The Chain of Survival…it works!

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Busy shift yesterday with various calls to medical emergencies that required some interventions before taking to the A/E.

One job we got sent to about halfway through the shift was to a collapse, unconscious, ? breathing. We,ve all been sent to these calls and it turns out to be nothing!

This one was something!

Arriving on scene we saw the patient on the pavement with the RRV Paramedic bagging away and the defibillator attached. (We were not informed en-route that an RRV was on scene) I quickly de-bussed and went over and took over chest compressions. The monitor showed V.F. (ventricular fibrillation…where the entire heart muscle is firing off in all directions and not pumping blood around the body) so I adminstered the second shock. This put the patient into spurious asystole (transient flat line due to myocardial stunning) so we continued with CPR for two minutes.

On checking the monitor we could see a cardiac output and listening to the patients heart with my stethoscope I could hear it beating normally again! Then we intubated quickly and attached the tube to the ventilator. Things were looking good…for a change!

The patient was a 76 year old gentleman who was on his way to the doctors as he had haematuria (blood in his urine) when he suddenly collapsed in the street. Luckily his grandaughter was with him and she dialled 999 straight away. 

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A bystander/passerby realised that he was in cardiac arrest and started CPR (chest compressions and mouth to mouth breathing). This was continued until the arrival of the RRV a couple of minute later.

The paramedic on the RRV adminstered one shock straight away to revert the ventricular fibrillation and carried on bagging (bag & mask which is squeezed to get oxygen into the patient)

Cardiac drugs were given via a cannula placed in the patients right external juglar and we made ready to place the patient onto the stretcher and into the vehicle. En-route to the hospital the patient started to spontaenously breath for himself.  A pre-alert was put into A/E and we arrived at the resus room 6 minutes later. 

It was nice to see everything in place and that this gentleman has a fighting chance of making a good recovery.

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The Chain of Survival

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17 Responses to The Chain of Survival…it works!

  1. Interestign post. I also think that its the first time that i’ve read any blog where the use of a stethoscope was mentioned. Santa bought me one for Christmas, along with a BP cuff, so my family all had their’s checked. Broke up the day between the war games!

  2. kingmagic says:

    If you ever get the chance to listen to someones chest, whether its a caz or an urgent, use your steth. Its the only way to get proficient…practice, practice, practice.

    Use it to listen to asthmatics, bronchitics, chest infections, heart sounds and bowel sounds. As well as obviuosly for taking BPs. And also to check for correct placement of an E.T. tube.

    Training school will show you and if you get a good crewmate during your training ask them to show you. Its always good to compare different patients with the same presentation as they will usually differ slightly in lung sounds.

  3. Marvellous! In the words of George Peppard as Hannibal in the A Team: “Don’t you just love it when a plan comes together?”.

    xx

  4. MY friends a physio (one of those without the job), and he first told me about the bowel sounds. I was amazed, i sat there for ages listening to them, i never even thought that was possible, or that noises even existed there. I was very nieve. From what im told my Mentor is good so hopefully i will get to listen a lot. Is yours service issue? Do you keep it on you’re belt in a pack?

  5. ecparamedic says:

    Best option with steths is to spend a little brass and buy a semi decent one. I’ve got a Littman Classic II and it does the job for me. It saves getting your colleagues earwax in your lugs too!

    Using your steth you can listen in to chests (more practice the better), tell the difference between a chest infection, asthma, LVF etc…. Also listen in to bowel sounds as part of an abdo examination, hear crepitus in broken bones, take a BP, listen in to heart sounds, assess the position of an ET tube, help confirm death etc etc etc.

    An extremely useful piece of kit and made all the better if you don’t use the £2 specials that our lot buy.

    SD

  6. Iain MacBain says:

    Good post for a good job. It also reminded me to start using my steth more. In reality I only tend to use it to confirm something I expect, other than tube placement, and as a consequence probably miss things I should not.

    Thanks for the kick.

  7. Thats the one that i got given from santa. My aunt wanted to treat me so i picked that one as i’d heard good things. Looking forward to hearing what they all sound like. first though i have to get through a write up of a joyous case study! You can imagine how much fun im having!

  8. inspectorgadget says:

    What a very excellent Blog Sir! Unfortunately, I have to ruin it by asking a technical question (being as we are both on WP) do you always get the Editoir screen when you make a new post? I get a screen where I can’t put any links or pictures. Do tell?
    PS I will link to you immediately.

  9. Kingmagic says:

    Thanks Inspector G.
    I log on through WordPress and then open up my “dashboard” or just click on new post on the log in page.
    The “new post” box has some facilities on the tool bar but underneath the “new post” should be the upload box.
    Hope that makes sense, if not have you tried the FAQ link in WordPress?
    I,m still new to this techno stuff…still getting used to electricity.

  10. magwitch says:

    Inspector Gadget,

    You, purpleplus and myself are all using WordPress – theme contempt. When you login you should get an option of New Post on the menu bar or else, if you’re in ‘write’ you should end up on the ‘editor page with an online editor showing ‘title’ and ‘post’ The ‘post’ area should have 2 tabs – Visual and code. The visual tab should also show an icon toolbar – pictures are added using the ‘tree’ icon.

    It used to be the case that all pictures had to be posted elsewhere (Flickr, your own site, etc) and then linked to the blog. There’s now an option under the ‘post’ area to upload pictures (although you only have 50mb of space).

    If this is nothing like what you get then feel free to contact me via my blog and I’ll send you screen shoots etc and see if I can help get you sorted.

  11. Guv Gadget, I downloaded ‘Windows Live Writer’ to write my posts, I just didn’t get on with the WP screen, I can’t ‘see’ what I am doing, down loading photos is a breeze, just one click, which is just as well as I seem to do a lot of it! I can get a much better idea of what the post will look like, before I publish, as it set’s it out in your chosen theme, as you write.

    KM, not sure where I was on the 6th Jan, but obviously not reading my blog suffer; nice one, I heard tell of such wondrous things, did you get to know how well the gentleman recovered

  12. kingmagic says:

    UHDD…as far as I can remember he made a good recovery and was discharged from hospital some weeks later. This job made up for all the others that did’nt make it.

    With the chain of survival in place it makes the odds better…but sometimes even in hospital with an entire team stood at the end of a bed its Goodnight Vienna!

  13. Nina says:

    You dont get many CPR stories like that. and another thing you dont get many Medical people talking about their work on the internet. it was interesting read thank you for posting it. love to read more
    Personally ive heard so much about CPR im mentally confused. the whole thing scares me really badlly
    But thats enough for me to say talk about myself. i love your post and wish to read some more ^_^

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