resus-defibme25

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Grey's Anatomy - Woman in hospital

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Surgery prep, patient is already completely asleep and intubated, exposed and vulnerable.

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Just wanna fuck your throat and comfort you through your gags, struggles, and tears with a calm "shhhhhhh, shhhhhhhhhh, I'm almost done"

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Martina’s accident

It was a bright, warm summer day as you were on your way to get some last minute shopping done. The sun, reflecting and radiating off your skin as you walked ever so close to the store. You pulled out your phone, desperately trying to kill time as you failed to notice the car driving at a dangerously fast speed, speeding towards you. The driver, not paying attention in the slightest continued to speed down the narrow road, missing the fact you’re about to cross the road. You desperately tried to jump back, but to no avail, the car hit you, flipping your body over the front, then the roof before it came to a complete stop against a pole. A sharp pain engulfed your abdomen, all the way to your toes as you started to heave on the warm pavement. A group of bystanders tried to stop the car, but it left the scene faster than it even arrived.

“Hello, Miss, can you hear me?”, a soft voice asks as she reaches for her phone in her pocket. “P-P-Pai..”, you try to blurt out as a small trickle of blood starts to run down your cheek. “Try not to move, help is on the way.”, the old lady softly says as she dials the emergency number. “Emergency services? Yes, hello, I need help, some lady got hit by a car and there’s blood coming out of her mouth.”, the lady says, the panic audible in her voice as her eyes are locked onto your broken body. “I-I think she is breathing, her chest is barely moving though, please, help her.”, she says as she tries to fight back a tear. “Please hurry. Did you hear that, help is on the way!”, the lady says as she kneels down next to you.

A fear engulfs her as her shaky hands gently touch your neck, trying to find for a pulse. The panic in your eyes is overshadowed by the thousand yard stare as your eyes desperately try to keep focus. Your weak attempts at breathing barely manage to get enough oxygen into your lungs as a set of sirens can be heard from a far distance. The old lady gently picks up your hand, tightly gripping it in yours as your body starts to lose the battle against itself. Your eyes, ever so glazed start to fall shut, then bolt open again, only for the cycle to repeat itself. “Hey, stay with me, hello.”, the lady says as she notices your struggle. She gently taps your cheek, desperately trying to keep you conscious as the ambulance finally arrives.

“She just lost consciousness.”, the old lady cries out as the door to the ambulance swings open. A team of paramedics exit the ambulance, led by a male doctor as they finally reach your body. The driver places the stretcher, with a monitor on it, right next to your broken body before the nurse starts to rumble through the bag on her back. “Get her shirt off, we need to get her on the monitor as soon as possible, try to get her BP and prepare the oxygen kit.”, the doctor commands as he gently creeps open your eyes before shining his penlight across them. “Pupils are reactive, get me the neck collar.”, he commands as the nurse starts to run the shears along your shirt. She quickly pulls aside the fabric, revealing your heavily bruised stomach before the doctor tightly secures the neck collar along your neck. As he slides the BP cuff along your arm, the nurse quickly dots electrodes along your chest before connecting them to the monitor. “BP is 85/40, heart rate is 101, we need to get her to the hospital quickly, I’m suspecting a major internal bleeding.”, the doctor sighs out as he hangs a plastic oxygen mask around your face, securing it tightly with the straps.

“Is she stable enough?”, the nurse asks concerned as she started inserting the needle for an IV into your arm. “She won’t be for much longer if we don’t get her out of here.”, the doctor sighs out as he moves towards your shoulders. “We’ll roll her onto the plank, then tightly secure her to the stretcher, there might be some damage to her neck or spine, but we won’t know for certain until she’s had an x-ray.”, the doctor says as the nurse pulls the plank closer to your body. “On my count, one, two, three.”, he orders as they gently pull your body to one side, allowing the plastic plank to be slid underneath you. They carefully lift up the plank, placing it onto the stretcher right next to you before tightly securing the straps, making sure your body can’t move at all as they start to make their way towards the back of the ambulance. They gently slide the stretcher into the ambulance as the monitor continues to display your elevated heart rate. The entire car shakes slightly as the doors get slammed shut before the ambulance takes off with it’s sirens blaring. The doctor’s eyes are glued onto the monitor as the sirens from the ambulance mask the erratic beeping coming from the machine between your legs. “I want an x-ray, CT scan and OR to be ready on arrival.”, the man shouts towards the driver as the nurse connects an oxygen meter to your finger, then the monitor. “Her O2 sats are far too low.”, the nurse sighs out as she sees the look on the doctor’s face. “A-Are you thinking what I’m thinking?”, she asks concerned as the doctor grabs his stethoscope. “Punctured lung, damn it.”, he curses out as a sudden wave of blood spurts out of your mouth, covering the oxygen mask providing your lungs with oxygen. “She’s haemorrhaging, get the suction.”, the doctor commands as he pulls away the mask from your mouth. The nurse quickly slides the tube into your mouth, then your throat as she attempts to remove the sudden increase of blood in your lungs. “BP and O2 are crashing doctor, we can’t keep her stable for much longer.”, the nurse sighs out as she desperately tries to clear your lungs. The monitor between your legs starts to go haywire as multiple alarms begin to go off. Your heart desperately tries to pump enough blood around, trying to make up for the amount you’ve lost as the doctor tightly secures an ambubag over your mouth. “We’re nearly there, hang in there.”, the doctor sighs out as the ambulance takes a sudden turn before coming to a harsh stop.

The doors to the ambulance slide open, revealing a team of gowned nurses and a doctor as they pull the stretcher out of the ambulance. “Female, early 20’s, victim of a hit and run, suspected massive internal bleeding, started haemorrhaging 2 minutes ago, vitals are all over the place as we couldn’t keep her stable.”, the doctor informs the team as they rush you towards the trauma room. They quickly transport you from the stretcher onto the table already present before removing the monitor from between your legs. “Prepare her for a chest tube, we need to get her lungs cleared.”, the doctor commands as your O2 sat continues to be dangerously low. A nurse quickly snips your bra, before coating the side of your chest in iodine as the doctor quickly puts on a yellow gown, followed by a pair of gloves. He grabs the scalpel, lowering it to your skin before making a crude incision between your ribs. A nurse swiftly follows, guiding a tube down the hole. That’s when it happened, a sudden rush of blood squirts out of the tube, covering the doctors gown in blood as the monitor starts to fire off a new alarm.

“She’s in V-Fib, charge the paddles!”, the doctor commands as he quickly interlocks his gloved hands before lowering them between your breasts. He violently starts to crush your sternum as the defibrillator whines to life. The man forces your chest to cave inwards, in turn making your stomach bulge outwards as the defibrillator finishes charging. A nurse quickly places a pair of orange gel pads onto your chest, while another one undoes the button to your pants. “Charged at 200 doctor.”, a nurse says as she firmly places the paddles onto your chest. “Clear!”, she shouts before pressing both buttons to the paddles simultaneously, releasing the shock onto your body. Your chest arches as the electricity runs through your body, before falling completely flat. The doctor let’s out a sigh before interlocking his hands once again, lowering them into your sternum. He counts out loud as he rhythmically presses down on your sternum while the team waits for the defibrillator to finish charging. “Charged doctor.”, the nurse says as she once again guides the paddles down onto their spots. “Clear!”, she waits a moment for everyone to clear your body before sending the shock through your quivering heart once again, making it stop completely inside your chest. “Asystole, resume compressions, get ready to intubate her!”, the doctor commands as a nurse steps up to deliver textbook compressions. A second IV is set up, blood being pumped into your body in an attempt to recover what you lost while the nurse continues to crush your heart between your sternum and spine. She nears the end of her set, pausing momentarily to let the doctor slide a tube down your throat. “Tubes in, continue compressions.”, he says as he grabs a roll of white tape, tightly securing the tube. The nurse resumes compressions, putting her entire weight into compressing your still heart as her ponytail bops up and down in rhythm of her compressions. Despite her best attempts, the line on the monitor continues to run completely flat as your body shakes violently from side to side. The nurse once again pauses for a moment, letting much needed oxygen flow into your lungs before she resumes her brutal attempts at making your heart beat again. “After this round, push epi.”, the doctor commands as his eyes are glued onto the monitor. The nurse’s breathing starts to become heavier and heavier each compressions as she nears the end of her set of compressions once again. “Switch.”, she says out of breath as she watches a nurse plunge epi into your IV. “She’s been down for 5 minutes doctor.”, the recorder in the corner of the room says as she looks at her stopwatch. A new nurse steps up before delivering textbook compressions onto your chest once again, shaking your breasts gently as your sternum becomes more and more bruised. “She’s fibrillating again.”, the doctor sighs out as the flatline on the monitor gets replaced by a squiggly line. A nurse next to the defibrillator quickly turns the nob to the machine as your chest continues to be bombarded by rough compressions. “Charged at 300.”, the nurse says as she quickly places the paddles onto the orange gel pads. “Clear!”, she shouts, waiting for the nurse to drop the ambubag next to your head. The shock once again violently rips through your body, making your back arche as the shock appears on the monitor. “Nothing, go again!”, the doctor shouts furiously, starting to lose hope. The same cycle proceeds, a nurse violently compressing your chest as the team waits for the defibrillator to finish charging. “Clear!”, the nurse simply shouts as she forces the shock through your heart.

“Hold, I think we have a rhythm.”, the doctor says as the frantic line on the monitor gets replaced by a more stable beeping. Nurses start to dig their fingers into multiple of your pulse points, confirming the reading done by the monitor. “Get CT and a fast x-ray machine in here, we need to know what’s happening inside her.”, the doctor orders as your vitals become more and more stable with each passing second.

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Martina’s surgery

Your body lays eerily still on the trauma room table as an ET tube gently pulls open your lips while a nurse gently wipes away some of the blood left over on your face. A portable CT scan quickly gets rolled closer to the table Andrew puts some cold lubricant on the probe. He gently places it onto your abdomen, carefully moving it around as the gel makes your bruising glitter from the light above you. “Both her liver and left kidney are ruptured, we need to get her to an OR as soon as possible.”, he sighs out as the image appears on the screen next to him. “Tell them we’re coming with a critical patient, have them bring in units of blood right away.”, Andrew commands as a nurse quickly picks up the phone. A nurse swiftly hides your body loosely underneath a gown while another one disconnects the ambubag before connecting an elbow joint with a softer, rubber balloon. The team undoes the brakes to the table before gently rolling it out of the trauma room towards the elevator right next to it. Your heartrate, promptly displayed on the screen continues to stay elevated as your heart struggles to beat around the small amount of blood still in your body while the team waits for the elevator to arrive. Finally, a ding echoes through the hallway as the metal cage slowly slides open. The team carefully pushes your bed inside it, before the doctor presses the button to go to the upper floor. “Hang in there girl, we’ll fix you up.”, he sighs out as he looks at the monitor, seeing your irregular vitals.

