high low tech

lakritzwolf  asked:

Hey Auntie! I have a character who ODs himself with sleeping pills that he washes down with vodka. His friends find him just before he goes into CA, they call an ambulance and do CPR. (One is a nurse.) After following you for a while I’m sure what I wrote is a medical BS Trope, so what actually happens when the Paramedics arrive? (I have a DeusExMachina to save him and everything after he arrives in the ICU falls under the I-break-it-I-buy-it-rule, so I just need to get him there.) Thank you!

Hey there! Welcome back!

Okay. Your character surviving a cardiac arrest from sleeping pills washed down with alcohol is, unfortunately, a slim shot. (Fiction writers live for long shots, so no judgment.) The reason for that is that most sleeping pills, in overdose, suppress cardiac function, which means that even if they get his heart beating again, it won’t be beating well.

So here’s what happens when EMS roll up on a cardiac arrest. I’ll give you a few high-tech and low-tech options, because of course I will!

1) They get their stuff off of the truck (usually 2-3 bags and a cardiac monitor).

2) They come in, ask a few questions – “What happened? Did you see him stop breathing? How long has he been down? How long have you been doing CPR?”

3) They’ll take over CPR, and hook up their monitor to check a rhythm. If it’s a shockable rhythm (V-tach / V-fib) they’ll shock every 2 minutes, though rhythms can change with no rhyme or reason. They may need a few rounds of CPR before they’re “shockable”.

           a) Chest compressions may be done by a device such as a LUCAS or AutoPulse, both of which wrap around the chest and do CPR for you. This is the “high tech” option, if you want a touch of sci-fi. It really does free up providers to do the non-mechanical stuff. With the AutoPulse, you basically haul the patient up by their arms, wrap the device around their chest, lay them down, and it just goes to town.

4) In addition to CPR (hands-on-chest), they’ll use a bag-valve-mask to “bag” the patient / breathe for them.

5) One of the EMSkin will start an IV and start giving drugs. If you want to be fancy, have them have trouble finding a vein, and use an IO gun – basically a hand drill – to put a needle in the lateral shoulder. It works like an IV, it’s just infinitely more brutal.

          a) Sample meds might include epinephrine (1mg, every 3-ish minutes), D50 (25g, usually just called “1 amp”, sugar water, given once); if the person has been shocked  more than twice, a med called amiodarone (300mg, given once).

6) Another will perform intubation, place a breathing tube, by putting a metal blade into the mouth and sliding a plastic tube down the throat and into the airway, then secure it with tape. It’s a thousand times harder than that description makes it sound.

7) Moving a cardiac arrest patient to an ambulance is a theatrical production of its own. The medics will bring a stretcher to the front of the house and, if there are no steps or just one or two, into the house. If there are steps or the patient is upstairs, they’ll grab something called a scoop stretcher, which is a metal carrying stretcher that literally breaks apart, “scoops” under the patient, and then they’ll be strapped down (with the cardiac monitor and oxygen tank), and carried down the stairs. The scoop will likely just stay under them for transport, because taking it off with all that stuff strapped in is a pain in the ass.

8) The beatings CPR and bagging will continue until morale the patient improves.

You ultimately wanted the resuscitation to be successful. So let’s have it be successful. At one point during a pulse check someone should, in fact, find a pulse! This can happen on the scene or in the ambulance, up to you.

Once pulses come back, they might – actually will probably – need to give a drip of a vasopressor like Levophed (norepinephrine) to maintain a blood pressure.

Alternatively, you could have them go to the ER, and have the ER put them on a type of heart bypass called ECMO, which will do the circulaty bits for them while the heart itself recovers. This is, again, the super high tech road, and involves putting some VERY BIG LINES into the leg and the neck.

Whew! That was a lot of work! And, if you’re following your EMS characters, they’ll be sweating, tired, etc. – it’s pretty back-breaking. 

I hope this gets you down the right road!!

Oh, one note: you say once the Paramedics arrive, but it’s actually just once the paramedics arrive. Professions aren’t capitalized unless they’re being used as part of a direct call-out of a particular person’s name; for example, Scripty is a paramedic, but you might refer to her as Paramedic Scripty (the same way Jackie is a nurse, but she might be Nurse Jackie). Capitalization FTW!

xoxo, Aunt Scripty


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