Time flows differently in crisis
Feb. 18th, 2015 02:36 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
lydyFriday, the thing we all pray will never happen happened.
I was in the bathroom at the time. I hear Todd yelling the patient's name repeatedly. We don't yell, in the sleep lab. We want people to, you know, sleep. So, I quick wash my hands and run out. I don't remember if I ran to the patient's room first, or the control room. Any gate, I was in the control room (and time is jumping around, all ready, not really marching by at a minute per minute pace), and Tim is on the phone, clearly talking to 9-1-1. I didn't stay to hear what he said. Instead, I note that the AED is still in its cubby. I grab it, and the backboard, and go into (return?) to the patient's room.
The patient is a big man. He's breathing, snoring. But he is very much not responding. Todd is rocking him back and forth roughly, and shouting his name, and there's no response. I say something about having the AED, and start to try to find the pads. I gather on the recording I can be heard to say, "Where are the fucking pads?" What I remember is that I don't clearly remember where the pads are, I know there in the back, somewhere. I open the zip compartment, and things go flying out. None of them are the pads. I take the AED out of its holder (this was an unnecessary step) and I don't remember who it was that pulled the drawer-like thing on the back of the machine open, and then there are the pads. They are both on a single strip, and I decide that we need to cut them apart. I don't know why I thought this was necessary, but it didn't take much time.
Then, I'm staring at the pads. They don't have words on them, just pictures, and I'm having the devil's own time deciphering the pictures. I probably would have done better with words, but would still have had the problem of left and right, like I always do. Todd, meantime, has figured out which go where. The patient is fortunately not wearing a shirt, so it's easy to apply the pads. We get that done. I push one of the buttons on the AED, obviously the wrong one, then I push the correct button.
The AED says to stand clear, then it says that it advises a shock. I push the correct button. There is a pause where it advises us to stay clear, and then it administers the shock. It looks just like on the television, but not quite as dramatic. Nevertheless, there is the characteristic jerking movement. The patient continues to breathe and snore. This strikes me as a bit odd, I wasn't aware that people could breathe while their heart isn't beating. His tongue is swollen, slightly purple, and protruding from his mouth. One eye is half-open and glazed. I think, "He looks dead."
The AED advises compressions. We try to get the backboard under him. Todd tries compressions. This isn't working, we try to get the backboard more completely under him, Todd attempts compressions again, this still isn't working. "We have to get him off the bed," Todd says. I say, "You take his shoulders, I'll grab his knees."
We dump the patient onto the floor by the bed. We were as gentle as we could be, I think, but I think there was a thump. Time is moving in odd spurts, fast then slow. There's very little room next to the bed, and Todd can't really get a good angle to do the compressions. I say, "Here, I'll raise the bed." The room has a Murphy bed, so I flip the bed up to give Todd more room. This works ok, but there's some stuff on the bed that gets in the way, so that the bed doesn't stay up. I have to hold it in up while Todd does compressions. He stops when the AED tells us to, and then it tells us to continue. I offer to do compressions, but Todd just starts them up again. Todd is stronger than I am and has more wind, so this is almost certainly the correct choice.
At some point in here, Tim comes in and says that he's going to go open the doors for the EMS people. I say, "Give me the phone. No, no, just throw it," and he throws it in my general direction. It would have taken too long for him to come into the room, step around the patient, is what I'm thinking...insofar as I'm actually thinking.
Todd stops doing compressions. I say, "No, no, don't stop. The machine will tell you when to stop." But Todd has noticed signs of consciousness. The patient responds to the question, "Do you know where you are." He's not able to articulate clearly, but his attempt to say, "Sleep lab," is understandable, although very slurred. At some point shortly after that, there's a cop. And then, at some point after that, I go down to the main doors to wait for the third wave of emergency responders -- the EMTs with the gurney are already there. At some other point, I did check on the welfare of the other patients still in bed.
When things are quiet, again, I go in to clean up the room. There is shit every fucking place. I know that some of these things I, personally, threw about. There are bits of things in all four corners of the room, the room is strewn with detritus. Time is finally back to the one minute per minute thing, and that's a relief.
They tell you that these things are chaotic. But it's hard to describe. When I describe it, I can't help but do so in a linear fashion. It does not feel linear at the time. Some moments, it feels as if time has piled up on itself and that I am having several different moments all at once. Other times, there's a weird pause, as if everything has stopped, including me. These moments did not give me time to think, they are the moments where thinking has stopped and I am just hang in a bubble of no time. There are moments which seem incredibly long, waiting and waiting. I found myself moving in and out of panic, as if it were a space that I had to keep on crossing.
