A really bad day at the office

The girl stood in front of our patient in the hall way and stared as if hypnotised as we did our job.  She must of been about sixteen.  Clutching at her legs were two other children aged possibly between four and six.  They too were staring – as only young ones do.  I caught the girl’s eye and tried to smile.

“You might want to take those kids away into another room my dear . . . they shouldn’t be seeing this eh”

Our patient lay sprawled out in a tight council flat hall way.  He was in cardiac arrest after suffering an asthma attack.  He was only nine years old.

Information on what had happened, and when, was limited to say the least.  No one seemed to know anything concrete.  A neighbour had eventually called us and when we finally arrived there was the inevitable chaos and confusion coupled with wails of disbelief and sorrow.

At this point your sphincter tightens to diamond crushing proportions.  You instantly curse yourselves for being first on scene and wish, almost sickeningly, that you’d been a bit slower.  But then, the training kicks in . . . in our case, bags flew open and kit went everywhere.  CPR commenced, pads were placed, back up requested and bagging started.

The boy’s asthma had caused his upper airways to contract so much we couldn’t get any air in with the BVM.  And we needed to secure the airway – fast.  Thankfully, help had arrived in the form of an FRU Medic and an A&E Support crew.

The time from now up until when we left scene was almost a blur.  Marvin and the A&E Support crew circulated the chest compressions between them whilst the FRU and I completed the advanced skills of intubation, chest decompression, IV access (via the tibia) and finally advanced drugs.

It was then time to go!  All the time we’d been on scene there hadn’t been an output for our patient.  They had remained and this only highlighted our need to get going.  Under “normal” circumstances with an old patient we might stay on scene and eventually ‘call it’ if they remained asystolic.  But not with a kid . . . never with a kid.  Once the airway is sorted and drugs in place – you go!

At hospital the resuss department were ready as we burst through the doors.  And after we’d handed over we stayed and helped whilst their best team of Doctors and nurses continued to work on him for another 45 minutes.

But sadly, it wasn’t meant to be.  Not this time.  The main consultant in charge, after getting the agreement from everyone about calling it, looked up at the clock.

“Ok, time of death . . . 22.50”  At that moment, some tears ran down her cheek.

There was silence.  More so than there had ever been with a death of this sort.  I looked around at everyone and noticed that others were equally upset.  It was then a nurse quietly pointed to the bay right next to this one.  Glancing through the curtain I saw another child of a similar age, lying dead on the bed.  The nurse whispered in my ear . . .

“We’d literally just finished working on this poor boy when you came in with yours . . . ”

That lump that grows in your throat at these moments?  Well, a large one started growing in mine right there and then.  I moved back out of the way and let everyone clean up so that the relatives could come in.

After walking back outside I caught up with the others to do paper work.  I told them what I’d seen and there was a few moments of silence.  The FRU summed it up poignantly though,

“Poor sods.  That’s what you call a really bad day at the office.”

Binder

 

 

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 Asystole – A “flat – line” rhythm of the heart.  All electrical output has ceased and the prognosis for the patient is generally not good.  You cannot shock this rhythm as there is nothing to shock.  The sound you hear in films (the long continuous beeeeeeeeep) is best associated with Asystole – but unlike the films you don’t shock the patient.

2 thoughts on “A really bad day at the office

  1. Heck, tough one. I feel for you all there!

    It’s amazing how many people we meet who still down-play asthma but it just goes to show…

    Question: Why IV access via the tibia?

    • He was a large lad so normal cannulation was nigh on impossible. So we (sometimes) have access to intra-osseous “drills” which we then gain access by drilling straight into a bone. In this case, the proximal tibia

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