Lost and Found

Why not Velcro? The thought occurs to me once again, in this urgent moment. I'm fumbling with the zippers on top of the red oh-two kit, knowing the woman on the carpet needs to be ventilated. Right now. I've pulled the oxygen cylinder from the compartment in the kit, spun the valve on the regulator open. I'm ripping open the plastic bag containing the bag-valve mask, but the tubing is secured with a "quick release" tie that does neither. Randy has started compressions, but my world is reduced to this act of wrestling with the equipment in my hand.

The paramedics arrive right behind us, kits in hand. "Get oh-two and a BVM going!"

The BVM is finally assembled, and I'm trying to get air into our patient's lungs. Her head is between my knees on the stained carpet, and I am holding her head back and up, to straighten her throat, forcing the mask against her face with my fingers. Her cheeks are puffing out with each squeeze of the bag, but I see no chest rise under Randy's hands.

The same medic wants to know if she's getting air. "Randy, hold off for a sec, I want to see if this is working." He rears back from her chest, I squeeze the bag, her mouth inflates, nothing's getting in. Crap. "I need an OPA!" The oropharyngeal airway is the quickest way to get the air past her tongue, to her trachea, before one of the medics gets to the task of tubing her. Randy is pumping her chest again.

Off to my right, I see Brian, our newest medic, the man running this code, twist and pluck something from his kit. Engine 43 is on scene for manpower, and he hands Mike the OPA kit. After ripping the zipper open (another zipper), Mikes's comparing the length of an OPA against her jawline, ensuring we use the best size for her anatomy.

I open her mouth to find toothless gums. Ah, shit. Dentures? I scoop my gloved finger into her mouth, but her false teeth are not there. I imagine them bobbing in a glass of water beside the bed where we found her. I'm holding her mouth open like a trophy trout, and Mike is twisting the OPA into place, past the back of her tongue. The tabs are supposed to rest against her incisors, keeping the device from sliding deeper into her throat, but without teeth, it will just float in place. Good enough.
Randy's watching us, and pauses his chest compressions long enough to verify the tell-tale rise of her chest when I squeeze the bag again. I can literally watch the pure oxygen inflating her starving lungs. "Good air!" I announce to everyone.

I look around, timing the delivery of life-saving breaths to Randy's rhythm from the corner of my vision. Brian is almost done with the IV, and Eric, the other medic, has already slapped the patches on her chest, is taking a 12-lead, a recording of the this woman's heart's electrical activity.

Two minutes

Eric analyzes the patient's cardiac rhythm. We all cease what we're doing and move back from our patient, isolating ourselves from her. The monitor indicates that a shock is warranted. "Shocking." Her body barely twitches when he pushes the button. "Resume CPR." We start our second round.

Brian finishes hooking up the IV, and moves to the head, Eric pushing a syringe of drugs into the port on the plastic tubing. "Stop bagging, I'm getting the tube." He has the laryngoscope in one hand and an endotracheal tube and stylet in the other. He rips open the stylet package, inserts the flexible wire into the tube, and lays at her head, on the living room floor, on his stomach. He quickly shapes the tube into a graceful curve, the inserted wire holding the shape. Brian cranks her mouth open, the blades of the scope slips past her tongue.

He's looking through a fiber-optic eyepiece. "Cords!" I've never heard this announced by a medic inserting a tube, but I assume he sees her vocal cords, a critical factor in the successful placement of an ETT. It's in and Brian is trying to pull the stylet out of the tube, but his fingers are slipping on the plastic, threatening to pull the whole thing back out. I grab the loop of the stylet, as he holds the tube with both hands, and the wire comes out easily. A syringe inflates the cuff at the tip, and it's in.

Before the BVM is connected to the tube, Brian slips a short collar over the end. This collar is connected by a long, spaghetti-like hose to the monitor, screwed into the capnography port. The monitor generates a wave form, either on the screen or a printed chart, allowing the medics to observe their interventions' effects on the respiratory efficiency of the patient. The bag-valve assembly slips onto the collar, and I commence squeezing. Brian borrows my stethoscope, verifies that the tube is properly place.

"That's two minutes." My captain is timing this code with my watch's second hand, the clasp of which I had struggled to release through my glove. It's on a doily-draped table, and he's been glancing at it, between notations on the patient report.

Four minutes

Brian calls to stop CPR. "Check for a pulse."

Several arms reach for the woman's neck, competing for the task of palpating her carotid artery. Randy wins, "I've got a pulse..." His fingers rest a moment on her throat. "Sixty-four."

Eric turns to address the husband, perched on the couch across the room. He was in the kitchen, hyperventilating, when we arrived, and I don't know how or when he moved past us, to his current vantage point. "Sir, we have a pulse!"

"Is that good?"

"Yes, my friend. That's very good."