The elevator arrives at the designated floor, slowly opening it’s doors before the team pushes your bed outside of it, towards the big double doors at the end of the hallway. Your lungs expand smoothly each time the nurse compresses the soft ambubag as the team transports you body onto the sterile table in the middle of the room. “Connect her to the automatic ventilator, I’m gonna scrub in.”, Andrew commands as he exists through a small door to the side. The nurse quickly disconnects the elbow joint before connecting a bigger hose to the open end of your tube. She hides your hair in a light blue bouffant cap before placing some white tape across your eyes while another nurse hides your lips behind a blue tube holder. They carefully remove your gown, making sure to not peel off any of the electrodes before covering your nude chest, and legs with green, sterile surgical sheets, leaving just an opening for your abdomen as the rest of the team starts to prep themselves as well. Andrew finishes scrubbing his hands clean, before quickly putting on the gown which is being held out in front of him by a nurse. A crackling sound is heard through the prepping area as a nurse tears open a package of sterile gloves, gently gliding them over Andrew’s hands as he ties his surgical gown shut against his body. He finishes prepping himself as he tightly wraps a mask around his face, before hiding his hair underneath a cap while he makes his way back towards the surgical suite.

“Everybody ready?”, Andrew asks softly as the team starts to gather around your body. The monitor next to the table continues to display your irregular vitals as Andrew reaches for the scalpel from the metal tray. He lowers the knife towards you abdomen, carefully making an incision as a nurse assists him in spreading the cut open before letting out a small sigh. “Get the suction in here, there’s so much blood.”, he says as he starts to dig around your abdomen, soaking his gloves with your blood. The nurse quickly guides the suction tube along the cut, trying to give Andrew a better view as the monitor continues to beat at an elevated rate.

“Vitals are relatively stable sir.”, a nurse next to the monitor says as Andrew continues to look around your abdomen, desperately trying to find the rupture in your liver. A sudden burst of blood covers a bit of his gown as the nurses next to your IV’s desperately try to keep enough blood flowing in you as the monitor once again starts to go haywire. “BP is crashing, we can’t keep her stable for much longer sir.”, a nurse sighs out as a faint alarm gets displayed on the screen of the monitor. “I just need a bit more time, damn it.”, Andrew sighs out as he starts to pick up the pace, while more units of blood get forced into your body. “Keep the suction, I nearly have it.”, he commands as the alarm from the monitor only grows louder. “Found it, hand me the staplers.”, he says as he holds out his hand while your heartrate is climbing to dangerous levels. “She’s going into V-Fib sir.”, a nurse sighs out as the line on the monitor starts to display a frantic pattern. Andrew quickly staples the rupture of your liver shut before removing his gloved hands from the cut made in your abdomen.

“Charge the paddles at 200.”, he commands as he pauses for a moment, looking at the monitor. Andrew quickly pulls back the sheets covering your breasts before interlocking his hands, lowering them to your sternum as a nurse swiftly tears open a package of orange gel pads. A nurse turns the knob to the defibrillator, making it spurt to life as he starts to rhythmically compress your chest. The whine coming from the defibrillator grows louder, until a double bleep interrupts Andrew’s aloud counting. “We’re charged sir.”, a nurse exclaims as she hands Andrew the paddles. “Clear!”, he commands as he firmly places the paddles onto the pads on your chest. The shock violently rips through your body, making your chest arch, before slamming hard down again on the table below you. “Damn it, charge again!”, he shouts as the frantic line on the monitor doesn’t seem to disappear. He once again interlocks his hands, lowering them on the spot covered in blood between your breasts before violently pressing down. The monitor continues to blare an alarm as Andrew puts his entire weight into crushing your heart, making your breasts bounce each time he forces your sternum to bend inwards. A nurse finally disconnects your tube from the automatic ventilator, instead replacing it with a green ambubag as she waits for Andrew to finish his set of compressions. “We’re charged.”, a nurse says as she takes the defibrillator paddles out of their docking stations, handing them to Andrew. Two big puffs of air get forced into your lungs, making your chest rise smoothly each time as Andrew firmly presses the paddles on the orange pads on your chest once again. “Clear!”, he shouts, releasing the built up charge straight through your heart. Your chest once again arches, slightly lifting your head as well as it slams hard down on the table, pulling your bouffant cap off a bit as your heart completely stops inside your chest.

“Damn it girl, don’t you die on me.”, he sighs out as he balms his fist, before slamming it hard down onto your sternum. Your breasts once again shake violently with the force of the thump, making a small spike appear on the screen before Andrew interlocks his hands once again. He counts his compressions aloud, ignoring his own breathing getting heavier and heavier as he continues to compress your still heart. “Push epi, give us something, damn it.”, he commands as he once again nears the end of his set of compressions.

He lifts his hands off your chest for a moment, revealing the bruised, bloody spot on it as another two big puffs of air get forced into your lungs. He watches as a nurse plunges a syringe full of epi into your IV before interlocking his bloody gloves once again. Your chest once again undergoes violent compressions as the line on the display of the monitor continues to run completely flat. “Hold compressions.”, a nurse says as she looks at the monitor. “She’s slipping back into V-Fib, charge at 300.”, Andrew sighs out as he tries to catch his breath for a moment. He pauses for a moment, breathing heavy before interlocking his hands again, waiting for the defibrillator to finish charging. Your body jiggles from side to side each time he forces your heart to pump blood around manually until a double bleep echo’s through the operating theatre. “Everyone clear!”, he shouts frustrated as he firmly locks the orange pads underneath the paddles. Your body once again reacts violently to the shock, your chest arching fully in the air before it crashes hard down onto the table again, making your breasts bounce as you land. “Nothing, charge again!”, Andrew shouts as he looks at the monitor. “Sir, she’s been down for over 15 minutes.”, a nurse sighs out while looking at him. “Charge the paddles, damn it, hand me the adrenaline shot.”, he commands as he holds his hand out. A nurse quickly tears open a package, pulling out a big needle before handing it over to Andrew. “C’mon girl.”, he sighs out as he plunges the needle straight into your heart, before emptying the syringe. “Paddles are charged sir.”, a nurse says as she holds them in front of her, waiting for Andrew to grab them. “Clear!”, he shouts before once again releasing the massive shock onto your heart. Your back crashes hard down against the table, your heart giving another few irregular beats before finally restoring back to a normal rhythm. “BP is rising, heartrate stabilising.”, the nurse next to the monitor says as Andrew catches his breath for a moment. “Close her up, prepare her for ICU, told you she’s a fighter.”, he says out of breath as he starts to walk towards the doors of the prep room.

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Reblog if you just want to be a pretty little fuck toy for older men 💝

[resus-defibme25]

i need a bf w a knife collection that tests all his blades on me

[resus-defibme25]

"You still in there, sweetheart?"

"I know you're still breathing, I can feel your ribs moving under my hand."

"Fuck, your eyes are so pretty when they're glassy and half-open."

"I didn't think you were gonna last, if I'm honest. Most don't."

"Wake up now. Wake. Up."

"Oh, was that it? Only had enough in you for a few more breaths before you gave up?"

"No pulse, either. That's disappointing."

"Well, you're very pretty as a corpse, my love, but I'd like to hear you scream for me just once more."

"Come on. Come back to me."

"Dammit, breathe already. I wasn't that rough on you."

"Don't you do this. Don't you fucking dare."

"Please... I need you."

"Wait, was that...? Yes."

"You're okay, love, you're okay. Just breathe now."

"Mm, you know... That kinda turned me on~"

[resus-defibme25]

[resus-defibme25]

[resus-defibme25]

[resus-defibme25]

Is it just me or is being spoken softly to by my dom while he roughly fucks me feel really good? “You’re doing so well” “I know baby, I know” “just a little more baby” “can you cum one more time for me?” Like the gentle calm tone with being roughly handled is just everything.

[resus-defibme25]

The Bachelorette Party

Bachelorette parties are supposed to be a fun get together in honor of a woman’s upcoming marriage, usually involving the bride and a few close friends and family members.

Becca was set to marry the man of her dreams, Ryan, after 3 and a half years of dating. Becca was a 27 year old brunette with brown eyes, was of average height and build, was fair skinned, always had her makeup on point, and had perky c cup breasts.

Becca and her fiancé had planned a smaller wedding, and wanted to keep their circle smaller for the wedding and related festivities to limit drama, which was exactly the case for both the bachelorette and bachelor party. For Becca’s bachelorette party, she was only inviting 3 other people for a night out at the local casino. The lineup included her younger sister Maddie, and her best friends Kate and Carly.

Maddie was a 22 year old who had had brown hair and brown eyes like her older sister, but had a taller, skinnier build, had a nose ring, a half tattoo sleeve on her left arm, and B cup breasts. Next up was Kate, a 27 year old conventionally attractive blonde with blue eyes, who had a skinny build, a tan complexion, didn’t wear much makeup, and had perky c cup breasts. Last but not least was Carly, a 26 year old brunette with a short pixie cut and green eyes. Carly had that cute, innocent, girl next door look and had a smaller, petite build, and sported C cup breasts as well.

As mentioned earlier, the 4 ladies had intended on going to the local casino for a night of drinking, gambling, and fun, but unfortunately, fate had other plans for the bachelorette party. The group has piled into one car- Carly’s car, since she was the group’s designated driver. While on their way over to the casino, a semi truck had taken a curve a little too hard and fast, striking the 4 ladies head on while frantically trying to avoid the truck.

The front of the car got crushed up, and the vehicle was forced backwards into a barrier, throwing all 4 ladies around violently inside the vehicle. The steering wheel slammed into Carly’s chest, with a cracking sound being heard instantly from her ribs and sternum taking the brunt of the impact. Over in the passenger seat was our to-he bride Becca. She was thrown around quite violently as well, striking her head on the ceiling, and the passenger door window, before falling unconscious. In the rear, passenger's side backseat, Maddie screamed in pain, feeling her left thigh get crushed while simultaneously being thrashed around. A loud snap was heard, and she saw bone penetrate her pants, sticking out in plain sight, causing her to scream loudly, terrified by what she just saw. Last but not least, Kate felt the armrest in between the two back seats slam into the upper right quadrant of her abdomen really hard, before being forced back, experiencing whiplash.

