five seconds for her. Her chest rises and her breasts follow the movement before relaxing. Meanwhile, Will connects the pads to the machine that automatically turns on when opened. He separates the sticky with plastic film before placing them appropriately on her naked chest before pressing firmly on both making sure they stick well.

As Tommy continues to breathe for Riley, her body lets out these little spasms following the seizure, scaring the room into thinking she might have another one. “Come on, Riley don’t do this to us,” Will says and smacks her cheeks a bit. He doesn’t expect it to do much but it was hopeful thinking.

“Give the sternum rub, it helped before,” Millie mentions remembering what she tried before the seizure. Will nods at the suggestion knowing it won’t hurt to try. He bawls his fingers and centers it between Riley’s large breasts before aggressively rubbing for ten seconds. The only reaction is the red welt forming in her chest. “No response to painful stimuli.”

The medics and police officers come rushing in moments after Will tried the sternum rub. Tommy continues to breathe while medics set up what they need to do and listen to Will’s update of what has been happening.

“Alright, let me check her out.” Enzo, the primary medic, says, indicating Tommy to back away. He does a quick assessment before indicating that now there is no pulse and starts CPR. Enzo uses the red welt from the sternum rub as a marker of where to place the heel of his hands and digs deep into Riley’s chest from the first compression. “One… And two… And three… And four… And five…” Once he reaches 30, he tells Tommy to give two breaths. Tommy pulls her head back which makes her body shift and pull up as well before it’s pushed back down by Enzo. “One… And two… And three…”

While those two continue CPR, the other medic, Kenzie, sets up the leads, IV, and medication. Once she is done with those things, she takes her gloved hands and pulls down Riley’s shorts enough to expose her groin areas. Kenzie takes her left two fingers and searches for Riley’s femoral artery. Once located, she can feel a pulse from the compressions Enzo is doing ensuring they are effective.

After two minutes of CPR, the AED machine indicates for everyone to step away as it analyzes. “Shock advised. Do not touch the patient. Charging.” The medics look at the LifePak confirming the patient has a shockable rhythm, V-tach. “Press the red flashing shock button now.”

The medics make sure everyone is clear before Kenzie presses the button causing Riley’s body to barely twitch in response. “Analyzing heart rhythm again. Do not touch the patient… Shock advised. Do not touch the patient. Charging.” The machine robotically says. A high-pitched frequency fills the silence in the air before the voice commands to push the red button again. This time, Riley’s body arches a bit, and her head sways from the electricity.

“Switch with me,” Enzo tells Kenzie, making a smooth transition. Kenzie starts compressing, feeling the pressure of Riley’s sternum compress down into her spine. There is a bit of resistance but halfway through her first round of compressions, she can feel and hear the crack/pop of her patient’s ribs. Up at the head, Enzo moves Tommy out of the way and prepares to intubate. “Ugh, her mouth is full of fluid. Continue continuous compressions until I get this sorted.” Enzo shakes his head as he prepares the suction. Once everything is attached, he brings the machine as close to his patient as possible before turning it on and opening Riley’s mouth. In a figure-eight motion, he vacuums the saliva built up. Once satisfied he turns the machine off and lays on his stomach to work on inserting the ET tube down Riley’s throat. He makes eye contact with Riley’s dead body as her eyes are open staring at nothing. “I’m in.” He says once he checks with his stethoscope that the air is delivered properly in her trachea with the ambu-bag.

Kenzie continues to administer deep violent compressions despite her small stature and Enzo pushes more meds having handed off the ambu bag to Tommy.

