How do I do it?

I’ve been a black cloud the last week. Both at my volunteer spot and the moderately sized hospital I work at.
Last Saturday, wow was it only a few days ago?, I had one of the hardest calls I’ve ever had to help with. We intercept a BLS crew so that our magical ILS skills (sarcasm) can save the day. Apparently it was a charlie-foxtrot from on scene till we get to them.
6 month old baby. A little girl. Apparently her drunk parents were arguing with her in the vicinity. Words were said, ancestries questioned, tempers flared. What also flared was a .45 caliber pistol. The husband wasn’t pointing it at his wife, he said it ‘just went off’.
Now, as anyone who knows anything about firearms can tell you, a loaded pistol does not just magically go off! And if it’s a 1911 like the one that discharged, there are several steps to take before it will fire. 2 separate safety systems, and in some cases three.
Anyways, the stray round hit this baby that was laying in her crib. Hit her near her right scapula. I think anyways. By the time we saw her, it looked like such a large gaping hole in the baby’s shoulder that we weren’t exactly sure where the round went in.
The BLS crew did what they could. Pulse? below 60 but palpable. Start compressions. Breathing? Not enough, start bagging. Wait. Do we have a bag that size? Look! Call for intercept! County EMS not available? Any volly’s that can meet us?
And this my friends is where I come in. It took my ILS truck (me on an ILS graduate license and my partner who has been an ILS provider for 2 years) almost 20 minutes to intercept with the BLS rig who was running flat out to meet us. Another 35 minutes to the Lvl 1 trauma center.
Hop onto their rig. SHIT! This doesn’t look good. Have my partner hop back with us. BLS truck has 3 providers? Good. One dive my truck, one drive theirs, one bag.
Baby is a pasty color, blood is all over their stretcher. The wound has been dressed as well as can be, but it’s starting to bleed through. Another trauma dressing is slapped on and taped in place. Lung sounds? With my adult steth, hard to hear. Sounds like air is moving in both sides.
Lines? None of course. Look for a vein. Nothing happening. Where’s the Jem-shidi? There it is. First time I’ve done one of these. There’s the pop. Aspirate! Some marrow return. Good. Secure it. Lets see…. Braslow tape out. Got a weight. Quick figuring. First bolus is running.
We’re too far out. Call dispatch. Is there a flight team available? None? Ok then we run code into city to the Only Trauma Center in the State, luckily only 30 more minutes away.
Put the kid on a 4 lead. Sinus. Brady. Very Brady for a kid this age. Still doing compressions? Ok keep em up. Oh hey I should spell you for a bit. Keep it up.
Another bolus going in. Good. Let’s give OTCITS as much notice as possible. Let em know we’re coming and what we got.
Report given. Reassess what we got. Good brachial pulses, but still too low. Airway is open and we’re bagging. OPA in place. We have an IO in place and running a bolus. No way of telling BP, out smallest cuff is too big for her. Can we secure the airway better? Nope, nothing that small except ETT, and we can’t use em.
Any spontaneous breathing? None?! Well keep bagging. Monitor. Still Sinus Brady. Call for orders for a third bolus and permission to start 2nd IO. Third bolus yes. Second IO, no.
Hey, there’s the city limits. OTCITS should be coming up soon. Pulses? None?! Great. Monitor? Asystolic… Not good. Full on coding the kiddo now. Have I mentioned I hate Peds yet? Well I do.
Hey we’re pulling in. Trauma team waiting for us. They haul ass iwth our gurney to the trauma bay.
Tell em what we got.
“6 month old, single GSW right shoulder area. Single exit wound. Went pulseless and apneic on us right before we pulled in. Single IO established. Epi given per protocol once asystolic. 3 boluses in. OPA in place.”
They work the little girl, the one who could have had a long and productive life ahead of her. The one who should never have found herself in this position. The one who’s parents are going to have to live with this for the rest of their lives.
After 20 minutes they call her. I feel my shoulders slump as I walk out. Gotta get our truck cleaned… Or in this case help Tiny Town BLS get theirs cleaned up. Time to go. Back to quarters. For more of this. Great. I hate ped calls.

That was my weekend shift. Last night at work was fun too.
Sitting with two patients because they were both in for SI. So someone had to watch them. One was very aged and not doing well. He coded about midnight. So while I was busy starting to call the code and doing compressions, his roommate decided that it woudl be a good thing to pull out his IV. And his Foley… Balloon inflated still. Talk about bloody. I’ve seen less blood from a GSW. So it was not a good night.
My first patient last night wound up being called about 30 minutes from when he coded. He did too much damage to his body over teh years with all kinds of drugs. Funny thing though. I don’t feel nearly as bad, if really at all, over this one as I did the kid. Two lives gone, but one seems to hit me worse than the other. I guess that’s life.

I’ve just had a bad week and needed to vent a little. The ped call still has me a little worked up over it. That was not a pleasant scene… But then again I know it was probably harder for the BLS crew that worked it first. Lord knows what I would have done to those ‘parents’ had I been in the room with them.

  • The Grumpy Dispatcher

    …… sigh….I, too, hate ped calls.Good work considering what you were handed, though I know that doesn't count for much as far as hating ped calls goes and won't make it go away……………. sigh.