Thursday, May 19, 2011


There is so much blood on the bed I can't believe it - the sheets are saturated with all hues of red. You can even see blood on her hands, darker than that on the sheets, where I'm assuming she was trying to hold pressure on the quarter-sized hole on her thigh before she went so hypovolmic she went unconscious. She breathing agonally, about 4 times a minute. I'm glad I told Fabio to grab an extra handful of 4x4's and Kling, and he is rapidly taping up the leg wound.

"I called as soon as she axed me," says the son, in the door way. "She gon be aright?"

"We're going to try. She's lost a lot of blood." I open her airway and slide in an OPA as I hand a BVM to a firefighter standing next to me. Her mucous membranes look like black and white photos of an airway.

I knew we were in deep shit when one of the firefighters, who arrived 45 seconds before us, came running back out. "STEP IT UP, GUYS! SHE AIN'T DOING TO HOT."

"Understatement of the Year," I mumble to myself, reaching for a pulse. Nothing at the wrist. A carotid is present, but so faint I can barely feel it. Fuck it, it's there, that's good enough for me. Fabio's pressure comes back as 70/30 and I immediately reach in the ALS kit for our EZ-IO and drill. I love this thing. Fluid is soon being pressure-infused as I take another look at the EKG. Her sinus rhythm suddenly gets squirrelly and I actually feel her pulse getting fainter as I recheck her carotid. She's going PEA. I've got the most likely cause being treated as well I can right now but the situation has some unique challenges. There's so much blood on the bed, but we can't do compressions on this mattress anyway.

We pull her off towards me, on the side of the bed, and a literal wave of blood accompaines her of the sheets, fanning out all over the floor and onto my pant knees. Fuck. Stupid. I should have backed up a little more. Nothing to do now but roll with it. Fabio starts CPR as I fire an epi down the IO. We've already got around 200mL of fluid in. Our backup arrives and I tell them to set up my intubation equipment. It's foolish to do all this, I think, her entire FUCKING VOLUME is spread out on the sheets, bed, and my pant knees. After slipping on a procedure shield I open the airway with the scope and am greeted by a wave of pale yellow mucus and emesis against what looks to be a waxwork replica of an landmarks and vocal cords. I suction and go in again, looking at the bottoms of the cords. The backup medic applies pressure and they drop.

I sink and secure, and hook up our ETCO2. The value is only 20, but at the very least confirms I'm in.

The whole neighborhood is outside, and I hear some curses about our response time. Fuck it. I did the best I could. We're not even really supposed to go to this area of town with a police escort.

We secure to a spinebord and push another epi. In the truck she briefly regains a pulse but looses it again. We can't find anywhere to stick an's all scar tissue and tiny pipes. We fire more epi in and even a bicarb.

It looked like all the blood she had was on the mattress, I tell the doc. The family told us prior to departure that she had a large aneurysm in her leg that was supposed to be operated on later in the week. They hang blood and put in a central line. They too get temporary returns of pulse and pressure, but it's to no avail. Nurses leave the code area an hour later, dripping with sweat.

I look at at our Alert and On Scene times. 8 minutes apart. She went from conscious and talking to completely vampire'd in 8 minutes.

I got blood on my shirt at some point during the run, and I toss it in the washing machine along with my pants. The detergent lifts all the blood as cold water pours in, washing it out to the sewer, and then to the sea.