This was a victory. He lived. He was conscious and answering questions by the time the EMTs got there. If this had happened at home, he very likely would not have lived. I found out later that Todd had initially assumed that what he was looking at was a bad wire, not cardiac arrest. Yet even so, from the first arrhythmia to the EMT people taking the patient away, it was 10 minutes. We know because it was on the record, and my boss reviewed the recording and timed it. That's pretty good. We made mistakes. There were various times where one of us was not doing the right thing and someone else stepped in and did it. This happened to all of us. I am very grateful there were three of us on shift that night, that made it so much easier. Not that it was easy. But we did it. We managed. And he lived. And I really hope I never have to do this again.
I was in the bathroom at the time. I hear Todd yelling the patient's name repeatedly. We don't yell, in the sleep lab. We want people to, you know, sleep. So, I quick wash my hands and run out. I don't remember if I ran to the patient's room first, or the control room. Any gate, I was in the control room (and time is jumping around, all ready, not really marching by at a minute per minute pace), and Tim is on the phone, clearly talking to 9-1-1. I didn't stay to hear what he said. Instead, I note that the AED is still in its cubby. I grab it, and the backboard, and go into (return?) to the patient's room.
The patient is a big man. He's breathing, snoring. But he is very much not responding. Todd is rocking him back and forth roughly, and shouting his name, and there's no response. I say something about having the AED, and start to try to find the pads. I gather on the recording I can be heard to say, "Where are the fucking pads?" What I remember is that I don't clearly remember where the pads are, I know there in the back, somewhere. I open the zip compartment, and things go flying out. None of them are the pads. I take the AED out of its holder (this was an unnecessary step) and I don't remember who it was that pulled the drawer-like thing on the back of the machine open, and then there are the pads. They are both on a single strip, and I decide that we need to cut them apart. I don't know why I thought this was necessary, but it didn't take much time.
Then, I'm staring at the pads. They don't have words on them, just pictures, and I'm having the devil's own time deciphering the pictures. I probably would have done better with words, but would still have had the problem of left and right, like I always do. Todd, meantime, has figured out which go where. The patient is fortunately not wearing a shirt, so it's easy to apply the pads. We get that done. I push one of the buttons on the AED, obviously the wrong one, then I push the correct button.
The AED says to stand clear, then it says that it advises a shock. I push the correct button. There is a pause where it advises us to stay clear, and then it administers the shock. It looks just like on the television, but not quite as dramatic. Nevertheless, there is the characteristic jerking movement. The patient continues to breathe and snore. This strikes me as a bit odd, I wasn't aware that people could breathe while their heart isn't beating. His tongue is swollen, slightly purple, and protruding from his mouth. One eye is half-open and glazed. I think, "He looks dead."
The AED advises compressions. We try to get the backboard under him. Todd tries compressions. This isn't working, we try to get the backboard more completely under him, Todd attempts compressions again, this still isn't working. "We have to get him off the bed," Todd says. I say, "You take his shoulders, I'll grab his knees."
We dump the patient onto the floor by the bed. We were as gentle as we could be, I think, but I think there was a thump. Time is moving in odd spurts, fast then slow. There's very little room next to the bed, and Todd can't really get a good angle to do the compressions. I say, "Here, I'll raise the bed." The room has a Murphy bed, so I flip the bed up to give Todd more room. This works ok, but there's some stuff on the bed that gets in the way, so that the bed doesn't stay up. I have to hold it in up while Todd does compressions. He stops when the AED tells us to, and then it tells us to continue. I offer to do compressions, but Todd just starts them up again. Todd is stronger than I am and has more wind, so this is almost certainly the correct choice.
At some point in here, Tim comes in and says that he's going to go open the doors for the EMS people. I say, "Give me the phone. No, no, just throw it," and he throws it in my general direction. It would have taken too long for him to come into the room, step around the patient, is what I'm thinking...insofar as I'm actually thinking.
Todd stops doing compressions. I say, "No, no, don't stop. The machine will tell you when to stop." But Todd has noticed signs of consciousness. The patient responds to the question, "Do you know where you are." He's not able to articulate clearly, but his attempt to say, "Sleep lab," is understandable, although very slurred. At some point shortly after that, there's a cop. And then, at some point after that, I go down to the main doors to wait for the third wave of emergency responders -- the EMTs with the gurney are already there. At some other point, I did check on the welfare of the other patients still in bed.
When things are quiet, again, I go in to clean up the room. There is shit every fucking place. I know that some of these things I, personally, threw about. There are bits of things in all four corners of the room, the room is strewn with detritus. Time is finally back to the one minute per minute thing, and that's a relief.