“Enzo, we need to load her up. She probably has a brain bleed and the hospital can do more for her than just CPR. Set up the LUCAS device so we can free up and move her.” Kenzie calls out from her compressions. He nods and quickly opens the bag they carried in with the gurney. He pulls the curved green back piece from the bag first before asking Will to help. “On the count of three, we lift and Kenzie you guide it under her,” Enzo says. “One. Two. Three.” Just like that, on three, Will and Enzo each grab an arm pulling the limp woman in a sitting position for a moment before guiding her back down gently. Her hair covers her face and Tommy moves it exposing her dead-open eyes. Kenzie goes back to compressions while Enzo picks up the next piece, setting up everything so no time is wasted. He connects the pressure canister before turning the machine on. He tells Kenzie to move as he lifts this big piece over Riley’s chest and clicks it to the back piece. He guides the suction cup of the machine down towards the woman’s chest before pressing the button that starts the plunger to move automatically and rhythmically. Riley’s body succumbs to the force and her belly protrudes differently from the manual compressions given previously. With a free set of hands, the medics work to gather their belongings and set up the gurney. Lowering and guiding it next to their patient, they request the help of the police officers, giving each officer the responsibility of a limb. Tommy remained responsible for Riley’s head and breathing while Enzo and Kenzie made sure the LUCAS device remained in perfect place. “One. Two. Three.” In a smooth motion, everyone lifted and plopped the girl into the stretcher. Her arms that hung off shrugged with each compression getting in the way so Kenzie strapped them up to the velcro on the device.

“Guys, I think there’s something wrong with her tube,” Tommy calls out. “Her chest isn’t rising when I squeeze.”

Enzo goes to the head of the stretcher and pauses the CPR device before seeing what Tommy meant. Sure enough, as Tommy squeezes the bag, there is no chest rise… but there is a hissing sound. Enzo removes the ambu bag and covers the ET tube with his own lips. He blows in air and just like that watches Riley’s chest rise. He quickly turns the LUCAS device back on. “Manually breathe for her every 10 seconds.” He tells Tommy. Kenzie pushes more meds and before guiding her hand back down to Riley’s femoral artery. She holds it firmly in place allowing her fingers to find the pulsating point.

“Do not touch the patient. Analyzing heart rhythm.” Everyone removes themselves and Enzo pauses the machine. “Shock advised. Charging. Do not touch the patient. Press the flashing red button now.” Making sure everyone is clear, Enzo pushes the button causing the entire stretcher to shake as Riley’s body arches under the suction up and hands threaten to escape the velcro. Riley’s head slams up and down as do her legs from the powerful shock. The machine indicates another shock is required and Enzo pushes the flashing button again. Again Riley’s body jerks against the resistance and her toes curl from the shock. It takes a brief seconds before the monitors let out a familiar beep followed by a few seconds of silence before another beep followed by another occurs.

“She’s in sinus brady. She’s back as of this moment. Tommy, you come with us and continue to manually breathe until we can get to the ambulance for a second ambu bag Let’s go, now!” Kenzie calls out as they rush her out of the hotel room passing the teammates and staff in the hallway. Just like that they disappear into the elevator and the rest of the team stands there in shock. Not even Amber has it in her to follow her girlfriend.

…

What was supposed to be a friendly tournament turned into one of the worst days in women’s ice hockey history for two teams as both had players in critical condition.

kk095

Gina’s Sudden Arrest

Gina Ashford was what many would consider to be an alpha female or a “boss lady/boss babe.” She was an assertive, headstrong go-getter who had a commanding presence that some might find intimidating. But this personality helped her tremendously in the business world, landing herself a spot as the VP for a large corporation. Gina didn’t just have a strong personality- she also had looks. The 51 year old VP looked excellent for her age, looking at least 10-15 years younger, and could easily attract men young enough to be her son. She was of average height with a slim, but toned build from working out every day after work, had medium length light brown hair, and bluish grey eyes. Even though Gina had both looks and success, she was never married and never had children- her whole adult life was devoted to her career.