After this awful wreck, 911 was notified by multiple other onlookers in nearby vehicles. Emergency services began swarming the scene in the coming minutes. The police were securing the scene and directing traffic around the bachelorette party’s mangled vehicle, while the fire department and EMS began to get acclimated on scene. A firefighter came up to the driver’s side window and took a peek inside the vehicle. Carly was gasping for air and clenching her chest, Becca the bride was unconscious, Maddie was crying hysterically in pain, and Kate was groaning in pain, drifting in and out of consciousness. “please… help us…” Carly uttered in a weak, breathy voice to the firefighter as they approached the vehicle. Meanwhile off in the distance, the driver of the semi that hit the ladies head on stumbles out of his vehicle, not a scratch on him. The driver reeked of booze and weed, and kept mumbling things to himself. The accident was already his fault for taking that curve too fast and striking the ladies, but he exacerbated things by being intoxicated. He was subsequently handcuffed by one of the cops, and was sitting on the step of one of the ambulances, being examined by a medic. “oh my god, did I fuckin kill them?!” the truck driver shouted out loud, watching fire department and EMS personnel surround the crushed up car.

The medics began assessing all 4 ladies, but the bride to be was in the worst shape. A weak carotid pulse was felt on Becca, and her pupils were sluggish. A c-collar was immediately placed on Becca, and she was carefully navigated out of the vehicle and into a backboard. The medic and fire fighter set the backboard down on the ground for a moment and started setting up a portable heart monitor on Becca, placing IVs, and removing most of her clothes and her shoes. With Becca’s level of consciousness and unstable vital signs, it was decided that rapid sequence intubation was the next best step. The medic opened Becca’s mouth and blood started dribbling out. Her mouth and airway had to be suctioned out a few times, but her mouth and airway were sufficiently clear enough for the 7.0 ET tube to be inserted. The tube was quickly inserted, and held in place with a blue tube holder, and an ambu bag was attached. The firefighter began squeezing the ambu bag gently every few seconds while the medic began fluid resuscitation on Becca. But suddenly, Becca’s heart monitor began beeping loudly. “Shit, she’s in v-fib. Starting compressions!” the medic said, as they began pumping away on the bride’s chest. Another medic scurried over with a set of defib pads, and stuck them onto Becca’s chest. The pads were charged to 250 joules, and a shock was delivered in a moment’s notice. A horrified passer-by in a car saw Becca’s limp, battered body jolt around on the backboard as emergency services attempted to revive the beautiful bride-to-be. The shock failed to revive the beautiful brunette, so CPR was resumed. Becca’s chest was pummeled with deep, strong compressions while the electrical whirring sound of the defib pads recharging could be heard. Once the defibs were ready, a second shock was delivered. Becca’s lifeless body trembled and shook, but remained in v-fib. Her ET tube filled with blood, so chest compressions were resumed while her airway was suctioned out. The suction tube made a slurping sound while draining the blood from the flexible, plastic tube that protruded from the patient’s mouth. It took a few attempts at suctioning the airway out before Becca’s airway was secure again. The team then decided to shock Becca a 3rd time. The bride’s eyes opened up from the increased strength of this shock, and her body tensed up for a moment. Becca let out a grunt- this is called an agonal breath, before going limp and flatlining. Becca’s eyes were open, staring blankly up at the evening sky, with a detached ET tube+tube holder taking up half her face. The defib pads and EKG electrodes were still littered across her chest. One of the medics shined a pen light into Becca’s eyes, discovering her pupils were fixed and dilated. “no pulse, no respirations, fixed and dilated pupils, asystole on the monitor...” one of the medics called out, shaking their heads. The more senior of medics replied “she’s gone, what a shame… time of death, 7:46pm. Notify the coroner’s office please.” The emergency workers shut off the flatlined heart monitor and placed a cover over Becca’s body. Instead of having a blast at her bachelorette party, Becca was now laying dead on a backboard, under a sheet on the side of the road, with her cute, wrinkly, size 7 feet sticking out.

While Becca’s code took place on the side of the road, the other 3 ladies were extricated from the vehicle and transported to the local emergency department, completely unaware Becca had passed away.

The first to arrive at the hospital was the driver, Carly. Carly was awake, alert, and struggling to breathe. She was on a backboard with a c-collar and donned an o2 mask. Tears rolled down her face since she felt a sharp, tearing pain in her chest every time she inhaled. You could see her neck muscles flex as she tried to draw in air with absolutely everything she had. Carly’s blood pressure was hypotensive, with a reading of 70/39, was tachycardic with a heart rate of 142bpm, and had an oxygen saturation that had dropped all the way to 87%. Carly was handed off to the first trauma team, and she was whisked off to a nearby room to begin examination and treatment.

Next up to arrive was Kate the blonde. She was also on a backboard and had a c-collar on, but did not have an oxygen mask on. Kate was awake and alert, groaning in pain with one hand on the upper right portion of her abdomen. One of the ER nurses moved Kate’s hand for a second and took a brief look, noticing a large, purplish bruise just below her ribs. The nurse palpated Kate’s belly, to which she winced in pain. The nurse was quickly able to determine that Kate had exhibited abdominal guarding. The young lady’s vital signs were: BP 83/42, pulse 136bpm, and o2 saturation 99%. Kate was then handed off to the 2nd group of ER personnel that waited in a nearby room.

Last but not least, the bride’s little sister Maddie arrived. She was awake and sitting up on a gurney, but her leg was in a splint, and the compound fracture/laceration was covered with some larger gauze pads. Since Maddie was in tremendous pain and had stable vitals, she was given intravenous oxycodone for pain management, and 5mg valium for anxiolytic purposes. Maddie was awake, but seemed a bit groggy from the pain+anxiety meds. She was taken into the last of the remaining trauma rooms where her examination commenced.

Over in trauma 1, the team started off by running trauma labs, doing a chest x ray, and performing an echocardiogram. The chest x ray displayed multiple rib fractures on both sides of the chest, and a left sided tension pneumothorax with right sided tracheal deviation. The echocardiogram displayed no signs of tamponade, but showed a major ventricular septal defect. Essentially, the muscular layer separating the 2 large, bottom chambers of Carly’s heart has been torn, creating an abnormal connection between both ventricles, and disrupting blood flow in and out of the heart. This particular injury is associated with a high mortality rate, and has to be treated urgently in order to increase the likelihood of a desirable outcome. With that in mind, the team opted to get Carly up to the OR ASAP and let the surgical team place the left sided chest tube during the surgery. The team placed a cover over Carly’s torso and began rushing her out of the room. “surgery? What’s going on?” Carly asked in a weak, breathy voice, to which nobody responded. Carly tried to reassure herself, thinking “it’s going to be ok! We’re all going to be ok! And we’ll have the bachelorette party once everyone’s better.”, completely unaware that Becca had already passed away on scene.

While the trauma team handed off Carly to the trauma surgery team, Kate was being examined in trauma room 2. Unfortunately, she was losing blood at a massive rate and had been started on the massive transfusion protocol. Kate also fell unconscious and was intubated by the ER team since arrival. Her tan complexion faded to something more pale and ghastly, and she became cool to the touch. She laid underneath the large overhead light, eyes gently shut, with a blue tube holder and ambu bag visible. Her chest had EKG electrodes scattered all around, and there was fresh ultrasound gel on her belly. An abdominal ultrasound displayed a massive retroperitoneal hemorrhage in the upper right quadrant of her abdomen, but it was unknown as to whether the liver, IVC, or other blood vessels were the source of such a bleed.

In the third trauma room, Maddie was being examined by the emergency physicians. They reset the compound fracture in her leg and ordered a follow up x ray to get the extent of the damage in her right leg. It was also noted that blood flow was also obstructed heading towards her right foot, so her right leg appeared discolored. This is a scenario known as compartment syndrome. Essentially, the  main artery which carries blood to the lower leg and foot was squeezed by the fractured bone and swelling in the area. Compartment syndrome is a surgical emergency, and needs to be dealt with urgently in order to restore blood flow to the affected area. With that in mind, the trauma team paged orthopedics and trauma surgery for consultation.

Speaking of surgery, Carly was now up in the operating room. The surgical team sedated and intubated her, and also placed a chest tube to alleviate the tension pneumothorax. Carly’s oxygen saturation improved somewhat, but her vital signs remained unstable overall, remaining hypotensive and tachycardic. The surgical team elected to perform a modified daggett procedure. This is an open heart surgery in which the heart is stopped, placed on cardiopulmonary bypass, the left ventricle is incised once the heart is stopped, and the tear in her ventricular septum is patched shut. Generally, this procedure is reserved for patients that have stable vital signs, but the team felt the risk was necessary in Carly’s case. Betadine was squirted across the middle of Carly’s chest in anticipation of a median sternotomy. A vertical scalpel cut was made beginning at the very top of the chest at the manubrium of the sternum, extended inferiorly several inches, continued past the xiphoid process, and ending a few centimeters below the diaphragm. The underlying fat and tissue was exposed after a 2nd incision with an 11 blade, and a sternal saw was procured. The saws blade was placed above the sternum, and the surgeon began breaking apart Carly’s sternum, working their way down slowly but surely. A high pitched grinding sound permeated the OR while the electric saw cut through one of the hardest bones in the body rather effortlessly. After the sternum was divided, a finochietto spreader was placed, and Carly’s chest was cracked open nice and wide, with her strong, young heart visible for all to see. With the chest cracked open, the next step was to begin setting up the equipment for cardiopulmonary bypass.

While the OR team was starting Carly’s surgery, Kate had deteriorated further and went into cardiac arrest. The first handful of minutes of Kate’s code were rather uneventful. She had converted to PEA, was given 2 doses of epi and atropine, and had a down time of 6 minutes. Kate’s chest was being pumped repeatedly by one of the ER nurses while one arm dangled off the side of the table, bobbing in sync with each individual compression. Her chest caved in and her belly bounced outwards from the force of the strong chest compressions she was receiving. It took another round of drugs and 3 minutes worth of efforts, but Kate finally converted to a shockable rhythm. The paddles were charged to 300 joules, gelled, and pressed up against Kate’s bare chest. Once everyone backed away, shock #1 was delivered. The blonde’s body flopped quickly on the table in response to the dose of electricity, but no change was present on the monitors. CPR and ambu bagging resumed for a few moments while the paddles were being readied for the next shock. This time, the paddles were recharged to 360 joules, and the next shock was delivered. The stronger shock caused Kate’s feet to kick up above the table and crash back down, showing off the cute, delicate wrinkles in the soles of her size 8 feet. This shock sent Kate back into PEA unfortunately, so aggressive resuscitation efforts were resumed.

