Saturday, January 9, 2010

Sometimes it works

Nothing under the scope of emergency medicine is as exciting or dreaded as a full arrest. It's something we train for regularly with CPR classes, AED practice, and extensive analysis and practical skill time in EMT classes, but it's a comparatively rare call. In my experience, you've got around 70% of your medical calls coming from real emergency problems that don't even progress to the point of unconsciousness (diabetic problems, breathing difficulty, and chest pain/heart problem), 25% from non-emergencies (over-concerned parents, hypochondriacs, and poorer people with a small problem who don't know any other way to get medical help), and the last 5% are the adrenaline boosters. That's your severe trauma, or catastrophic medical call, and even out of those I'd say that only 1/4 end up in a full code (CPR, AED, intubation).

However, even noting how rare they are, I've worked on enough to know how they generally go. Check vitals, start CPR, apply AED, intubate, pronounce them dead and allow the police to take over. It's a sad reality, but most of the people we do CPR on don't come back. It's not because we're doing it wrong, it's just because they're usually too far gone. I know people who have been running calls for years who have never had one of their CPR patients end up being saved. Given how all the patients I've worked on have fared so far, I was willing to bet I was going to be in that same pool of people.

Until 12/31/2009.

On that day, I was lucky enough to be performing CPR on a man who did not die immediately thereafter, and I have to tell you that it was invigorating. I was suprised beyond speech because I had just never seen anything like that happen. We showed up and he was grey and cold, no discernible pulse. By the time he was in the ambulance he was awake. A new years miracle.

But what I found most interesting was not the play by play re-enactments, although those are fun. What I continue to think about even today, over a week later, is the reaction we all had afterward. "Great job in there", we say. "Nice work". As though it were through our superior efforts that this man was brought back to life. As though we were so incredibly skillful on this day that our will and talent alone carried him back from the grave.

In truth, we did nothing different or more for our patient that morning than we had done for many patients before. Same pattern, same rhythm, same tools, even most of the same people. The difference was the patient. His body wasn't ready to go, and it responded to our efforts as others hadn't. If anyone were to be congratulated, it was our friend with the IV in his arm for having such a resilient body.

And within that truth lies the reason behind our training. We train for hours and hours every year on the proper sequence for a full arrest, knowing that most of the recipients will never benefit from it. It's only in the knowledge that every so often, every once in a while, there's that one person who's not QUITE so far gone yet, and he deserves a chance to come back. This week we found that person, and it's made me that much more willing to try just as hard on every man down hoping to find another one.

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