Recently, Gina was in our area for an important business related meeting with a few other higher ups in the corporation. The morning of the meeting, Gina woke up in her hotel room with a stiff neck, a headache, and felt a little dizzy at times. She brushed off these symptoms, attributing them to jetlag and not sleeping well the night before. Despite her symptoms, she got up, showered, got ready and headed out the door. The meeting was being held across town, maybe 15 minutes away. The company had a car waiting just outside the hotel lobby to drive her and the other executives to the meeting. During the elevator ride down from her room, Gina began to feel more dizzy. She squinted her eyes a bit, becoming sensitive to the light in the elevator, and winced in pain for a second as the pounding headache returned.

The elevator dinged and the doors opened after reaching the lobby level. Gina exits the elevator and starts heading towards the lobby’s main entryway. Her steps became a bit slow and wobbly, having trouble maintaining balance. Gina could feel her heart racing inside her chest while her symptoms intensified. Suddenly, Gina’s eyes rolled back, and she crumbled to the ground, fainting. A hotel security guard and one of the front desk agents see Gina collapse and scurry over to her aid. “Ma’am? Is everything ok?” Matt the security guard asks in a concerned tone, gently tapping Gina’s shoulder, trying to get her attention. Gina just laid on the floor, eyes closed, mouth agape, not responding to the security guard. “miss Ashford? Are you ok?” the front desk agent Emily asks, gently nudging Gina to see if she’d wake up. Matt and Emily tried multiple times to get Gina to wake up, but she just wouldn’t. “shit. We probably need to call 911.” Matt says, a bit flustered, digging through one of his pockets trying to reach for his cell phone.

Matt finally gets ahold of his phone and dials 911. “911, what is your emergency?” a female voice on the phone asks. “yeah…hi… a lady fainted in the lobby of our hotel and she’s not waking up. We’re at the Spring Towers downtown off Atlantic boulevard.” A nervous Matt utters into the phone. “alright sir, I have emergency services en route to your location. Can you tell me if the woman is breathing?” the dispatcher calmly replies. There’s a pause for a moment while Matt checks. “ok…. Yes! She’s breathing! She just won’t wake up when we touch her or say anything to her.” Matt replies anxiously. Matt the security guard was incredibly nervous at the moment, knowing something was seriously wrong. “Ok, I need you to stay on the line for me.” The 911 dispatcher instructs Matt. While awaiting further instruction from the dispatcher, Emily the front desk agents can hear Gina grunting and groaning. “Ma’am? Are you ok?” Emily asks in a calm voice, placing her hand on one of Gina’s shoulders, to which the 51 year old VP doesn’t respond.

Suddenly, Gina’s eyes shoot wide open, staring right at Emily. “Ms Ashford?” a worried Emily asks. Gina’s body becomes stiff and straight on the floor. Her head and neck become arched. Her arms were straight along the side of her body, with her hands curled. Her legs were straight, her feet were pointed downwards, and she began seizing and convulsing violently on the floor of the lobby. Matt and Emily jump back a few feet, taken aback by what they were seeing. “whoa!” Matt shouts into the phone. “sir, what’s happening?” the dispatcher asks. “you guys gotta hurry! She’s having a seizure or something!” Matt shouts into the phone. “ok, please remain calm and stay on the line for me.” The dispatcher says to Matt before giving him further instructions. Gina made eye contact with Emily while she was seizing on the ground, forever etching this moment into the young front desk agent’s mind forever. Gina kept seizing violently, grunting in pain, with her face turning bright red. This attracted a crowd of nosey onlookers from elsewhere in the lobby, who began to surround Matt, Emily, and Gina. Some people watched in shock and awe, while others whipped out their phones and started taking pictures and videos, completely violating the powerful businesswoman in such a scary moment of her life.

