Yellow?

Sometimes on serious calls things go fabulously well, other times they go horribly wrong and still other times things go very strangely. This is the story of a call gone weird.

My trusty partner and I were cruising down the road minding our own business when we got a call for a diabetic problem. This is normally a fairly ho-hum kind of call, so we settled in for your standard everyday pick-‘em-up-and-drop-‘em-off routine and drove to the house.

When we pulled up in the driveway, we saw the Fire-Rescue truck had arrived before us. I grabbed my jump bag and we ambled into the house. As soon as I opened the door it was apparent that strange things were afoot. First off, one of the fire fighters was doing CPR on someone lying on the floor. This is not a good sign. Second, there was one light in the whole place, a small table lamp set next to them. The place was otherwise pitch dark. I flipped on a light switch…nothing happened. I went over and got the story as I set down my bag and started drawing out equipment. A friend of the patients had come after the patient called her to say she wasn’t feeling well. The friend arrived to find the woman unconscious and assumed she’d slipped into insulin shock. She hadn’t. She’d slipped into cardiac arrest. Having assembled the necessary equipment I moved to a position just above the patient’s head so I could put a tube in her trachea. As I did this I got a glimpse of the EMT I’d been talking to. It was Pam, I surmised, an EMT with years of experience. I relaxed a little.

Your first job in a cardiac arrest, after you’ve gotten CPR out of the way, and you’re sure they don’t need to be shocked, is to get a plastic tube down their throat. This makes it much easier for you to breathe for the patient, protects their airway and gives you a route by which you can administer medication. I grabbed my laryngoscope, clicked on the blade and went diving for our patient’s trachea.

Some people’s tracheas are a bit more anterior, or forward than others and hers was very anterior. This made it much harder to see, and thus very difficulty to hit the hole you is aiming for. One solution to this problem is to "digitally intubate" the patient. To do that you simply stick your left hand down the person’s throat until you feel the protective flap that closes off the trachea. You lift up the flap with one finger and use an adjacent finger to guide the plastic tube in your right hand home. This works pretty well, and doesn’t require that you actually visualize the trachea, so it seemed the perfect solution. I skillfully jammed my hand down the patient’s throat and fiddled with the tube for a half a minute, and couldn’t find the flap. "Dang" I thought "Back to the old blade and light"

I moved back to the patient’s head, and began getting the laryngoscope back together as the EMT ventilated her with the bag again. About that time I kicked the plug on the only light in the room loose and the room went black. Not to be deterred, I flipped the blade in place on the laryngoscope and the light at the end came on. I put the blade to use a second later, carefully inserting it into our patient’s throat. This gave me all the light I needed to do what I needed to do, but plunged my colleagues back into utter darkness. Pam scrambled behind me for the light plug and found it just as I was coming up for air again. When the light came on, dozens of previously unseen roaches scurried from beneath us. This was extremely unsettling, as I’m sure you can imagine, and we all instantly came to the unanimous decision that it was time to load our patient and find more comfortable surroundings.

We got our patient on a backboard, and then to the stretcher. We wheeled her to the ambulance and after a quick check for tag-along Roaches, we loaded her in the ambulance. As soon as we got inside I tried again for the airway tube. I’d missed the first time and we’d had to revert to ventilating her with a facemask. This time I got it and drugs became our next immediate priority.

The first two drugs indicated for asystole, or flat line, are; epinephrine, which is basically adrenaline and comes in a yellow box, and Atropine; which blocks impulses sometimes sent erroneously by the body that tell the heart to slow down…or maybe stop. Atropine comes in a purple box. When you work your first "code" or cardiac arrest, you are very excited. This is not the sort of thing normal humans deal with everyday. Codes happen pretty regularly, however, and after about a hundred of them, they become routine. That is not to say that we don’t appreciate their importance. It’s just that the process is pretty much the same every time. We work sort of like Airline Pilots. We are keenly aware that lives are at stake and that procedures must be followed, but don’t turn cartwheels over doing the same thing for the hundredth time. Sometimes we try to liven things up a bit. We play some music, chat, or harass each other as we’re going through the process. Having just endured the attack of the roaches I was in the mood for a bit of levity. I grabbed the Atropine and the Epinephrine out of the bag and held them in front of Pam, whose head was still down as she did CPR. "So" I said, "What do you think? Purple or Yellow?" She suddenly looked up and I saw I had made a small error. It wasn’t Pam, it was a girl about Pam’s size with the same haircut, but her face was filled with horror. Her name was Lee, and she was brand new to the Fire Department and she was dealing with her first code. She was obviously horror stricken because it had suddenly come to her attention that the Paramedic who was supposed to be saving the day had obviously just gone completely off his rocker. I tried not to smile at my error and her disbelief. "Right", I said "Yellow it is." She stammered for a second and then I did smile. "Sorry," I said, "I was just being funny. You’re doing great." She looked a little relieved that I had possibly come to my senses and went back to pumping on the woman’s chest. I did my magic for a few minutes, checked the patient’s glucose level, pushed more drugs, called the hospital, and before we knew it we were at the hospital.

The next time I saw Lee we were on stand-by somewhere, waiting for the police to quell some minor riot so we could pick up the pieces. "You know," she said "You scared the crap out of me the first time I met you." It seems she had been pretty sure I was off my rocker before we even left the house. She had no idea why I was trying to stick my arm down the woman’s throat, and had actually moved between the woman’s friend and me so she couldn’t see what I was doing. The "Yellow or Purple" question had convinced her beyond all reasonable doubt that I was an absolute fruit-loop. I am still not sure she was ever really convinced otherwise.