We saved someone today. To be honest, it was kind of a joke. I was working BLS on the overnight, and an hour before six, our official off time, they dispatched a cardiac arrest ten blocks away. We buffed the job. It was at a nursing home. The man had a tracheostomy and was a vegetable at baseline.
The nurse, to my surprise, was actually doing CPR when we arrived. I attached the AED and it said, "No shock advised." The man was swollen with CHF and Liver Failure. Even his chest was edematous. I continued with CPR as my partner gathered information.
The medics showed up a few minutes later. One of them, a middle aged black woman, touched the man's leg. It was cold.
"C'mon guys," she scolded harshly. "What are you thinking?" implying that we should have pronounced him DOA.
I rolled my eyes. The paramedic patch on my shoulder was out of her view. The man wasn't pronouncable. Staff said he was breathing fast as they were bathing him and then seized before arresting. No rigor mortis. His torso was still warm.
They put the man on the monitor. He had a slow paced rythmn from an internal pacemaker. His pulse was incredibly hard to palpate, but he had a distinct heartbeat upon auscultation.
The irony was not lost on me.
"How about we get a blood pressure," I asked, bearing a shit-eating grin.
Vitals were: BP 52/18, Pulse 38, Respirations 4 & agonal
"You know what we should do," I said, thinking nothing of it, "we should pace this guy."
With the edema, the medics didn't seem too eager to start an IV. I figured we'd just transport and gathered our gear.
The second medic was forty-year old white guy with tatoos poking from under his sleeve. He had a cool, I've-been-doing-this-forever vibe. As I made ready to leave, he stopped me. "No," he said, speaking softly, "wait. We're gonna do what you said. We're gonna pace this guy."
Some discussion ensued about how to use the pacemaker.
Lo and behold, it worked. We got the man's pulse up to 80.
As we stepped into the ambulance, the black woman pulled out an ACLS manual. I shook my head and suggested they try starting an IV in the man's scalp. He had a big one just calling our name. No takers.
The man lived.
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