Finally, the ambulance pulls up right in front of the lobby, and in come medics Tracy and Stephanie. “ok everyone, let’s take a few steps back so we can work.” Tracy barked at the nosey crowd, essentially having to force her way through it. “hey! Over here!” Matt yells across the lobby, waving one of his hands in the air to get the attention of the two medics. Tracy and Stephanie see Matt and fast walk over to him. The medics get over to the two hotel employees and can see Gina still actively seizing on the floor of the hotel lobby. The two medics immediately spring into action. “push a round of Ativan, and I’ll place an oral airway.” Stephanie tells Tracy. Tracy grabs a syringe and a vial of Ativan out of the medication bag and injects it into Gina’s arm. “ativan in. No IV yet, so it might take a minute to kick in.” Tracy called out to her partner. Stephanie placed an oropharyngeal airway into Gina’s mouth in order to keep her airway open, and to prevent her from biting her tongue or lips while seizing. While waiting for the seizure meds to take effect, the two medics start snipping away at Gina’s expensive work attire and remove her Gucci high heels, leaving her barefoot, stripping the VP down to just her bra and underwear. Tracy sticks the EKG electrodes onto Gina’s chest, while Stephanie starts pushing buttons on the heart monitor to get it activated. Once the heart monitor was on, you could see that Gina’s heart rate was through the roof, while her BP was critically low.

Gina’s violent thrashing and flopping came to a slow and gradual stop once the meds started to take effect. At that point, the medics were able to set up IVs in both arms. But during this process, Gina never regained consciousness, and her vital signs were in a dangerous place. Gina laid unconscious in the lobby, eyes wide open, staring up above with a pained look still on her face. Since Gina wasn’t regaining consciousness, the medics decided to intubate her and leave the oral airway in her mouth. A 7.0 ET tube was secured in the 51 year old’s airway, and taped in place. Moments after intubation, the heart monitors showed pulseless v-tach, so Tracy snipped off Ms Ashford’s bra, and began pumping her chest fast and hard. “…5…6…7…come on…” Tracy counted to herself, pummeling the attractive woman’s chest. Stephanie was readying the defibrillator paddles, gelling them and charging to 150 joules. The paddles were pressed up against the patient’s bare chest, and a shock was delivered. Gina’s body jolted sharply on the lobby floor in response to the shock. Matt, Emily, and the nosey crowd watched in horror while Gina’s dying body reacted to the jolt of electricity. “no change, hit her again at 200.” Tracy told Stephanie after taking a quick carotid pulse. The paddles were recharged, pressed back up against the woman’s chest, and shock #2 was delivered. Once again, Gina’s body reacted violently to the electric shock. Her chest shot up for a second, and her arms flailed for a brief second before going limp once again. A woman in the nosey crowd screamed as she watched Gina react to the shock. “Still nothing. Charging to 250.” Stephanie called out, shaking her head, looking at the heart monitor. Tracy delivered a cycle of chest compressions while the defibrillator whined as it was charged. Finally, the paddles were pressed up against the woman’s bare chest, and the next shock was administered. Gina’s feet leapt up above the tile floor, slamming back down half a second later, showing off the deep, thick wrinkles in the soles of her size 8 feet.

This shock failed to restart Gina’s heart, and she was now in v-fib. Tracy resumed chest compressions and Stephanie injected epinephrine and atropine into the VP’s IV line. After a few cycles of CPR and ambu bagging, the medics decided to shock Gina again. The paddles were charged to 300 this time, and the next shock was delivered. KA-THUNK. Gina’s lifeless body twitched sharply on the floor while the nosey crowd continued watching, with a few gasping and shuddering. The strong, alpha female VP was in such a vulnerable, helpless situation- a stark contrast from her usual self.

