Nursing Homes... again
by

I believe all of us have these as our own personal nightmares. Lately, the last few "Cardiac Arrests" have been interesting to say the least. One in particular comes to mind though. My partner and I have been working togehter now for approximately 3 months now. We have a nursing home that the numerics 450 and 500 are the same outfit but, different departments. 450 is the extended care facility and 500 is the independent living side. They are locayed on 2 different driveways (keep this in mind) 30 sec drive apart. When a dispatch in the late evening (23:00 Hrs ballpark) for Respiratory difficulty came in we thought nothing of it. My partner and I had a dispute on what the dispatcher said when we went responding but, the repeater on our pagers proved me wrong (Ok. no biggie). We arrived on scene and could NOT get in.... we rand the doorbell, banged on the window/doors but no responce. You'd think someone would be aswering if they wanted us. After a few minutes my partner calls dispatch to find out what's up with a call back. Guess what? wrong address given by dispatch. We quickly relocate the 30 sec drive to the "right place" and after gaining access a CNA I believe, in a very calm manner calls to us and walks us to the room's direction. As we round the corner I catch nurses ans CNA's frantically running in and out of the room. I overhear someone say "good... the medics are here!". As I pop my head in the door way I find myself witnessing CPR in progress.... (I'm thinking... awww s#^t). I turn to my partner and start asking for things and directing him for monitor and spiking a bag. Pt's airway has the classic "coffee ground" vomitus present. I asked the staff for their suction and behold it doesn't work! My partner runs out and gets ours from the rig outside, gets a backboard and instructs our other ALS unit (that's relocated for our vast territory) to respond to the scene. We get her intubated and I see asystole x3 leads. Ok cont. CPR down time I'm told is less than 10 min at this point (including dispatch). I go to start an IV as my other units Medic a/o/s. Guess what... she has an IV in already a 22. I think great but, as we pushed EPI it infiltrates (F### Me). My other ALS partner starts looking for another site while our EMT's are pumping and bagging (we kinda pushed the nursing staff out by this time). We each try 2 times in the ACF's, EJ's and nothing. Almost as if she had no blood to give. We put a few more rounds down the tube as we cont. CPR. We decide time to move Pt to litter. As we relocate her off the CPR board of the home to our back board we see at least 500 cc's worth of the "coffee ground" vomitus under her shoulder blades (what the HELL!). The Emt's look at us ALS providers for direction. She and I look at each other and agree.... CALL THE DOC. We give report to her and she okay's stopping all efforts based on findings. The best part was... She was a DNR.... It get's even better... she had been sick for several days with this "coffee ground" vomiting and been on medication. Pt's physician had been in the afternoon doing a "housecall" and Pt requested to change her DNR to "full code" 12 Hrs prior to her expiration. Get this at 90 something she wanted "to experience everything in this life" .... including CPR !!!!