While Kate was fighting for her life, Maddie was taken up to the operating room to fix her leg. The surgery entailed a fasciotomy in order to restore blood flow to her leg, and surgical reduction with internal fixation of her fractured femur. She was sedated and intubated on the table, ready to go. The first step of her procedure was the fasciotomy. A large, 20cm incision was made on her medial thigh away from where the laceration from the open fracture protruded. The underlying subcutaneous tissue was dissected in order to expose the underlying fascia of her thigh. The next step was a longitudinal incision in the fascia itself along the line of the initial skin incision in order to expose the compartment. A small, transverse incision was then made over the intramuscular septum, with the incision extending over the anterior and lateral compartments. Following this step, the superficial peroneal nerve was identified in order to be protected and avoided, as severing/injuring this nerve can cause irreversible damage and complicate the procedure. Next, the fascia lying on top of the anterior compartment was incised further via extending the transverse incision over the intramuscular septum. Once this was done, the compartment was released successfully, and blood flow was almost instantly restored. With the fasciotomy complete, the team’s next focus was the femur fracture.

While Maddie’s surgical team shifted their efforts to the next portion of the surgery, Carly was a few doors down in a neighboring operating suite. While setting up the heart-lung bypass machine for Carly’s surgery, her vital signs started decreasing at an alarming rate. The team had to stabilize her vitals sufficiently in order to start the heart-lung bypass portion of the procedure. The OR team administered vasopressors intravenously in an attempt to increase her blood pressure and heart rate, but all the drugs seemed to do was buy Carly time instead of fixing the problem. Ultimately, Carly became pulseless, converting to v-fib. Internal massage was started immediately. One of the surgeons wrapped their hands around Carly’s weakly fidgeting heart and started squeezing, desperately trying to bring the young lady back. One of the surgical nurses detached the ventilator and attached an ambu bag to the breathing tube and began artificial respiration. The internal paddles were charged to 20 joules, lowered into Carly’s chest, and a shock was delivered once everyone stood clear. A dull, wet thump was heard in the operating room, but the shock failed to convert the young lady out of v-fib. The large, spoon shaped paddles were recharged to 30 joules and lowered back into Carly’s exposed chest cavity, promptly delivering the next shock. Carly’s body jolted more sharply this time due to the increased strength of the shock. Carly’s heart twitched for a moment, then stopped, then restarted. “sinus bradycardia on the monitors. We got her back.” One of the OR nurses said, feeling a bit relieved. With a pulse restored, the team upped Carly’s vasopressor doses, kept up fluid resuscitation, and began prepping her for bypass.

Back in the ER, Kate was still being coded. Her total downtime was 23 minutes, and she looked white as a ghost on the table. Through the blue tube holder, you could see that Kate’s lips were turning a paleish shade, and there was a bruise forming on the center of her chest from the lengthy resuscitation efforts. The trauma team had shocked Kate unsuccessfully 6 times since they converted her back to v-fib for the 2nd time. The heart monitors still showed v-fib, so the team recharged the paddles to 360 joules, and delivered yet another shock into Kate’s lifeless body. Her body thrashed around on the table before going still, but no change was shown on the monitors. The team shocked Kate yet again, but this time, Kate became asystolic. One of the ER nurses also noted fixed and dilated pupils. At that point, the trauma team made the tough decision and terminated the code, calling time of death at 8:53pm. The ambu bag was detached and the monitors were shut off. The EKG electrodes were disconnected, and a toe tag was placed before Kate’s body was covered up.

In the few hours after Kate’s death, Maddie was moved to the surgical recovery area, appearing to start her long road to recovery while Carly was still in the operating room being worked on. Carly’s ventricular septal defect was closed via multilayered suturing, and the ventricle incision was closed with a patch and fibrin glue. The surgical team began weaning the young lady off the heart-lung bypass machine. Fortunately, Carly’s heart was able to be restarted, and her chest was closed via sternal wire, and the skin incision was closed with suturing. She was then moved to the ICU for observation.

Both Maddie and Carly survived this ordeal after many months of healing and physical therapy. The two were naturally devastated when they were informed of Becca and Kate’s passing. What was supposed to be a fun night unfortunately turned into a tragic, painful memory for the 2 ladies.

[resus-defibme25]

I know that I have been away for some time but writing this today reminded me how much I love to write these stories for all of you. I hope you enjoy and look forward to sharing more soon. Graphic Warning!

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The holidays are a time to spend with family and celebrate. That was the plan for the Wilson's thanks to the long weekend they were headed down to their vacation home to spend time together as a family. There was a total of five adults in the family. The father is Mike Wilson who is 53 years old and had what many referred to as a "dad bod" and stood at five foot ten. His 49-year-old wife Kelly was an elementary school teacher standing at five foot four and had a slim build. The happy couple had three kids together. The eldest Connor was 26 years old and had recently landed his dream job working for a top law firm, when he wasn't working, he was at the gym and is very muscular and toned and towered over his dad at six two. The middle child was their first daughter Kylie who is 22 years old and was set to graduate at the top of her class. She went to college on a tennis scholarship and had a girl next door look to her with C cup breasts and long blond hair and matched her mother at five foot four. The youngest of the family is April a 20-year-old female standing at five foot two and was a competitive swimmer at her college. She was almost anorexic skinny and had B cup breasts with mid back length dirty blond hair.

The family loaded all of their bags into the car and hit the road. It was going to take about three hours to get to the vacation home. An hour had already passed and they were all laughing and singing along to the radio. It was rare for the entire family to have time together so this weekend was special to all of them. They were driving down the interstate when suddenly a semi truck broke through the barrier and headed straight towards them at a high speed. Mike paniced and veered to the right to avoid the collison. In doing so he positioned the car to be t-boned by the semi. The car crunched inward and skidded down the road about twenty feet before stopping. All of their bags flew around the car and the family thrashed around from the impact. Mike and Kylie took the brunt of the imapct and were knocked unconcious. Connor groaned in pain as he reached for his phone to dial 911. The operator dispatched several EMS and fire departments to the massive crash. Within a couple minutes the fire department arrived on scene. The truck driver hobbled out of his truck to check on the Wilson's. One of the firefighters pulled him to the side as the rest of the crews went to work extracting the family. They were able to pry open the front passegers door and Kelly started to scream hysterically "My husband, check on my husband please." The firemen reached across Kelly and pressed two fingers into his neck to check for a pulse. Finding none he knew that he must have been killed on impact. "We will take care of your husband but first we have to get you out." he said calmly attempting to console her. Kelly was able to get out of the vehicle with little assistance and complained of arm pain and had a large gash to the right side of her head where she must have slammed it on the side window. The sat her down on one of the steps of the firetruck and dressed her head wound.

The fire department had to use the jaws of life to pry the door off of the back passenger side door. Upon entrance Connor on the right side was the only one conscious but his legs had been pinned to the seat in front of him. After careful maneuvering they placed a c-collar and blackboarded him out of the vehicle. His left arm had a bone sticking out of it and he couldn't move his legs. They moved him ten feet away from the car before placing him on the asphalt. Next, they had to extricate April who had been sitting in the middle of the two siblings. She had not been wearing a seatbelt and was face down on the console in front of her. They placed a c-collar and extricated her with a backboard and placed her a few feet from her brother. They cut off her blood-soaked white top exposing her perky breasts and severe bruising to her chest and abdomen. The had a large gash across the top of her head which was dressed her right leg was fractured badly so an inflatable brace was put onto stabilize it. Finally, the fire department attempted to get Kylie out. She had a piece of glass lodged in the left side of her neck and her left arm had been crunched together and was likely beyond saving. Upon placing a c-collar and extricating her they placed her by her little sister and snipped away her hoodie and placed leads across her chest.

With all of the family members extricated they placed a yellow sheet over Mike and waited for the coroner's office to arrive. Three ambulances were on scene with multiple crews attempting to stabilize the remaining four family members. After bracing Kylie's left arm in an orange inflatable cast and placing gauze around the shard of glass in her neck, they started an IV in her right arm. After starting fluids, the paramedic at the head felt for a pulse. "No pulse, start CPR please." the medic called out as the monitor went into v-fib. The other paramedic centered their gloved hands in the middle of her bloodied chest and began deep rhythmic compressions. Her breasts shook which each compression and her stomach pushed outwards. The defibrillator was charged to 200 joules and gelled. Placing the two metal paddles on her chest the first shock was delivered. Her body twitched with the electricity before going still. There was no change on the monitor so the defib was charged to 300 joules and a round of epi was pushed as CPR continued. The second shock was sent through her dying body causing a sharper reaction as her back lifted slightly before crashing back down. Her breasts rippled with the impact before her heart went still and asystole traced across the monitor. Deep violent chest compressions were resumed as the desperate resuscitation attempt continued.

Connor was stabilized and loaded onto a gurney before being loaded into the back of one of the ambulances. His mother was escorted into the ambulance as they blocked the car and her two daughters from her view so that she did not see the graphic scene. The mother and son talked on during the ride and started crying together not knowing the full extent of what had just happened. Connor was not in only his black boxers and had leads across the chest and an IV with fluids flowing into him. He remained stable throughout the trip.

April was losing blood at a rapid rate and the paramedics had little that they could do to help. The gauze on the top of her head had to be replaced every minute or so. They decided that they best that they could do to save her was to get her to the hospital. Luckily a med evac helicopter had landed at the time that they had loaded her onto a gurney. They loaded her into the ambulance and the flight team took over. Upon taking off the flight medic placed a foil sheet over her and intubated her to maintain her airway. Shortly after takeoff April deteriorated into v-fib. The flight medic cracked out the Lucas and placed one piece under her back and the unit above her chest. He snipped away her bra as her small breasts fell to the sides. The plunger was lowered to her chest and upon being flipped on the unit gave perfect compressions. Epi was pushed into her IV in and the defib pads were placed on her bare chest. After it charged to 200 joules the Lucas was stopped and the shock was delivered her small body twitched with the shock before going still again. The Lucas continued CPR as the defib was charged to 300 joules. The second shock caused her chest to press against the plunger of the machine and fall back down. There was still no response as the flight medic muttered "come on girl you're too young for this" as he charged the defib to 360 joules and delivered the third shock. Her body shook with the shock and then returned to its original position. The monitor showed normal sinus rhythm as the flight medic let out a sigh of relief "now hang in there girl were almost there" the Lucas remained on April in fear of another arrst.

