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NYC 911 System – Sat night 21:00 – 09:00
I had two "good" calls on Sat night
16 y/o female, pedestrian struck by a cab. Unconscious with agonal respirations. Paddles applied shows sinus tach at 174 but no palpable carotid or radial (PEA?). CPR performed for approx two minutes and faint pulses felt. We arrived same time as BLS, we were on scene for under 5 and had her in Belleview in about 12 minutes from going on scene. Attempted to intubate but unable due to blood and vomit (preceptor). Our brief exam revealed a flail chest (could I have done that with cpr?), distended abdomen, bruising to tib/fibs and ankles. I was asked to bag the patient in the ER so I got to observe them put in two chest tubes as well as the rest of the trauma team workup. (Got to watch an abdominal ultrasound with a Sonosite Titan) She was off to OR within 20 minutes of our arrival. Checked back later and her biggest problem seems to be an ICP of 35 and a probable Diffuse Axonal Injury. Not good, even if she makes it…
2nd call dispatched at 02:50 for an unconscious lying by his car. Talk while enroute was of a probable intox or OD. Arrive on scene at parking garage and told that vehicle was seen driving in at around 02:00 and he was found lying next to the open drivers door of his still running vehicle at around 02:40.
As we ran up the ramp we could see an elderly male lying on the floor looking everything like an arrest, as we got closer though we could hear loud snoring respirations. Assessment reveals HR 48 regular, respirations of 24, GCS 3, Pupils fixed and dilated, no obvious trauma. Loaded him into bus and worked out the differentials. Dilated pupils and Tachypnea – Not an opiate OD, Glucose at 79 so not likely that either. BP at 220+ with fixed and dilated pupils – likely a massive CVA. (We did not have time to do a 12 lead EKG)
I asked if I could intubate, I was told that I have one try. He was breathing so everything was moving and I didn’t get a good visual but tried to aim for where I thought it was but I didn’t push it far enough in. I wanted a second shot but we were at the hospital and he didn’t let me (I consoled myself later when I saw the resident take 10 minutes and a bougie to get it done)
At Belleview again they worked up a stroke code and Dr Chung literally forced us to stick around for the results of the CT. He spent quite some time with us going over the pedestrian struck patient’s CT and then again when the results of the second CT came back. Massive intracranial bleed – ventricles entirely filled with blood – also not good for this guy. If any of you meet this Dr just hang on to him, he really treated us like part of the team and explained and showed everything.
Other than that we had 1 Anxiety, 1 A fib (who vomited all over me) and 1 severe chest pain (probable gall stone per ED staff) Wind chills under 0 degrees F all night.
Good stuff
