Additional help has arrived at this point, and a second defibrillator is taken from the backup ambulance. Given that the patient is young, and all other avenues have been exhausted, the crew notifies medical control and requests permission to attempt double sequential defibrillation. The patient is defibrillated an additional three times at 360 joules, this time with no cardioversion. Lidocaine 100 mg and epinephrine 1 mg are given. There’s a brief ROSC again, to a sinus tachycardia, but the rhythm quickly deteriorates back to v fib. Two grams of magnesium is administered via IV. (See Figure 1 above.) He’s defibrillated again, this time at 360 joules. While obtaining a 12-lead ECG post ROSC, the patient’s rhythm again decompensates, this time to torsades de pointes. He’s converted back to sinus rhythm with pulses. CPR continues, 300 mg of amiodarone is administered and the patient is again defibrillated at 200 joules. ![]() There’s a brief return of spontaneous circulation (ROSC) with sinus tachycardia, but it quickly decompensates back to v fib. He’s subsequently defibrillated at 200 joules using a biphasic defibrillator. On rhythm recheck, the patient is in v fib. Given that it’s a suspected overdose with a possible toxidrome, 1 gram of calcium chloride and 150 mEq of sodium bicarbonate are also given. Epinephrine is administered 1 mg 1:10,000 IV. An intraosseous line and an external jugular peripheral line are placed for access. As CPR continues, the patient’s airway is suctioned of thickly pooled oral secretions and he’s intubated without difficulty. The initial rhythm displayed on the monitor is asystole. The first medic takes control of the airway and starts to ventilate with a bag-valve mask (BVM) as the police officer continues compressions, and the second medic attaches the monitor. Rescue 1 pulls up a few minutes later and the crew radios for a second crew. Have EMS expedite.” He returns to the patient’s side and attaches the AED, but there’s “no shock advised” so he continues CPR. He radios dispatch, “ Cardiac arrest with CPR in progress. He instructs them how to do chest compressions and runs to the cruiser to grab an AED from the trunk. With the help of bystanders, the officer pulls the teenager onto the ground. There’s no pulse, no breathing and he’s cold to the touch. The officer opens the patient’s airway and checks for a pulse. He pushes past the obviously excited and upset friends and sees the teenager slumped in the back seat, cyanotic and unresponsive. The crew calls en route.īack at the scene, the police officer exits his cruiser and immediately realizes something is seriously wrong. The address is less than five minutes from the station. The tones suddenly activate for an “unresponsive male, possible overdose.” The crew recognizes the address-they were there two weeks ago and had talked to a teenage male about entering rehab after waking him up with Narcan (naloxone). ![]() ![]() Meanwhile at Rescue 1, the dual paramedic crew is catching up on charts from the busy shift the night before. A friend sees a police car driving by and starts screaming and jumping up and down for help. Someone at the house party calls 9-1-1 in response to their screams for help. He appears blue and is cold to the touch. Someone mentions that he left about an hour ago to “get something from his car.” His friends go outside to investigate, and find him slumped over in the back seat. Initially, the night is going well, but soon his friends become concerned when no one can find him. In honor of his return, his friends invite him to a house party to celebrate. A 19-year-old male is a known heroin abuser to his friends and family, and after much encouragement he successfully completes rehab and comes home.
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