They tell you that these things are chaotic. But it's hard to describe. When I describe it, I can't help but do so in a linear fashion. It does not feel linear at the time. Some moments, it feels as if time has piled up on itself and that I am having several different moments all at once. Other times, there's a weird pause, as if everything has stopped, including me. These moments did not give me time to think, they are the moments where thinking has stopped and I am just hang in a bubble of no time. There are moments which seem incredibly long, waiting and waiting. I found myself moving in and out of panic, as if it were a space that I had to keep on crossing.
This was a victory. He lived. He was conscious and answering questions by the time the EMTs got there. If this had happened at home, he very likely would not have lived. I found out later that Todd had initially assumed that what he was looking at was a bad wire, not cardiac arrest. Yet even so, from the first arrhythmia to the EMT people taking the patient away, it was 10 minutes. We know because it was on the record, and my boss reviewed the recording and timed it. That's pretty good. We made mistakes. There were various times where one of us was not doing the right thing and someone else stepped in and did it. This happened to all of us. I am very grateful there were three of us on shift that night, that made it so much easier. Not that it was easy. But we did it. We managed. And he lived. And I really hope I never have to do this again.
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no subject
Date: 2015-02-18 09:54 am (UTC)(Am reminded that I'll be doing my First Aider's refresher course next month. I hope never to have to employ those skills but if I do, I hope the outcome is as positive as yours)
WoW!
Date: 2015-02-18 11:32 am (UTC)no subject
Date: 2015-02-18 03:06 pm (UTC)*hugs*
no subject
Date: 2015-02-18 04:34 pm (UTC)It came out very well.
You should be at least pleased with yourself if not proud.
I know I am impressed.
no subject
Date: 2015-02-18 04:37 pm (UTC)Totally makes sense that Todd thought the machine wasn't working, rather than the patient's heart. If you get wonky data due to bad wires on at all a regular basis, he's going to freak out the next 20 times he sees an anomalous reading, thinking it's another heart attack.
Anyway. It sounds like you did really well by this guy. He lived! You're right, it's super unlikely he'd have lived if this had happened to him at home.
(And. I had no idea people could breathe if their heart wasn't beating.)
no subject
Date: 2015-02-18 06:27 pm (UTC)I have a friend who's been an emergency responder, and her descriptions of several incidents in which she was actually involved rather than turning up later -- a car crash where she had to get her passenger out of the car, stuff like that -- sound really remarkably like your description of the general state that the brain and one's reactions get into.
P.
no subject
Date: 2015-02-18 07:00 pm (UTC)I also have to say that it sounds like the boys, especially Todd, were where they should be, doing what they should do.
no subject
Date: 2015-02-18 07:12 pm (UTC)no subject
Date: 2015-02-19 12:20 am (UTC)no subject
Date: 2015-02-19 12:37 am (UTC)no subject
Date: 2015-02-19 01:10 am (UTC)Yeah, the breathing and snoring thing seems weird to me, too. I don't think I would have thought o use an AED on someone who was breathing (and snoring) but otherwise unresponsive. Thanks to your write-up of the experience, I now know a bit more about gasping, "agnonal respirations," and breathing patterns during cardiac arrest in general. I hope I never need to remember this newly-gained information. And that you never have cause to pull the AED from its cubby again. At least, not in a crisis.
no subject
Date: 2015-02-19 03:35 pm (UTC)no subject
Date: 2015-02-19 06:00 pm (UTC)can sometimes kick start a heart.
continuing with the compressions was entirely
the best thing to do.
its when having people to switch off turns helps
he'll get a pacemaker that he needed in the first place
its amazing what a body can go thru
and keep on going.
other times its a poof, wtf?
you did good.
there are kinesiology exercises that
you can do that will help you.
untangle the nerves short circuiting into dyslexia.
when mom had her stroke i found out
when i stress i loose fone numbers .
Mom was an O.T. you in find the exercises
at "http://braingym.com" but you can do a google search
and find them on u-tube- PACE is the first set that
helps connect the 2 sides of the brain efficiently .
BUT really YOU did good
You did what was needed
and he lived.
and will do well next time,
being in the sleep lab
its unusual you don't find this happening more often
because its sadly very common .
many folks that wake up with an adeline rush and soaking wet
do because that's how the body restarts after the heart stops.
_my dads long term problem he needed his pace maker for years,
Great JOB! you did it!
gentle hugs(virtual ones don't hurt)
no subject
Date: 2015-02-19 02:17 am (UTC)no subject
Date: 2015-02-19 07:01 pm (UTC)