Shock after shock failed to restart Gina’s heart, and the already dire situation was becoming desperate. “what’s happening?! Why isn’t anything working?!” Emily the front desk agent asked the medics, teary eyed and visibly upset. The two medics were so locked into their efforts that they didn’t respond to the young front desk agent. Stephanie took over CPR and started delivering deep, harsh chest compressions. Gina’s belly bounced outward while her pretty eyes remained wide open, continuing to stare up above. The medics kept up their efforts of chest compressions, ambu bagging, and meds, but Gina deteriorated further, going from v-fib, to PEA, to agonal, to asystole. The two medics were becoming exhausted after each performed multiple cycles of chest compressions. At one point, Tracy shined a pen light into Gina’s eyes. “fixed and dilated, been down 20 minutes.” Tracy said to Stephanie, shaking her head. Stephanie delivered a few more chest compressions before backing off and holding her efforts. Stephanie let out an exhausted sigh, then said “we did everything we could Tracy. I think we need to call it.” The tension in the room was palpable at that moment. Tracy paused for a moment weighing out the options. “yeah… she’s gone. Time of death, 8:42am. Let’s call the coroner’s office and get them over here.” Tracy said reluctantly.

The ambu bag was detached from the ET tube, the flatlined monitors were switched off, and the EKG electrodes were plucked off of Gina’s bare chest. The two medics picked up Gina’s lifeless body, placed her on a gurney, and then put a sheet over her body, and wheeled her into the ambulance while they waited for the county coroners office to arrive on scene. Unfortunately, Gina’s death was quite sudden, with her final moments being so violating and public.

Since no cause of death could be readily determined by EMS, an autopsy was performed. The autopsy showed that Gina had died from a rare type of brain aneurysm. A large fusiform aneurysm was discovered in the basilar artery with a 3cm dilation- which is well above the recommend threshold for surgical intervention. These types of aneurysms only occur in 3-5% of all brain aneurysm cases, and have mortality rates as high as 60% according to some studies. Sadly this rare and deadly clinical entity took the life of Tracy and Stephanie’s latest patient.

kk095

The Crash That Changed Everything

*hello everyone! I wanted to try something different here. I told chat gpt to read all of my resus stories, then come up with one of its own, and this was the end result. I thought it came up with an interesting story, and hope you enjoy!*

The sun was setting in a fiery blaze of oranges and pinks as Alexis and Brandon set out on their road trip. They had been planning the trip for months, eager to escape the stresses of everyday life and spend some quality time together. Alexis was driving, her hands gripping the wheel tightly as she navigated the winding roads that led out of town. Brandon was beside her, humming a tune as he tapped his fingers on the dashboard. Everything was perfect, until it wasn’t. One moment they were laughing and chatting, and the next, they were hurtling towards disaster. The sound of shattering glass and metal filled the air as their car was sideswiped by a distracted driver, and their lives were forever changed. The screeching of tires filled the air as the car spun out of control, the sound of metal crunching against metal echoing through the empty highway. Alexis’s heart pounded in her chest as she clutched the dashboard, her knuckles turning white with the force of her grip. Beside her, her boyfriend Brandon let out a strangled cry, his body lurching forward as the car came to a sudden stop. For a moment, everything was silent, and then the pain hit them both at once, searing through their bodies like a wildfire. It was only then that Alexis realized that their lives would never be the same again.

Alexis and Brandon’s world had been turned upside down in an instant. As the car was struck, their bodies were thrown forward with a sickening jolt. Glass shattered around them, and metal groaned and creaked under the force of the impact. For a few moments, they lay there, stunned and disoriented, struggling to make sense of what had just happened. The smell of smoke and gasoline filled the air, and Alexis could feel the heat of the engine on her legs. She was scared, and her heart was racing as she turned to Brandon to see if he was okay. He was groaning in pain, clutching his side and moaning softly. Alexis felt a sharp pain in her arm and could see blood seeping from a cut on her forehead. The realization that they were hurt hit her like a ton of bricks, and she knew they needed help – fast.

“Brandon?...” Alexis asked nervously, her eyes filling up with tears. “I’m ok babe… I promise…” Brandon replies, having a pained look on his face. “I’m so sorry babe! I didn’t mean it!” a guilt ridden Alexis cries out, taking full responsibility for the accident, even though it wasn’t her fault. While the couple checked on each other and tried to make sense of the tragedy that just unfolded, a traffic jam started to form on the highway, and several of the onlookers called 911 to alert emergency services of what had happened.

