"Pulse is erratic, Jay." I could tell from the look in my partner's eyes that she was really concerned, but she was always very concerned about her patients, sometimes concerned to the point that it drove her crazy. I took a look at the monitor and could tell that it was having a difficult time discerning the pulse rate, which was indeed indicative of an erratic pulse. The rate that it was indicating was fifty.
"We should be there in a minute," I assured her.
"Call Emily back," she said, shaking her head. I'd been partnered with Sam long enough to know to listen to her instincts. I picked up the phone again and dialed, and Emily picked up on the first ring. She must have been waiting for the callback.
"Pressure's dropping; pulse is erratic and dropping," I informed her.
"Push a half a milligram of atropine," she instructed.
Sam already had the atropine out and was attaching it to its special syringe. I took the syringe from her and squirted the medication directly into a port on the patient's endotracheal tube. Sam and I were both watching the monitor, and we saw the patient go almost immediately into tachycardia or rapid pulse. His heart rhythm had gone too far in the opposite direction.
"Oh, shit!" Sam said, voicing both our sentiments.
We felt the bump and light sway of the ambulance as we pulled into the hospital drive that led to the emergency entrance. As we pulled up outside of the big automatic double doors to the ER, someone opened first one ambulance door and then the other, and a blast of arctic air invaded the ambulance. ER personnel were already standing by to help with the stretcher, and they unhooked it from its stays and lifted it to the ground, while Sam carried the IV bag and I carried the monitor. Emily Evans was beside the patient before we got to the doors, asking me for a report as we wheeled the patient into the trauma room.
"We need a crash cart over here," Emily ordered. She didn't raise her voice at all, but her confident tone left no doubt as to who was in charge, and the crash cart, with its defibrillator on top, was quickly wheeled into place as she cut the guy's shirt open.
She took the paddles from their holders on the sides of the defibrillator and positioned them on the chest to get a 'quick look', whereby you get an ECG waveform through the paddles themselves without taking the time to hook up electrodes. We could see that his heart was in V-tach, or ventricular tachycardia, which meant that his heart was not pumping effectively.
"No pulse," Sam informed her after palpating the carotid artery.
"Let's shock him," Emily said. "Two hundred joules." I reached over and adjusted the dial on the defibrillator that controlled the amount of electricity released. "Clear!" Everyone took a step back as I hit the charge button and the machine whined up to power. Emily then hit the discharge buttons on each paddle simultaneously, and we watched the patient's back arch and his hands jump as the electricity was released into his body. We could see that there was no change on the monitor.
"Three hundred." I readjusted the machine and the process was repeated. Still there was no change. "Three sixty." Still no change. The patient was turning an ever-deepening shade of grayish-blue before out eyes, and his skin had a pasty look to it. Nobody commented, but I thought to myself that it didn't look good.
Emily palpated the carotid artery, and then opened his pants and palpated the femoral artery just above the hip. "No pulse. Begin CPR," Emily directed. Sam attached a bag-valve-mask to the end of the patient's tube and began squeezing it, and we watched his chest rise as the air was pushed in. I began doing chest compressions as Sam ventilated him.
We kept this up for several minutes, and then Emily administered epinephrine and shocked him again. Still there was no change. She administered lidocaine as we continued with the CPR. Still there was no change.
Another paramedic named Ella Robertson, who was just coming on duty to relieve me, took over the chest compressions as I got tired. We weren't going to lose a young man without putting up a hell of a fight, but the monitor was now showing no ECG activity at all. After a while, I took over compressions again, but after ten minutes, we still saw no improvement.
Finally, Emily stepped back, her face reflecting a mixture of both controlled frustration and resignation, and said quietly, "That's it. He's dead."