The Nursing Home Series [1]
by

Too late now
Yes, yet another nursing home call.

I was a new EMT riding on basically my first call as a full-out EMT. Dispatch was to a local nursing home for difficulty breathing. So we trot in with oxygen and our jump kit. I'm first in the room, and find a staff member doing one man CPR on an elderly gentleman in the bed. Watch him bounce up and down!

So, I turn around and ask for "defib, suction, Reeves, now!" We managed to remove the nurse from the patient and get him on the floor. The BVM was attached to an oxygen concentrator at 4 LPM, which we quickly corrected, then continued CPR.

About the time we got our defib hooked up, the medics turn up. So now we're doing CPR, and they're doing the monitor and drug thing. After a couple of minutes, the medic in charge says "check for a pulse". So I do. Lo, and behold, he's got one at the carotid, and a nice radial to boot. At exactly the moment I look up and say "He's got a pulse", the charge nurse walks in and says "He's a DNR."

My answer to the nurse was "Too late now, honey!"

Philip Goldsmith



Nurse? Doctor? from Jim Easley
Unfortunately I have been on the same type of "Code Blue" except in the hospital. I was working as a nurse in an ICU in a hospital-when two nurses ran out of a room across the hall screaming "CALL A CODE, CALL A CODE!!!" A pulmonary Dr. (who was discharging my only pt.) and I walked across the hallway to the room to find the pt. unconscious, apneac, and pulseless on the floor. Just him, the Dr., and me. The Dr. pulled rank and started doing chest compressions despite my vigorous protest that since he was a board certified pulmonologist he should be the one responsible for the pt's airway. (no crash cart in room, pre-HIV) so guess what? You got it I did the lip-lock maneuver (mouth to mouth). 3 minutes go by and the Doc and I were getting very lonely when the door opens and the room fills up with nurses, nurse aides and no crash cart. We ask for a crash cart and suddenly we are alone again. The Dr. still refuses to do ventilations so I go back to the lip lock.

The crash cart arrives under a full head of steam. I know this because they ran it over the Dr.'s leg. The Dr. asks for an E.T. tube, laryngoscope, and a stylet. I watch in horror as the house supervisor opens the respiratory drawer and starts throwing things out the door looking for what the Dr. requested. I manage to catch a tube as it flies by and the Doc does a tactile intubation and R.T. starts to BMV the pt.

The Dr. gets up off of the floor to survey the scene when the house supervisor decides there are too many people in the room, grabs him by the back of his belt and drags him out the door. I grab him and drag him back into the fray-mean time the pt is actually getting bagged and compressed by R.T. and a nurses aide, but the three other nurses are fighting over who is going to document. From the door way the Dr. suggests the pt. be hooked up to the monitor and if it is not too inconvenient, maybe an IV can be started. The house supervisor starts looking for a tourniquet and removes the one I am using to start an IV to start an IV on the other side. The pt. is finally hooked up to a monitor and is in V-fib. The pt. is defibbed successfully when the charge nurse dashes into the room and yells, "stop the code he is a DNR." At that point the Dr. offers to pull the tube and get the hell out of there. The E.R. Doc finally arrives (he was putting in a chest tube in the ER-so he had an excuse) takes charge of the pt. who is finally admitted to ICU and is discharged 7 days later.
Stay safe? Jim Easley




The Arrested Liver
Went to a nursing home for a "full cardiac arrest, CPR in progress." Was just around the block, and was on scene in about 45 seconds. Grabbed the jump bag, monitor, and O2, ran up the three flights of stairs, and looked for the room. A nurses aide pointed me down the hall, where I found a patient on the bed, one nurse standing beside her (the pt.) hips, doing compressions (rather like abdominal thrusts, but I'll get back to that), and another nurses aide trying to bag the pt whose head was turned away towards the door, rather than in a sniffing position. One singular RN was overseeing the whole thing, giving orders.

My partner asked what happened, as I was hooking up the monitor: "Well, we walked in, and she wouldn't open her eyes. She's got heart troubles, and she's also got sugar problems." (Nice, specific history....could be helpful) When did you start CPR, I ask. "About five minutes ago," they say.

Hmm....Look at the monitor...appears to be sinus with 1st degree AV block....that's interesting....hmm....

"Oh, Yeah," the nurse says, "we got some vitals signs for you." You did?, I think...shouldn't be any....."Her Blood Pressure is 132/78," (Good job doing CPR, for abdominal thrusts, I think), "And her PULSE IS 138." Uh...say that again? I ask...."Pulse 138," she says.

Hmmm....interesting. I tell the CNA to stop her abdominal thrust/chest compressions, and place the ol index finger on a carotid.....well, she's right. About 138. Pretty regular too. Partner has started the automatic B/P cuff, and it shows 130/80 or so. Well, now....

I pull the BVM off the face of my patient, her head rolls towards me, and with wide, pleading eyes, she stares at me and softly says .....


"Help."


Every test was negative except for a slight UTI....and a contusion to the liver.....from CPR.



Bagging = BVM
Been there, too...I walked into a room once and a nurse's aide was bagging the patient with a NonRebreather Mask at 4lpm... Squash the reservoir...wait 3 minutes while it refills...