"Shocking" announced the paramedic as the fifth shock was delivered to Kylie as her battered and broken body bounced on the roadside. She had been in full cardiac arrest for 11 minutes. As her body went still her heart began to beat slowly and then began to normalize. They scooped her into the ambulance and rushed her to the hospital. Less than three minutes into the ambulance ride Kylie went into her second cardiac arrest. One of the paramedics began CPR by placing his hands on the fresh bruise from where her chest had been compressed for over ten minutes. The paramedic at the head continued ventilations with the ambu bag that was attached to the ET tube which was secured by a blue tube holder. A round of epi was pushed and it took almost a minute for v-fib to be acquired. They charged the defib to 360 joules as they gelled them and rubbed them together. Placing the cold metal paddles on her bare chest they shocked Kylie once again. Her legs kicked up and her toes crunched up showing off the wrinkles on her small feet before relaxing again. With no change they recharged the defib as CPR continued. The second shock was delivered as her right arm shot off the gurney and her left stayed in place due to the orange brace. After the shock Kylie luckily converted to normal sinus. The paramedics prayed that they were almost to the hospital as Kylie had now experienced two full cardiac arrests and they were unsure if she would survive or not.

Connor was rolled into the hospital and placed in the large trauma room that had six beds each separated by a curtain. Once he was transferred onto the trauma bed they cut away his boxers leaving him nude on the bed. They ordered scans of his entire body and wanted to get him a CT scan. They log rolled him onto his side and pressed on each vertrebrae. The doctor knew that he was most likely paralyzed due to catastrophic spinal cord injury. Connor began to drift in and out of consciousness as his heart monitor displayed bradycardia. The medical team attempted to stabilize his heart rate but he completely loss consciousness. They then elected to intubate Connor to preserve his airway. There was a dark bruise starting to form on his abdomen right where his seatbelt was. "Shit, he might have internal bleeding too, get an ultrasound set up, this guy is in much worse shape than I thought" the attending ordered.

Kelly had her head wrapped in gauze and was given a sling for her arm until x-rays could be taken. She was in her own room when she saw her daughter April being wheeled past her room with a large machine on top of her. "Oh my god, is April okay?" she asked the nurse. "The doctor's are doing everything they can for your family, I need you to stay calm, I will go check out what is going on and come back okay?" the nurse replied leaving the room. Kelly agreed but thoughts kept racing through her mind.

April was wheeled through the hallways of the hospital to the trauma room and placed on a bed directly across from Connor. "20-year-old female t-boned by a semi-truck, she wasn't wearing a seatbelt. Went into cardiac arrest in flight which lasted four minutes in total, one round epi and multiple shocks required. Stable since." The med flight medic said as they removed the Lucas and transferred April onto the bed. She now laid completely nude on the bed with wires and tubes across her body. A round of x-rays and blood tests were called for, upon checking her pupils they requested a neuro consult after noticing her left pupil was blown and her right was sluggish. After the x-rays were completed, they palpitated her abdomen which was firm to the touch as she likely had internal bleeding. The x-rays showed that April had multiple broken ribs and her right leg was broken in two different places. Her complexion was starting to fade, and her oxygen levels were decreasing. Upon further assessment it was noted that her lungs were not inflating properly so a chest tube was called for and was to be placed in her right side. Betadine was splashed on the side of her chest and the attending made quick work of the placement. A large amount of air rushed out before thick dark red blood poured onto the floor. As this happened April's heart gave out and she went into PEA. CPR was immediately started, and the first round of drugs were pushed. After three minutes April converted to v-fib as the defib pads were ripped off her chest and the paddles were charged to 300 joules. The attending took the paddles in his hand as a nurse applied gel to them. Rubbing them together the unit alerted that it was charged, he placed the paddles onto her bare chest as everyone backed away. Her arms flung outward, and she formed loose fists as the shock coursed through her body. There was no change after the first shock so CPR was continued. Her arms that had fallen off the bed bounced with each compression as her body shook on the bed. A moment later the defib was charged to 360 joules and were placed back on her battered body. The increased voltage caused April's petite chest to bounce off the bed before slamming back down. The second shock had the same effect as the first as a male nurse resumed CPR on the young woman. The paddles were gelled and charged for the third time and placed on her chest again. This time her arms scrunched in and her left leg jumped off the table before crashing back down. The third shock sent April into asystole as CPR was resumed.

At the same moment that April was receiving her third shock Kylie was being rolled into the hospital doors. Unfortunately, Kylie had crashed once again and was in asystole. The paramedic straddled her on the gurney to continue compressions. Her right arm dangled off the side of the gurney and bounced rhythmically with each compression. As they rolled Kylie down the hallway she was taken right past Kelly's room. At the sight of her daughter being resuscitated she jumped off the bed and followed them. The paramedics and Kelly entered the trauma bay as they gave the update "22 year old female involved in MVC suffered an arrest on scene lasting 11 minutes and then coded again in the rig for 6 minutes, entered her third cardiac arrest as we rolled her in." They transferred her onto the bed directly next to Connor with a curtain separating them. CPR was taken over as drugs were pushed. A chest tube was started on the right side as Kylie passed her two minute mark. A round of drugs were pushed and a few moments later she converted into v-fib. The paddles were charged and gelled and placed directly onto the same spots that still glistened with residual gel from her past defibrillations. Her body bounced around the bed as her mother watched in horror. With no effect CPR was resumed and the paddles were recharged.

A nurse approached Kelly telling her that she couldn't be in the trauma bay. "These are my children" she yelled. The nurse urged her to return to her room but ultimately allowed Kelly to stay in the corner. She watched as Kylie was defibrillated two more times before returning to asystole and CPR resumed. She watched her body take a beating from the intense resuscitation. As she tried to look away she noticed that April was a few beds away. As she went around the curtain April came crashing back down from a defibrillation and her body shook with the impact. April had now been down for over ten minutes as she returned to asystole. It was all becoming too much for the mother to watch and she turned her back. She saw Connor laying flat on his bed as a nurse pressed their fingers into his neck. "No pulse begin CPR" the nurse said. She now had three children in full cardiac arrest. One in their first cardiac arrest, the next in their second cardiac arrest, and the last in their third cardiac arrest.

Connor deteriorated from bradycardia to v-fib as a nurse centered their hands in the center of his tone chest. Each compression caused his ribs to cave in as they fought to get his heart to beat again. The defib was charged to 200 joules as the paddles were gelled. Placing them on his bare chest they discharged. His whole body of which he was unable to move on his own now twitched on the bed from the electricity. With no change the paddles were charged to 300 joules and he was shocked again. His body shot off the bed and crashed back down. The only body part that stayed in place was his head that was kept in place by his c-collar. Connor was shocked another two times before converting into asystole. More drugs were pushed into his frail dying body as aggressive CPR ravaged his chest.

In the bed next to Connor they were squirting betadine across Kylie's chest as they made one last desperate attempt to save her life. The scalpel slid across her skin separating it. Layer by layer they cut away until they could see her ribs, a saw was called for as they cut away at her ribs to gain access into her thoracic cavity. As they entered the cavity a large amount of blood poured out onto the floor. The attending took his gloved hands and wrapped them around Kylie's still heart. He used his own hands to beat her heart for her. Each compression showed up on the monitor as the doctor was able to watch his own work. A syringe was inserted directly into her heart as drugs were used once again to convert her into a shockable rhythm. It took two minutes of internal massage for Kylie to convert into v-fib. Once she did the internal paddles were charged to 20 joules. The spoon shaped paddles were placed directly on her heart. Pressing the shock button her body barely twitched as her heart took the full force of the shock. There was no change after the first shock so internal massage was continued as the paddles were recharged to 20 joules. The next shock let off a dull wet thunk as Kylie fought for her heart to beat again. With still no change a nurse took over internal compressions while the attending looked for the cause of her arrests. He found that one of her arteries tore off of her heart. He carefully sutured it back on and charged the paddles to 30 joules. The bloodied paddles were placed into her chest one more time as her heart was shocked with everything the medical team had. Her toes scrunched as her hands bounced. Her body went still after the shock as did her heart. Kylie had now been down for 18 minutes during her third traumatic full arrest. "Does anyone have any ideas?" the attending asked as the nurse continued internal massage. The room fell quiet as the attending shined his light into her bright blue eyes. "Fixed and dilated. Time of death 5:38 PM. Thank you everyone." The attending announced as the nurse removed their hands from her chest. The monitors were switched off and the ambu bag was detached. The closed her eyes for the last time as they draped a toe tag on her big toe. Finally they placed a white sheet over her ravaged body.

A few beds down the newly deceased womans sister April was still fighting for her life. She had been down for almost twenty minutes, she was shocked twelve times and received numerous rounds of drugs with continuous CPR. The neuro consult finally arrived to the horrific scene as he did a quick assessment. "There is brain matter coming out of her skull, her pupils are blown. I think she's gone." he said as he walked away. The attending wanted one more attempt. He took a large syringe and filled it with epi. He placed it directly over her heart as he slowly lowered it into her chest. After pushing the epi April converted to v-fib at her 22 minute mark. He gelled and charged the paddles to 360 joules. He placed them back on her bare chest and shocked her. Her body flopped around on the table before going still. With no change April was shocked three more times. The final time the attending rubbed the paddles together and muttered "come on, you're too young for this" something she had already heard. He placed the paddles on her chest, pressing them into her he pressed the shock button as her chest heaved into the air and came crashing back down. The monitors went flat for the final time. At the 27 minute mark of April's code she was pronounced dead. "Time of death 5:48 PM" the attending announced. The nurses cleaned April up just as the others had just recently cleaned up her older sister. They placed the toe tag and draped the sheet over her body.

Connor was a much less exciting cardiac arrest. After the eight minute mark of his code they were unable to cardiovert him for the next nine minutes. After they had maxed him out on drugs he converted to v-fib one more time. The shocked his nude dying body four times before he ultimately flatlined. "Time of death 5:58 PM." the attending announced. Again a group of nurses disconnected everything and gave the same treatment to Connor as they did to his younger sisters.

As all three children of Mike and Kelly laid dead in the trauma room a nurse went over to a corner where she found Kelly on the ground. Upon trying to wake her she noticed that her lips were blue and she was cold to the touch. A doctor came over and confirmed that she must have passed away over fifteen minutes ago. Any attempt to save her at this point would be futile. They moved her onto the bed next to April's body and placed a toe tag and covered her with a sheet after pronouncing her dead. All four family members would later be moved to the hospital morgue where there father had already been transferred to. The entire family perished in a tragic accident on a day that was supposed to be filled with fun and memories.

[resus-defibme25]

The Circle of Life

The ER is a unique place for many reasons, but one of the things that makes it most unique to me is that it’s a place where people are born, and occasionally a place where people die. In the case of last shift’s events, it was a place where both took place.

Our patient was 31 year old Allie Snyder. She stood at 5’6 with an average build, pin straight brown hair, big blue eyes, and 36 weeks pregnant. Allie and her fiancée Andrew were expecting their first child together, and were ready to welcome their baby girl into the world in just a few weeks. Allie’s pregnancy was relatively uneventful and everything seemed to be going according to plan. But last night, Allie started experiencing shortness of breath and severe abdominal pain around 2:30AM. Her fiancée Andrew grew concerned by the sudden onset of these symptoms, so he called 911.

