A Code is a Code Except When It’s Not

4 Mar

I’m going to get on a soapbox for a hot second about a call that we had on Tuesday night (during the rain / sleet / snow / slushy roads Nor’Easter).

 We get a call at one of the local ‘rehabilitation centers’ – one that I call Catatonic Manor because the residents always appear doped to the gills and in a catatonic state for a cardiac arrest, CPR in progress. The notes of the call say that the patient is cool to the touch, not breathing and no pulse. Case comments go on to say that the staff is doing CPR and that they have the situation under control.

 Remember – this is at a nursing home / rehabilitation center so theoretically at least, the staff has some medical training. They are supposed to be RNs, LPNs, CNAs – you know things that require tests and certifications and licensures and stuff. At least they should have their CPR certification. And what’s the first step of determining if CPR is warranted? You look, listen and feel for 3-5 seconds to see if the patient is breathing. You follow that up with 2 breaths (assuming not breathing) and then take a pulse at the carotid artery for 60 seconds. Naturally, if your patient is breathing, you do not give them any breaths and you can be assured that they have a pulse. ‘

Anyways, I digress – back to the call – it’s us, the paramedic fire truck, 2 paramedic zone cars and our field supervisor going to this call. We get there and the fire truck is already on scene. We grab the bulk of our cardiac arrest equipment and head in. We find a patient alive – meaning breathing, pulse – but unresponsive. Teeth had clenched down, pupils were pin-point and there wasn’t a damn soul doing CPR. So WTF about that whole thing of ‘staff is doing CPR and that they have the situation under control’? Other than the firefighters in the room, there isn’t a nurse, tech or janitor in the immediate line-of-sight.

We get her in the back of the ambulance after letting everybody and their brother know that this is NOT a cardiac arrest and it is determined that the patient has had a seizure.

I believe in very few black and whites in EMS. But whether you are dead or alive is one of them. If you have no pulse and are not breathing – technically you are dead. If you’ve had a seizure and still have a pulse and are breathing – no matter how crappy or insufficient those respirations are – you are still alive.

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