Alexis and Brandon heard the distant sound of sirens and knew that help was on the way. Soon, a team of paramedics arrived on the scene, rushing over to assess the couple’s injuries. They carefully extricated Alexis and Brandon from the car, placing them on stretchers and securing them with neck braces. The couple was in a lot of pain, but they felt reassured by the presence of the paramedics, who were calm and professional despite the chaos around them. The sound of the ambulance siren pierced the air as Alexis and Brandon were loaded into the vehicle, and they were whisked away to the hospital. The journey was a blur of pain and fear, but the paramedics did their best to keep the couple calm and stable. Once they arrived at the hospital, Alexis and Brandon were taken to the emergency room, where the usual trauma team awaited.

First to arrive was Alexis, who was wheeled in by medic Tracy. “23 year old female, restrained driver in a high speed MVC. Hypotensive and tachy, O2 saturation normal. Left humerus fracture reduced and splinted on scene, abrasions to the chest wall, head lac on forehead above the right eyebrow.” Tracy told Dr Lindsay, who would ultimately be Alexis’s doctor. “ok, let’s get her into trauma 1. Page radiology and trauma surgery.” Dr Lindsay called out to the rest of her team, which consisted of nurse Nancy and nurse Heather at that moment. Alexis laid on the backboard in a c-collar, crying, and asking about her boyfriend. Her light brown hair had droplets of blood on it from her forehead laceration, and her blue eyes were puffy from all the crying she’s done since the accident. She was stripped down to just her bra and underwear, exposing her pleasantly plump body to the trauma team. Her chest had bruises and abrasions on it, and had EKG electrodes stuck on it. “Brandon?! Is Brandon ok?!” a terrified Alexis cried out to the trauma team. “let’s transfer her on my count. One, two, THREE!” Dr Lindsay firmly ordered the team, transferring the girl onto the table, underneath the large overhead light, beginning their assessment.

Meanwhile next door, medic Stephanie wheeled in the boyfriend Brandon. “26 year old male, restrained passenger in a high speed MVC. Hypotensive, tachy, oxygen saturation normal. Blunt abdominal trauma to upper left quadrant, possible spleen injury.” Stephanie told Dr Jose, who would be in charge of Brandon. The boyfriend’s trauma team would consist of Dr Jose, nurse Ashley, and nurse Jamie, who was the new addition to the trauma team. Brandon was also transferred onto a table, underneath a large, overhead light. The tall, thin, Hispanic man laid on the table, stripped down to just his boxer shorts, in a c-collar, and also had EKG electrodes on his chest.

Next door, Alexis’s breathing became erratic and she was deteriorating at an alarming pace. Dr Lindsay started the pleasantly plump young lady on the massive transfusion protocol to get her vital signs back up to normal limits, but it only appeared to do so much. “diminished breath sounds on the left side Linds.” Nurse Heather called out to the doctor after stething Alexis for a bit. A chest x ray ultimately confirmed a collapsed lung on the left side. To help reinflate her lung, they would need to insert a chest tube, a procedure that could be quite painful in a patient that was awake. Despite her pain, Alexis tried her best to remain still as the medical team prepared to insert the chest tube. They gave her a local anesthetic to numb the area, but she could still feel the sharp pressure as the tube was inserted through a small incision in her chest. She winced in pain as the tube was slowly advanced into her chest, but she tried to remain as still as possible. As the chest tube was inserted, the trauma team could see the relief on Alexis’s face as the pressure in her chest began to decrease. They quickly attached the tube to a drainage bag, and Alexis could feel the weight of the bag pulling at the tube in her chest. It was an uncomfortable sensation, but she knew that it was necessary to help her breathe more easily. “It’s going to be ok. It’ll be ok.” Alexis kept thinking to herself. Alexis could breathe a little better at that point, but her vital signs were continuing to drop at an alarming rate. Dr Lindsay knew she didn’t have much time to get the young lady stabilized.

