A friend of mine recently asked me what were the worst jobs for me personally. I told her that it was anything involving really sick kids or grieving parents. I still struggle to actually talk about some of these jobs but I told her I'd write something about one of them here.
Driving along, coffee in hand chatting happily to my partner. Bamm. The radio announces that job I had most been dreading. A paediatric arrest. A 2 year old child, put down to sleep and found pulseless and non breathing a short time later. We discussed on the way to the job who was going to do what, and as I had managed the airway at my last (adult) cardiac arrest it was C for circulation for me this time. My partner and I were both secretly praying MICA or another crew would get there first. They didn’t.
We arrived at the same time as an MFB (Fire brigade first responder) crew who were 10 steps behind us on the way in – mum was at the door looking strangely calm as we walked up and were led to a kid’s bedroom. There was dad doing CPR on a tiny little body on the floor. Oh Crap this is a real one. Pucker factor of about 10/10. I felt physically sick. A microsecond pause as we both took in the scene before us and then it began. My partner quickly had airway under control, suction, then in with one of those tiny plastic OP airways you hoped you would never need to use, baby bag-valve-mask and some O2 flowing in. No pulse could be felt or heard, damn. … one of the fireys was asked to begin CPR. Sit rep to the other cars that were coming… “confirm full arrest”.
I was desperately calculating the joules in my head in case we had to defibrillate her as I cut the Little Mermaid pyjamas off and put the paediatric defibrillation pads on the tiny pale body. Mum and dad are just outside the room and that horrible noise I can hear is a mother in the worst kind of pain I can imagine. I dare not look at her as I’m not sure I’ll be able to hold it together. The monitor shows a sluggish EMD bradycardia at about 15 bpm. This kid looks just like child of a friend …don’t think about that…Concentrate. More CPR, some attempts to get a history of what had happened, a pause …. asystole on the monitor. CPR again… Return of the bradycardia at about 20 bpm.
MICA arrived. Thank god. Tears of relief welled up in my eyes and I had to blink them away and focus on what we were doing. Handover was a blur. Next thing I was prepping a bag of fluid, drawing up some adrenaline and pleased not to be making the hard decisions anymore. Intubation was tricky but the guys did amazingly well with the tiny airway. I notice the MICA guys hands are shaking too. Another ambulance crew appeared and began talking the parents through what was happening. I sent someone out to get more oxygen from the car, then swapped out with the firey and began doing CPR as MICA tried deperately to get IV access.
Drugs, CPR, pause, more CPR, check the monitor… 30 then.. 40 bpm….
Come on -I’m willing the monitor to show more beats. CPR again, I look at my watch… we’ve been at this more than 30 minutes already. More CPR…then suddenly the rate on the monitor begins climbing…A pulse at last....We all work together and get ready to go, I slip my hands under her little back and scoop her up in unison with the other guys. So many hands holding so many tubes, wires and fluid. We all shuffle for the front door. Onto the bed and the heart rate is now 130. Still no sign of any breathing and we quickly load, breathing for her as we go.
We drive the MICA guys, the girl and her almost catatonic parents in to the hospital. Sitting next to her mother in the truck I can’t find any words to say, I feel useless. Come on…say something. I can’t even comprehend what she must be going through. I just try to explain what is happening - I don't know if she is hearing me. Into the trauma room, we give handover and suddenly my part in all this is over. I hear someone in the hallway say they don’t think she’ll make it. I know they are probably right. I head back out to the car to write my case notes, there is a huge lump in my throat and I feel like dropping my bundle – not now, that can wait til I get home.
10 comments:
I don't know how you handle these types of cases. Since becoming a mother, something like this happening to my little boy has become my worst nightmare.
Was the little girl alright in the end, do you know?
Sadly no. I was told she never regained consiousness or began to breathe on her own. Her parents made the agonising but inevitable decision to stop the life support a couple of days later.
Oh how sad. Her poor parents :(
Crap job mate - know how you feel - I did one similar, but with a 9 month old that looked like a 6 month old because she had been a premature baby.
I was working on an ambulance then, and the guy on the FRU came runnong out with a very blue baby in his arms as we pulled up. Sadly that one died too.
The ambulance service is a very rewarding job, but when it gets shitty, it gets shitty big time.
I have just been reading all your posts and will regularly check back for updates.
You sound like a top bloke who really cares about your patients.
Keep up the good work!
Dreadful situation well blogged.
Good to find an Australian emergency services blogger.
Dang... That's a heck of an "introduction" for a new reader (from the US here)! Found you via Eyes of an EMT. Crappy outcome for the kid, but outstanding writing.
Paramedic in Scotland, there is not much you can say. Sounds like you guys pulled out all the stops and gave the parents time to say good bye and make the decision. well done for your part and sorry about the outcome. thoughts with you.
Thanks for all your comments - really appreciated I can tell you!
Medic - I've just posted a basic overview in reply to your question.
Yeah Patrick we have a pretty good support crew here, they were actually waiting for us when we got back to branch.
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