Code Blue

The call came at about 1920 hours.
The information from dispatch said that the patient was a female in her upper eighties who had suffered a fall.

It started like any other call, we hopped in the ambulance, put the address into the GPS, hit the lights and set out.
It took about 8 minutes to get to the scene, which was an apartment complex on the side of a hill. When we pulled up a fire engine was there with lights flashing but no personnel around, they were probably inside starting the assessment.
We got out the gurney and were headed inside when we heard a voice call out, we looked around but there was no one in sight, and were about to continue in when the voice called out again and we realized that it was coming from above us. My preceptor stepped back from the building and looked up and I heard some say something to him and then he started a fast walk straight for us and said in low voice, "we have a Code Blue".

Code Blue means the patient has no pulse and is not breathing adequately.

Immediately we headed for the elevator, I hit the up arrow and we waited for the doors to open, when they did we saw the elevator was small, too small to fit the gurney. We backed out and headed down the hall for the stairs. One look at the stairs and my preceptor decided we should leave the gurney downstairs, so we grabbed our gear and headed up the two flights of stairs to the third floor.

A firefighter was waiting halfway down the hall and motioned into an open door. As we headed in my preceptor asked me if I wanted airway, I said sure.
We saw the patient on the floor in a small entryway, she was a very thin and small and a firefighter was doing CPR. The entryway was pretty cramped so we decided to move the patient to the living room.
After the move my preceptor had the firefighter stop CPR and did a pulse check. We had a pulse. Rate of around 30bpm. Too slow.
The patient was unconscious and a firefighter had been giving breaths via Bag Valve Mask (BVM), after the move I had taken up the BVM, my preceptor told me to prepare to intubate and had the other medic get an IV. I picked up the bag and got out the gear I'd need, while a firefighter continued the BVM. "Ready" I said as I took over using the BVM, "Go ahead." I put down the BVM and picked up the tube and my Mac blade that I had ready, inserting the blade and opening the mouth,  I used the the suction machine to clear it of secretions, then, seeing the vocal cords I inserted the tube, pulled the blade, and then pumped the stabilizing bubble at the end of the tube up.
Now it is important that during this whole process you take no longer than thirty seconds, so that should help you visualize how fast I need to go.
I held the tube with one hand so it wouldn't get dislodged and attached the BVM to it with the other. Then as someone listened for lung sounds with a stethoscope I gave a few breaths, the person who listened said said it was good, so I secured the tube and gave breaths every 8-10 seconds.

Breath . . . . . . . . Breath . . . . . . . . Breath . . . . . . . .

While I was doing that the other people hadn't been sitting idle. We now had an IV established and were about to push a drug called Atropine to help speed up the heart.
After that was pushed my preceptor decide we should head out instead of working the code onscene. So the next challenge would be getting the patient out of the building. He decided to backboard the patient to make her easier to carry and then go down the elevator. Someone grabbed a backboard and we tilted the patient slid it under her and the strapped her down.

All the while I was using the BVM.

Breath . . . . . . . . Breath . . . . . . . .

When we got to the elevator we had to put the patient at almost a 45 degree angle in order to fit in the elevator.
After a short ride to the ground floor we jumped in the ambulance and sped to the hospital. during the trip we continued with some drug administration, but never got the heart rate up to over 50 ( it needs to be over 60)

I don't know what happened to this patient but it is very highly likely that she died later at the hospital.

Now just so that you dont think this kind of call is a regular occurrence, I have only been on four of this kind of call and that is considered rare. the main kind of call that we get is not very serious and easy to take care of.

Jonathan