A short while later, Allie was in our emergency department. Upon arrival, she was still short of breath and complained of severe abdominal pain, but her blood pressure was 70/40, a fetal heart rate of 192bpm, and her oxygen saturation dropped down to 89%, even though she was wearing an o2 mask.

The usual team and I quickly began examining Allie once she was transferred onto the trauma room table. “let’s run a full battery of tests. CBC, BMP, tox screen, HCG, d-dimer, and cardiac enzyme test.” I ordered the nurses. “Let’s get an ultrasound too, we need to see what’s going on with the baby and the reproductive structures.” Dr Lindsay added. Dr Sarah also added that we should prepare to do an emergency c-section in the event we couldn’t stabilize Allie.

Nurse Ashley drew the labs, which ended up being quite a few vials of blood while nurse Nancy prepared the ultrasound machine for Dr Lindsay. The cool ultrasound gel was squirted onto Allie’s big pregnant belly, with Dr Lindsay grabbing the ultrasound wand and spreading the conductive gel around a bit. “Ok… baby’s fine for now. I don’t see evidence of a uterine tear or rupture. no signs of placenta previa or accretia, fallopian tubes are open and intact so we can rule out a blocked fallopian tube or ectopic pregnancy. I don’t know guys, are you seeing something I’m not?” Dr Lindsay said, more or less thinking out loud while trying to assess the patient. I personally didn’t see anything abnormal, and neither did Dr Sarah, so we felt we needed to treat her symptoms and keep her reasonably stable until we could get her lab results back.

Since her blood pressure was low, we decided to hang a bag of normal saline into her IV line. As for her shortness of breath, we kept her on the o2 mask with high flow oxygen. Her oxygen was still hovering around 90% though, so it wasn’t quite where we wanted it to be.

“Hey, one of you should probably talk to the boyfriend. He’s pacing around the waiting room asking questions.” Nurse Heather said to us, just popping into the trauma room for a moment. Dr Lindsay nodded and said she’d step out of the trauma room to go talk to Andrew and tell him what was going on.

“Hi, you must be Andrew? I’m Dr Lindsay, I’m one of the ER doctors here.” She said, politely introducing herself. “How’s Allie? Is the baby ok?” a concerned Andrew asked Lindsay in response. “we’re doing what we can to stabilize Allie and the baby. Allie’s blood pressure is low and the baby’s heart rate is high…” Lindsay said before being interrupted. “shes’s unstable? What’s happening?!” Andrew shouted. “we performed an abdominal ultrasound and everything was normal. We ran a battery of tests to see…” Lindsay responded before an upset Andrew interrupted again, taking what Lindsay said out of context. “normal?! This isn’t normal! What did the tests say?! We need to know!” Andrew demanded. “the tests were sent off to the lab. They’re being run as fast as possible, but it still takes time to run them properly. I know this is scary and I can’t imagine what you’re going through, but your fiancée and baby are in good hands.” Lindsay replied, trying to calm the man down and empathize with him a bit.

Andrew paused, nodded, and took a seat in a chair in the empty waiting room. “yeah. You’re right. I’m sorry about how I acted just now. It’s just that this all came out of nowhere, ya know?” Andrew said to Lindsay. “I totally get it. I’m gonna head back to the room and see how she’s doing. Once we get any updates, I’ll come back to let you know, ok?” Dr Lindsay replied, to which Andrew nodded, before walking away.

When Lindsay got back to the trauma room, she was surprised at what she saw. Allie had started bleeding vaginally, and quite profusely. The bed was saturated in blood, and began to drip onto the floor. “what happened?!” a concerned Dr Lindsay asked. “she started hemorrhaging a few minutes ago. We pushed rhogam and hung a unit of B+ to start transfusions.” I replied to her. “where’s she bleeding from?!” Lindsay asked, surprised. “no idea. We’re working on that.” Dr sarah responded.

On the bed, Allie was groaning in pain, with one hand on her large protruding belly. “please… save my baby…” Allie pleaded to the team in a weak, frail voice. “we’re gonna try to save both of you sweetie, ok?” nurse Nancy replied to Allie, holding her hand in an attempt to reassure her. “I know I’m gonna die… just save my baby…” Allie replied, with an impending sense of doom. “you’re not gonna die hun, don’t say that!” Nancy replied, even though Allie was deteriorating rapidly. The monitors began chirping loudly, showing that Allie’s blood pressure was taking a nosedive. She took a few deep breaths before weakly saying “tell Andrew…”, before fading away into unconsciousness. “tell Andrew what, hun?” nurse Nancy asked. “PEA, starting compressions!” I shouted. I began pumping away at the young mother’s chest. Her blue eyes were still open, still looking at Nancy as her head bobbed a bit in sync with the compressions I was giving. Dr Lindsay then tilted Allie’s head the other way to begin rapid sequence intubation. Nurse Nancy looked a bit she’ll shocked for a moment, but she snapped back into it and went to the drug cabinet to get the first dose of epinephrine and atropine. Meanwhile, Dr Sarah wanted to perform an emergency c-section, so nurse Ashley was setting up the proper equipment.

Intubation was just completed at the other end of the table by Dr Lindsay. She was able to secure a 7.0 ET tube into the woman’s airway, and secured it with a blue tube holder. Nurse Ashley then took over ambu bagging so Dr Lindsay could assist Dr Sarah.

Meanwhile, I continued CPR. I felt the woman’s ribs pop underneath my gloved hands, along with her cold skin. The monitors showed v-fib though, so we put the c-section and compressions on pause so we could deliver a shock. The paddles were charged to 250, gelled, and pressed up against Allie’s bare chest. Once everyone stood clear, the shock was delivered. A thunk was heard from the shock. Allie’s chest shot upwards and her back arched, but the shock failed to produce ROSC. “still in v-fib. Charge to 300.” I ordered the team.

The paddles were recharged and the next shock was delivered. The patient’s lifeless body jolted around on the table in response to the shock, but v-fib still persisted. “no change! Hit her again at 360!” I shouted out to the team. This 3rd shock caused Allie’s feet to leap up above the table by an inch or two, before crashing back down a moment later, showing off the thick, silky wrinkles throughout the soles of her size 9 feet. “PEA, resuming compressions!” I called out, re-starting deep, strong compressions. “pushing epi and atropine.” Nurse Nancy called out.

With the code going back to PEA, Sarah decided to perform the emergency c-section. Dr Lindsay lathered Allie’s big belly with betadine while Sarah picked up the scalpel.

Sarah made a midline incision beginning just below the belly button, extending it downward a few inches, and just ending up a bit before the pubic symphysis. Lindsay grabbed the retractors off the c-section tray and pulled horizontally on the incision with the retractors to give Dr sarah a better line of sight. Since Lindsay’s hands were full, Dr Sarah asked nurse Nancy for some assistance. “nancy! Since Lindsay’s hands are full, can you come over here? I need you to reach into her belly and pull her bladder inferiorly. I need to cut her uterus open, and I don’t wanna hit the bladder in the process and cover us in pee.” Dr sarah said to Nancy, to which she nodded before stepping over. Dr Nancy reached into the incision area, reaching for the young woman’s bladder, pulling it downwards with one hand and keeping it in place with the other. With the bladder out of the way, Sarah made a small vertical incision through the lower uterine segment. She then reached for a pair of scissors to extend the incision vertically to the fundus. This created a large enough opening to deliver the child.

With one hand, Dr Sarah retracted the uterine tissue and with the other hand, reached in the uterus, grabbing ahold of the baby, removing it head first. The baby wasn’t crying at first, so Sarah yelled for someone to suction the nose and mouth. The child had some amniotic fluid and meconium in it’s mouth, but that was quickly ameliorated and the baby started crying. Dr Sarah then cut and clamped the umbilical cord, before handing the baby off to Nurse Nancy who took the crying little girl and moved her to an incubator nearby. Dr Lindsay then removed the retractors, while Dr sarah simply packed the incision area with surgical sponges. In c-section a where the mom is coding, the goal is to get the baby out, then restart the mom’s heart, then focus on closing if ROSC is obtained.

However, PEA still persisted and Allie had a down time of 20 minutes at this point. Her eyes were still open, staring blankly up at the ceiling. Her body was ice cold to the touch, and her breastbone was bruised from all the compressions I’ve been delivering. Her c cup breasts jiggled in sync to the compressions I was giving, but it didn’t seem that anything we were doing was working.

Since I grew tired, I took over ambu bagging and ashley stepped in to deliver CPR. With a fresh set of hands now, she delivered deep, fast compressions on Allie, making her chest cave in. We pushed another round of epinephrine and atropine, and pushed the first dose of bicarb, hoping that we could reverse the outcome of this code.

We coded Allie for another 10 minutes, bringing her total down time to approximately 30 minutes, but she never converted to a shockable rhythm. She was asystolic, and had fixed and dilated pupils. At that point, we terminated the code and called time of death at 3:36am.

We detached the ambu bag and turned off the flatlined monitors. Nurse Nancy wheeled the incubator out to take the baby up to pediatrics while basic postmortem care began. “I’ll talk to the husband.” Dr Lindsay said in a defeated tone, before throwing her blood soaked gloves and gown in the trash before exiting the room.

Lindsay made the walk over to the empty waiting room where Andrew was still waiting. “how is she? Is the baby ok?! What’s the tests say?!” Andrew said, jumping up out of his chair, eager for news. “Andrew, let’s sit down for a moment.” Dr Lindsay said, taking a seat next to him, putting her hand on his back. “Andrew, there’s no easy way to say this… but Allie passed away.” Dr Lindsay told the young man. His eyes began tearing up instantly, and he began nodding his head. “What happened?” he replied in a choked up voice. “she began bleeding profusely, and we couldn’t control it fast enough. Her heart eventually stopped beating, and we unfortunately couldn’t restart it.” Lindsay told Andrew. “what happened?! Is the baby ok?!” he exclaimed, tears beginning to fill his eyes. “yes, the baby girl is ok. We’re taking her up to pediatrics for observation due to the nature of the delivery, but we expect her to be ok. As for what happened to Allie… I don’t have an answer at the moment. The blood tests didn’t tell us anything noteworthy, and we couldn’t make a diagnosis otherwise. I’d personally recommend an autopsy to further look into what happened to Allie. But Andrew, I’m so sorry for your loss.” Lindsay replied to the distraught man.

Back in the trauma room, the team was just finishing up basic postmortem care. A cover was placed over Allie’s body, and a toe tag dangled in front of her pretty feet.

