Its Not Pretty…!!!

September 9, 2008

People outside the job seem to have lots of misconceptions about resuscitation. On the TV or in books its portrayed usually in a sanitised manner keeping to the basics of it what entails. This is usually CPR…CardioPulmonaryReusucitaion…Cardio = heart…pulmonary = lungs…resuscitation = the act of reviving someone who was previously dead (ie no heartbeat and no breathing).

Occasionally the process of defibrillation, the electric shock, may be chucked in (and paras/techs/nurses/docs up and down the land will cast a critical eye over the proceedings to see if its done right!).

But most active resuscitation’s, either in the street or in a persons home, can be brutal, messy affairs. We need to ‘get down to skin’ so off come the patients clothes either by use of scissors/tuffcuts or simply ripping them off.

We need to secure the airway and the Gold Standard is intubation where a very large tube is passed down the throat and into the lungs. We need to get venous access so a needle is inserted either into the hand or arm or even the neck. We need a drug route.

This is on top the basic stuff ie artificial respiration by way of a ‘bag & mask’, chest compressions by pumping the sternum sufficiently deeply enough to squeeze the heart and any ‘plugging’ of major bleeds if the patient is in arrest due to severe trauma.

It is hard work which brings a sweat on regardless of the ambient temperature. And bear in mind there is usually only two of us working away in the corner of a room trying to move furniture without interrupting compressions and often in poor light. Sometimes we are lying on the floor in piss, shit and blood (it happens although we try to avoid it).

Then add the arrival of relatives who get obviously distressed at the scene before them. We can multi task like no bodies business…cracking on with the resuscitation and giving orders to others/relatives/bystanders and grab the next piece of kit/drug ready for use and looking at the patient and the monitor deciding if and when to ‘shock’.

Then throw in the variables…is there a DNR order (do not resuscitate) in place? Will the patients relatives object to what we are doing on the grounds of religion. (I have been vociferously asked what the constituents were in a fluid I was giving to a Jehovah’s Witness by her brother whilst she was being resuscitated.)

Sometimes the bedside manner can change from ‘pink & fluffy’ to downright ‘bite yer bollocks off’ if someone gets in the way of us. But that’s the nature of the job. East Mids Ambulance Service have started a course showing different people from different backgrounds how, and more importantly, why we need to do what we do. Click on link below.

East Mids Ambulance Service Resuscitation

The other thing which is never shown on TV or written in books is the extrication from someones house. I have lifted, carried, dragged people through doors, windows, fences, walls etc. We have had to carry people down umpteen flights of stairs due to the lifts being broken, and still having to carry on resuscitating the patient.