Nearby, Dr Jose started his initial examination of Brandon. When they examined Brandon, they found that he had no feeling or movement below his waist. They tested his reflexes and examined his lower extremities to see if there was anything to their suspicions. The results were clear: Brandon had suffered a serious spinal cord injury that had left him paralyzed. Dr Jose wanted to send Brandon over to radiology to confirm a possible spinal cord injury, and to further examine the abdominal injuries he had sustained. So without further ado, Dr Jose, nurse Ashley, and nurse Jamie took the young man over to radiology for a CT scan. Brandon’s CT scan showed a few things: he had sustained internal bleeding in the upper left quadrant, which is usually caused by an injury to the spleen, and that he sustained a spinal cord injury at the L4 and L5 level. Dr Jose paged the trauma surgery team, and off to the OR the young man went.

Back in the ER, Alexis had become unconscious and continued to further deteriorate, so Dr Lindsay chose to intubate her. Suddenly, Alexis’s monitor alarm sounded, and her heart rate dropped to dangerously low levels. The trauma team sprang into action, administering chest compressions and drugs into her IV line. Nurse Heather placed their hands on Alexis’s chest, pressing down hard and fast in a rhythmic pattern. As they performed CPR, the team also prepared the defibrillator pads and placed them on Alexis’s now bare chest. They had to clear the area to make sure that nobody was touching her before administering the electric shocks. The team member in charge of the defibrillator charged up the machine and delivered the first shock. Alexis’s body jolted in response, but her heart rhythm did not improve. The team continued with CPR and prepared to deliver another shock. As the team worked to revive Alexis, they could feel the pressure mounting. They knew that time was of the essence and that every second counted. They delivered multiple rounds of shocks, and with each shock, they hoped to see a change in Alexis’s heart rhythm, but unfortunately the young lady’s heart just wouldn’t restart. The trauma team knew that they still had one last chance to save Alexis’s life, and they quickly assembled for a thoracotomy, a surgical procedure that involves making a large incision in the chest to gain access to the heart and lungs. They knew that the chances of success were slim, but they had to try. With grim determination, the team worked to open Alexis’s chest and expose her heart. The sight was overwhelming, and Dr Lindsay’s hands moved with precision and skill as they clamped off the descending aorta near the diaphragm and began assessing the injuries to Alexis’s heart. Dr Lindsay then started direct cardiac massage, which involves using their hands to compress the heart and manually pump blood through the body. The team knew that this alone might not be enough to revive Alexis, so they also decided to use internal defibrillator paddles. They carefully placed the paddles directly on Alexis’s heart and charged up the machine to deliver a shock. The shock jolted the patient’s body, but her heart did not start beating on its own. The team continued performing direct cardiac massage and prepared to deliver another shock. They administered multiple rounds of shocks and continued to perform direct cardiac massage, hoping that Alexis’s heart would respond. But despite their best efforts, they were unable to revive her. The team knew that they had done everything they could to save her, and ultimately had to terminate the code, calling time of death on Alexis at 8:13pm while she was still in v-fib.

Hours after Alexis had passed away, Brandon was now in the surgical recovery unit. His spleen had to be surgically removed, and his spinal cord injuries were treated to the best of the surgical team’s ability. Dr Jose paid Brandon a visit after his surgery, and informed him of the bad news: that he was paralyzed from the waist down, and that Alexis had succumbed to her injuries in the emergency department earlier that night. The news was devastating for Brandon. Dr Jose knew that he would require specialized care and rehabilitation to help him regain as much function as possible, but they also knew that the road ahead would be long and challenging. Despite the grim prognosis, Dr Jose remained hopeful and determined to do everything in their power to help Brandon recover. They stabilized his condition, administered pain relief, and worked to minimize the risk of complications. They also made sure that Brandon’s loved ones were informed and supported during this difficult time.

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