Allie’s autopsy revealed that she passed away from an amniotic fluid embolism. Amniotic fluid embolisms are hard to diagnose and manage due to the rapid onset of symptoms, and the clinical rarity of it. On top of that, this condition has a mortality rate of 80% according to most studies. There’s also no standardized treatment for the condition, so physicians tend to treat the symptoms that they observe rather than the big picture problem, which was exactly the case for us. Regardless, this was a tragic case for everyone involved that we won’t forget any time soon.

[resus-defibme25]

Fatal Fix

*hey everyone! Here's another new story. Enjoy!*

We had just gotten through a busy evening in the ER. It seemed like we had a steady drip of people coming into the emergency department between 8-10pm. We didn’t have any critical patients, but our personnel and resources were spread thin for a couple hours. But once all the patients were discharged or handed off to all the appropriate departments, our small community ER became a ghost town. Me and the usual team were all hanging out at the main nurses station, just chatting and catching up with each other. Nurse Ashley was telling us about how her and her boyfriend Vincent just booked a trip to Orlando to go to Disney and universal, while nurse Nancy talked about how her daughter was recently accepted into university for nursing- following in her mother’s footsteps.

Our chatter came to an abrupt halt when we got a call from dispatch. “oh, what now?” dr Lindsay complained. “can’t this person die later or something?” Nurse heather said with a chuckle, half joking but half serious, feeling a little burnt out from the ER being busy earlier in the evening. Nurse Nancy picked up the phone and answered the call from dispatch. After a brief phone call, nurse nancy let us know what was said. “ok guys. 28 year old female, looks like it’s an OD. They Narcanned her on scene, but she’s still a bit groggy and her vitals are unstable. The medics were told she snorted some cocaine, but since she responded to narcan, that may not be the case. ETA is 5 minutes.” “alright, let’s get trauma 1 ready. Let’s make sure we have an intubation tray and a crash cart in there just in case.” I said, taking charge. “and I’d make sure we run a stat tox screen- we need to know what we’re dealing with, so the lab definitely needs a heads up.” Dr Lindsay added.

We all sprung into action and started getting the room ready for our incoming patient. Nancy, Ashley, and Heather all started making sure we had sufficient amounts of meds and other supplies we may need for an overdose case. Dr Lindsay and I put on a fresh gown and gloved up and began supervising the nurses while they got our trauma room ready.

By time we got the room ready, the ambulance pulled in. On the stretcher was 28 year old Jade. She was a tall, thin girl who had jet black hair and short bangs. She had big blue eyes, and colorful tattoos all over her body, creating some contrast between her pale skin. She had tattoo sleeves on both arms, a sternum tattoo, a large neck tattoo, and tattoos up and down both legs. She also had piercings in both nipples, and she had gauges in both ears. She was a beautiful girl, but not in the conventional sense.

When Jade was brought into our ER, she was actively seizing on the stretcher. Her eyes were wife open, staring up above with a pained look on her face. She was grunting and groaning, and foaming slightly at the mouth. Her toes were curled on the other end of the stretcher, showing off the prominent, silky wrinkles throughout the soft soles of her size 9 feet. There was a bite guard placed in her mouth in order to prevent injuries to her tongue and lips. Her vital signs were all out of whack too. Her heart rate was in the 170s and climbing, and her EKG was abnormal. It was somewhere between sinus tachycardia and v-tach, but something else didn’t look quite right, so we knew we needed to slow her heart down in order to improve her vital signs. Just like dispatch told us, the medics were informed that Jade had snorted cocaine at a party on multiple occasions tonight, but felt that assessment was either incorrect, or the cocaine had something else in it.

After the medics gave us all pertinent information, they helped us move Jade onto the table before exiting the room. She continued seizing on the table during our initial examination of us. “pupils reactive but constricted.” Nurse nancy said after shining a pen light into the patient’s eyes. “let’s run a stat tox screen, a CBC, and a BMP.” Dr Lindsay called out. Nurse Ashley was able to draw the 3 vials of blood necessary for the lab tests, but it was tough since the patient was essentially a moving target. “alright, let’s push a round of lorazepam to see if we can calm this seizure down.” I ordered the team. Nurse heather was responsible for meds this time, so she pushed a round of lorazepam into Jade’s IV. Typically, anticonvulsants take anywhere from 30 seconds to 2 minutes to work, so we had to play the waiting game.

Luckily, the meds worked sooner rather than later. Jade’s violent thrashing came to a gradual stop shortly after the medication was administered. However, her heart rate was still dangerously high, and her oxygen saturation was decreasing while a foam cone started to form around her mouth. “let’s get some suction in here. I think she’s choking on all that foamed up saliva.” I called out, to which nurse Nancy responded promptly. A slurping sound was heard from the suction tube removing the excess foamy saliva that was blocking jade’s airway. Jade’s oxygen saturation improved a bit, but Dr Lindsay felt we should intubate for the sake of airway management. Nurse Ashley set up an intubation tray for dr Lindsay. She picked up a laryngoscooe and a 7.0 ET tube and began the intubation process. Dr Lindsay carefully navigated the tube to the correct depth, pulled out the stylet, and held the tube in place until nurse Nancy taped it in place. The ET tube was hanging out the left side of Jade’s mouth, while the bite guard was still on the right side. Jade’s eyes were still wide open during this whole process, so it looked as if she was watching us work on her. An ambu bag was attached to the end of the ET tube, and Nancy began ambu bagging.

Post intubation, Jade’s oxygenation improved, but her heart was still racing. “She’s in stable v-tach. Let’s see if we can chemically cardiovert her.” Dr Lindsay said, looking at the monitors. “I agree. Let’s push a round of magnesium sulfate and a round of dofetilide.” I added. Nurse heather got the meds ready and pushed them intravenously. We waited to see if the meds worked, but the only discernible change in her condition was an EKG change. There was a widening QRS complex along with a heart rate that was now in the 180s. “I think we need to continue chemical cardioversion. Lets get some calcium channel blockers and amiodarone and see if that does the trick. And any news from the lab?” Said dr Lindsay. Nurse heather once again got the meds ready and pushed them. “no news from the lab. We gotta give them some time.” Nurse nancy replied. “I don’t know, time’s not on our side here. She’s gonna be circling the drain pretty soon if we don’t know what we’re dealing with.” Dr Lindsay replied. “Is there anything we can do to buy her some time?” nurse ashley asked. “well, not really since the chemical cardioversion doesn’t appear to be doing anything.” I responded. “hey… I don’t feel a pulse.” Nurse nancy said, shaking her head. “crap… pulseless v-tach. Someone start compressions. Charge the paddles to 150!” I called out, a bit flustered.

Dr Lindsay began deep, strong chest compressions on our cute, tatted up patient while Ashley charged the defib paddles to 150 joules. Jade’s skinny chest caved in from the force of the compressions and her belly rippled outwards. One of her arms fell off the side of the table and began bobbing in sync with each individual compression. “paddles ready dr Kenny” nurse ashley said, handing me the defibs. I rubbed the paddles together to spread the conductive gel, then pressed the paddles up against Jade’s bare chest. Everyone backed away in anticipation of the shock. Once I knew everyone backed up, I pushed the shock button. Jade’s chest shot up quickly and returned to its precious position in the course of a second or two. “no change.” Nurse nancy said, shaking her head. “ok, recharge to 200.” I tell ashley.

Dr Lindsay resumed compressions in the meantime. “1… 2… 3… come on now…” she said, thinking out loud while pumping away at the young lady’s bare chest. “ok. Everyone…. CLEAR!” I called out. Jade’s body flopped on the table in response to the quick jolt of electricity, but she remained in pulseless v-tach. “No change, resuming compressions.” Dr Lindsay said, shaking her head. “let’s push a round of epi and atropine, then shock again in a minute or two if that doesn’t get her back.” I ordered. Nurse heather nodded, and injected epinephrine and atropine into Jade’s IV line. “meds in dr kenny" she said.

Dr Lindsay grew tired from performing several cycles of compressions, so nurse ashley swapped in and began delivering chest compressions. Nurse Ashley delivered strong compressions with interlocked fingers, causing Jade’s chest to recoil in response. After 2 more minutes of compressions, we did a pulse check. Jade was still in pulseless v-tach, so we decided to shock her again at 250 joules. The paddles were gelled, charged, and pressed back up against the lady’s bare chest. Once everyone backed away, we delivered the next shock. Jade’s feet kicked up above the table and slammed back down half a second later, showing off her cute, wrinkly soles. “she’s in v-fib.” Dr Lindsay called out, shaking her head while looking at the monitor. “resuming compressions…” nurse Ashley announced.

We now knew the code was going to be a longer one, so our optimism began to decrease. Typically, if patients don’t come back after the 1st or 2nd shock, they end up toe tagged and in the morgue. But we were still determined to give our beautiful patient a shot at survival.

The code continued and we shocked Jade 2 more times unsuccessfully, with a total downtime of 14 minutes. “hey, we got lab results.” Nurse nancy called out while we continued coding our patient. “cocaine and fentanyl OD.” She continued. “fentanyl is some nasty stuff. But I guess that explains all this.” I replied, in reference to the code blue. “let’s push another round of epi and atropine, and let’s get a round of bicarb in there.” I continued. Nurse heather pushed all the requested meds intravenously.

The meds failed to obtain ROSC, but it maintained v-fib, so we decided to charge the paddles to 360 and shock jade yet again. The paddles were charged, gelled, and placed back onto her bare chest, and the next shock was delivered. Jade’s pasty, lifeless body flopped on the table in response to the shock. “still nothing, let’s hit her again.” I said. We recharged the paddles and repeated the same process. The next jolt of electricity caused jade’s limp body to twitch on the table in response, but v-fib still persisted.

The code became redundant at this point. CPR, shock, v-fib, meds, repeat. We repeated this process for several minutes, but Jade remained in v-fib. We discovered fixed and dilated pupils, and Jade has been down for 22 minutes. At that point, we ceased resuscitation efforts and called time of death at 12:39am while Jade was still in v-fib.

Nurse Nancy detached the ambu bag and gently closed Jade’s eyes for the final time. Ashley stepped away from the table since she was the one delivering compressions. Jade’s sternum tattoo looked a bit discolored from the bruising from the 22 minutes worth of violent compressions she received from us. We then shut off the chirping monitors and disconnected the EKG electrodes from her chest. We placed a toe tag on the big toe of Jade’s left foot, and then covered up her body. She was then taken up to the hospital morgue, becoming yet another drug casualty.

