We were sent for an “External Hemorrhage” which is usually either a dialysis shunt rupture or a varicose vein rupture. 99% of the time the bleed is controlled by the BLS guys before we get there and we’re cancelled.
Not this time, though. CAD update was “bleeding from neck”. WTF?
BLS crew arrives and gives no update. We’re waiting for the cancellation that never comes.
As we walked towards the house the BLS crew update is, “Bring a scoop stretcher up with you.”
We grabbed our gear and the scoop and trudged up the stairs into the house. A guy standing in the front hall said, “Go up stairs, turn left, go up the next set of stairs, turn right and go down the hall. Hmm, it’s a two story house, which means that we’re going to the attic. Which has a small apartment added on with an equally small stairway of course. Narrow and with a right angle about half way down. If this patient weighs more than about 100 pounds, it’s not going to be fun getting him down.
Question #1. Why do very sick people always gravitate to the top floor? Question #2. Is it that they know they’re dying and figure that by going to the top floor they’ll be closer to heaven? If I ever figure that one out, my life will be complete. One of life’s imponderables I guess.
We got upstairs and found the BLS crew, FD, and of course the patient. Who is lying on the floor surrounded by blood. Lot’s of bright red blood with lots of clots. I’m guesstimating about 500 cc’s of blood. Damn. He weighed about 11o pounds more or less. At least we had that going for us.
“Does he have a pressure?”
“Yeah, about 90/p.”
Splendid. Which as I’ve mentioned before is what my mother used to say when things were anything but.
“Well, let’s get him on the scoop and get down to the ambulance.”
The BLS crew had the bleeding controlled with direct pressure and a dressing.
While we were securing the patient to the scoop, we got the story. 60ish year old manwith cancer of everything. Shunt in his neck, feeding tube, IV port in his chest, suprapubic urinary catheter. Oh, and a tracheostomy. I have to mention that because it becomes crucial later on. Full code, of course. No mention of DNR or hospice. I wonder what idiot at the hospital forgot to have that conversation.
We moved the patient downstairs and out of the house. On the front porch my partner asks me if we are going to our ambulance or the BLS one. I look at the BLS ambulance which is right in front of the house and then down the street half a block past the fire truck to our ambulance.
This turned out to be a very wise decision, as you’ll soon see.
The patient was conscious, he was alert, he was following commands. He was also a train wreck, but a manageable one we figured. Once we got the past the part where he had a terminal illness, he was doing OK.
Our plan was to get him in the ambulance, do the necessary monitoring, start an IV if possible and transport to his hospital of choice.
Off we went to the hospital and I prepped what I thought was a decent vein for the IV. My partner got on the med radio to call the patient’s hospital of choice and that’s when the shit show commenced.
First the radio wasn’t transmitting. While my partner was trouble shooting that, whatever process had caused the patient to start bleeding externally now caused the patient to bleed internally into his tracheostomy. (Later opinion from the hospital was that the cancer had eroded the innominate artery.) Which he declared to us by coughing blood up out of his stoma and all over the ambulance. And my partner. Note that that was the BLS truck. It must have been my wily old paramedic spidey sense that told me to go to the BLS ambulance.
My partner grabbed a suction catheter and started suctioning bright red bubbly blood out of the airway.
Then, just in case we hadn’t got the point that the call was going to hell, blood started to come out of his mouth and nose too.
The Shit Show had just been upgraded to a Goat Screw.
I grabbed the portable suction while I yelled to the EMT driving that we needed to divert to the closest facility, which was only about three minutes away. Uncontrollable bleeding + unmanageable airway = Closest hospital.
Through all of this the patient remained conscious, breathing, and aware of the fact that he was dying right in front of us.
I don’t think I’ll ever forget the look in his eyes. Mine probably had a very similar look and I know that my partner’s did as well. It’s pretty awful to watch someone dying helplessly.
My partner tried the med radio again with no luck.
I called dispatch on my portable radio and told the dispatcher to call the hospital on the phone and tell them we were bringing in a patient bleeding from his trach with an uncontrollable airway.
The patient coughed up more blood, covering my partner again. I, being the experienced provider that I am, didn’t get a drop on me. Comes with experience, I guess.
We got to the hospital in short order and transferred the patient over to the staff. Per usual for this joint, they didn’t have the full code team waiting for us because per usual they didn’t believe that we were telling the truth.
As soon as they got a look at the patient and pooped their drawers, much overhead paging of the resuscitation team started.
We cleaned up and watched for a while as the patient did his best to die and the hospital staff did their best to keep him from dying. He was in cardiac arrest for a while, but they got him back. They managed to intubate him, which we never even attempted to do being so busy just trying to keep him from drowning in his own blood. It helps to have doctors, nurses, Xray techs, respiratory techs, and lots of equipment. And plenty of working room of course.
I have no doubt that the patient finally beat them in the end and died.
UPATE: From a FB commenter,
Stephen Husak I call bullcrap story. You say he was in full code but yet when you were carrying him out of the house he was concious and alert and following commands while you were deciding ambulances. Then he was back in full code when you diverted.
The person who corrected you had it right, buddy. In all my years in EMS, I’ve never seen a “partial” cardiac arrest. Cardiac arrest is the term that I use for cardiac arrest. Nurseys use “code” for cardiac arrest, because they don’t know better.
Another UPDATE: Apparently the term “Full Code” is causing some confusion. Around here, and I’ve heard the term used in other parts of the country as well, “Full Code” means that the patient or their family, wants all resuscitative measures taken, no matter how futile. It has nothing to do with whether the patient is in cardiac arrest or not. I’ve always thought the term “Full cardiac arrest” was silly because, as I note above, I’ve never seen a patient in “Partial cardiac arrest”. Nor has anyone ever been able to explain to me what a “partial” cardiac arrest might be.