[resus-defibme25]

Aussie lived by himself and had never really had any medical concerns. That all changed one morning when he was taking a shower before heading to work. As he stepped out of the shower he reached over for his towel when there was a sudden intense pain in his chest. He grabbed his chest as his vision went dark and he crashed onto his bathroom floor. His nude damp body laid there for a small period of time. Fortunately for Aussie his good friend and neighbor Ella is a paramedic and when she was leaving her house she saw that his car was still in the driveway. It was a strange sight because normally he would have been gone before she left. She walked over to his door and knocked a few times calling out his name. She knew were he hid a key and quickly entered the house. She kept calling out his name and made it up to his bathroom. She tried to open the door but felt it collide with something heavy. "Aussie you okay its Ella?" She pushed again and saw that it was Aussie naked on the floor. She quickly used all of her weight to burst into the bathroom and kneeled beside his body. She felt for a pulse and upon finding none she quickly centered her hands on his bare chest and pushed down hard and fast. With each compression she muttered under her breath "1,2,3,4,5..." all the way to thirty. After thirty compressions she tilted his head back and gave him two quick rescue breaths. She felt for a pulse again and started to panic when there wasn't any. She remembered that he had an AED in his bedroom and left him momentarily to run and find it. After grabbing the AED she returned to his side and opened it up. She wiped down his chest with a towel before placing the large pads on his chest. The AED whined to life as it read out "Stay calm, do not touch patient analyzing" After a few moments it read out again "Shock advised, do not touch patient, charging". Each moment felt like an eternity as she looked up and down Aussie's nude body before snapping out of it. "Press flashing shock button" Ella pressed the button as Aussie jerked around on the floor slightly before going still again. "Resume CPR" the AED read out. She centered her hands again and resumed CPR. "Come on Aussie don't do this" she pleaded. After three rounds of CPR and rescue breathing she realized she had never called 911 since she was so used to responding to calls instead of making them. She pulled out her phone, dialed 911, and placed it on speaker phone. She gave all the necessary information and pleaded for them to hurry. She had already been performing resuscitation for over five minutes and knew every second counts. Each moment felt like an eternity as she desperately compressed his chest. His nude body shook with each compression on the cold floor as his heart laid still in his chest. With no drugs available the only option was to continue pushing blood around his body and providing oxygen in hope of keeping his organs alive. After five more minutes of consistent CPR the paramedics arrived and brought their equipment into the bathroom. With little space to work they picked up his nude body and dragged him into the hallway in order to have more room to work. Once he was repositioned they attached the leads over his bare chest and started an IV to push drugs. They immediately pushed epi when the machine read out asystole in order to attempt to convert his heart into a shockable rhythm, One of the paramedics began CPR as the harsh compressions caused Aussie's entire chest to cave in and out. After a few moments the drugs were able to convert him into v-fib so the AED was charged to 300 as they backed away. The shock made him twitch around on the floor. With no change CPR was continued while the AED recharged to 360. At this point they also intubated him and secured it with a blue tube holder in order to provide as much oxygen as possible. The next shock caused his large chest to shoot up slightly before crashing back down. The shock sent Aussie back into asystole as they loaded him into the

ambulance in hopes that the hospital coudl do more for him.

The ambulance ride was uneventful as continuous CPR was performed and in the entire 7 minutes he remained in asystole. Upon arrival to the hospital he was taken directly into the trauma room as a team of medical professionals took over his care. Knowing that he had been down for over twenty minutes the team was unsure if he would make it. With a new IV started another round of drugs was administered as his heart began to twitch in v-fib. The AED pads were ripped off his now pale chest and the paddles were gelled and charged to 360. To everyone's surprise this shock was able to convert him back into normal sinus rhythm. He was stabilized and sent to the ICU as tests were performed.

A couple days later after a speedy recovery it was deemed that he had a heart attack but was now stable enough to be discharged. Ella decided to stay at his place for a few days to watch over him. Upon arrival home Aussie informed her that he was tired and just wanted to rest. His chest was still in pain from the over twenty minutes of CPR that he had recieved. He went and laid down and about thirty minutes later Ella went to check on him. "Hey Aussie, how you feeling?" with no response she thought that he must be sleeping but went closer to him and watched his chest. It was not moving at all and at this moment panic washed over her. "Aussie?" she exclaimed as she felt for a pulse but could not find one. "Come on don't do this to me again" she muttered under her breath. She pushed his t-shirt up and tucked it under his chin. Tilting his head back she placed her warm lips over his before providing two breaths. Each one made his chest rise and fall. She then made her hand into a fist, raised it into the air, and slammed down into the center of his chest. His body contracted and his belly rippled from the impact. With no response she once again placed her hands in the center of his chest and began CPR. The room was silent with only Ella huffing with every compression as she desperately tried to save him for a second time. After every thirty compressions she gave another two breaths to keep his blood oxygenated. She did five rounds of CPR which took a few minutes before grabbing the AED from beside his bed. She peeled the pads off their sheet and placed them on his bare chest. She pressed the on button as the machine whined to life and she continued CPR. The electronic voice started again just like it had a few days prior. "Stay calm, attach defib pads to patients bare chest, do not touch patient analyzing" she backed away. "Shock advised, stay clear of patient, press flashing shock button." She pressed the button on command as Aussie jerked in his own bed. "Continue CPR" the machine read out again. She placed her hands back on his chest which felt like it was growing colder by the minute. She felt his ribs pop again as they never finished healing from his last intense resuscitation. The machine read out every few moments "Continue CPR". Two minutes later the machine gave the same instructions to back away while it analyzed. "No shock advised, continue CPR". Ella knew that meant that he was not in a shockable rhythm. She grabbed her phone and dialed 911 and gave all the information. She did not realize that it had already been ten minutes since she began resuscitating Aussie. She was instructed to move him onto the floor so that a hard surface was on his back. She struggled to move his large body but eventually made it to the ground. She moved the AED to the ground as well as she continued CPR. Each compression caused Aussie to jerk around and his belly to shake. At the fourteen minute mark of his arrest the AED read out again "Shock advised, do not touch patient, press flashing shock button". Pressing the button again this time Aussie rose off the floor and crashed back down. She continued CPR for another minute before the machine was ready to shock him again. The same sequence went on. As she pressed the shock button Aussie flopped on his bedroom floor and his head lolled to the side. Aussie had now been under constant resuscitation for twenty minutes by the time the paramedics arrived.

The paramedics entered the bedroom and were slightly taken aback to see their patient from a few days ago once again under resuscitation. They quickly set up their monitors as they placed the leads across his chest and turned them on. The monitor showed asystole as they started an IV in Aussie's right arm and quickly intubated him and secured it with a blue tube holder. "How long has he been down?" one of the paramedics asked. Ella didn't reply as she knew that if she told them that it had already been twenty minutes they would likely pronounce Aussie on scene. "How long Ella?" the paramedic asked again. "Ten minutes, I was able to shock him a few times and he just went back into asystole when you got here.' Ella replied knowing that none of that was true. "Alright push epi and check pupils." the paramedic responded. The drugs were pushed through his IV and took a penlight out of their pocket and shined it into Aussie's eyes. "Equal but sluggish" the paramedic at the head responded as he picked back up the ambu bag attached to the ET tube. "Let's set up the Lucas and see if that does anything" they grabbed a large case from behind them and pulled out the Lucas. They had to roll his large body to the side as they placed the board on the ground and then rolled him back on top of it. They then placed the unit directly over his chest and placed the plunger in the correct position. With a press of a button perfect mechanical compressions were delivered as Aussie's chest was caved in with each and his belly pushed outward. After thirty seconds the drugs took affect as the monitor showed v-fib. They charged the AED to 300 and paused the Lucas. Pressing the shock button Aussie's feet kicked off the ground slightly as his chest and arms were restricted by the unit. "No change, charge again." The Lucas was resumed as the unit recharged and a few moments later he was shocked again. His hands made loose fists as they were strapped against the unit and then relaxed again. "Still no change, charge to 360." Again the Lucas continued pounding away at Aussie's chest while his fibrillating heart desperately awaited another jolt of electricity. Once the unit was charged he was shocked again. The line on the monitor jumped sharply before falling again and went flat. "Ella we have been here for almost ten minutes and he was down for ten before that." one of the paramedics said. "Load him up, they can do more for him at the hospital.... please." Ella replied with a cracking voice. The paramedics were hesitant at first but then agreed as they loaded Aussie onto a stretcher and rolled him outside. The neighbors were all outside and watched as Aussie was rolled out of his home and loaded into the ambulance.

The ambulance ride proved to be ineffective as the Lucas continued to compress his chest as he remained in asystole the whole way to the hospital. The ventilations continued and more drugs were pushed but his dying heart was refusing to convert into a shockable rhythm. As they reached the ER they rolled the gurney out of the ambulance, and all that could be heard was the constant clicking of the Lucas. His body was now pale and cool to the touch as he had been down for a prolonged period of time. As they entered the trauma room one of the paramedics started giving the overview “Aussie...” but was cut off by the attending “How long has he been down? This is his second arrest this week” “25 minutes” the paramedic responded. “How long has he been asystolic?” the attending asked in a cold tone. “Last 3 minutes” he knew it was a lie but couldn’t bear, to tell the truth as he saw Ella fighting to hold back tears. Alright, he might still have a chance.” The attending now took charge of the team who had already moved Aussie onto the bed and disconnected the Lucas and connected him to their own monitors. “Push epi, and check pupils” The drugs were pushed in as a penlight was checked his pupils which were sluggish but reactive. In a matter of a few moments, the heart monitor showed v-fib as the paddles were charged to 360 and gelled. The AED pads had been ripped off and there were still bright red marks from where they had been stuck to his body. The cold gelled paddles were placed exactly over the red marks as the shock coursed through his dying body. His chest flailed and his toes scrunched with the shock, but no change was detected. A nurse continued deep harsh compressions on his beaten chest that had received more CPR in the past few days than most people do in a lifetime. In another moment the paddles were back on his chest as he was shocked again. His arms flailed to the sides as his torso flopped with the shock. Knowing that they were almost to the 30-minute mark the entire medical team knew that if the next shock sent him back into asystole, he would be pronounced dead right then and there. Each moment passed in slow motion as his chest caved in and out with each compression and his belly rippled. The whining of the defibrillator could be heard as they were charged to 360 for likely the last time. More gel was applied before being rubbed together and pressed onto Aussie’s bare chest. The Ambu bag dropped to the side of his face as the entire team stood away. His chest heaved into the air, head snapped back, arms and legs flailed, and all came crashing back down. A short flatline was seen on screen and then a beep, and another beep. “Normal sinus” the attending declared. “We got you this time Aussie” he whispered. Aussie was stabilized and hooked to a respirator and set with tubes and wires covering his whole body as he was taken to the ICU so that more tests could be made. He wasn’t out of the woods yet but still had fight left in him. Ella stayed by his side for the night hoping to be there when he woke up.