UCONN Emergency Medicine Interest Group

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First Shift

In DAY IN THE LIFE on May 22, 2011 at 6:36 PM

I arrived at the ED at 5 pm for my first 8-hour shift of the elective. It was relatively quiet, I thought. I attributed this to the snow—it started to come down in earnest around 7pm. By 10pm it was, as my dad has always called these blizzards, a white out.

I had no concerns in the world. Perhaps something cool will come in, I hoped.

The receiver crackled on—just like an old radio my grandparents have.

“67 year-old-female, sinus bradycardia with a pulse of 30, en route.”

My attending’s smile softened; my glazed-over face peaked with excitement.

“Get room 1 ready–fast” my attending murmured to the charge nurse. She looked at me and told me to grab 2 liters of normal saline, tubing, blankets, and a few other things that I immediately forgot. The department was instantly buzzing.

Nurses were shuffling patients from one area to another to clear Room 1. My attending was huddled around the emergency receiver with another ED attending.

Through the commotion, I could not hear what was being said; but I knew the doctors were anxious.

The emergency doors swooshed open; the muffled howl of the winds crescendoed and then reached their cadence as a swarm of EMS officers rushed in, wheeling a stretcher.

They were bagging the patient; she was intubated en route, I overheard.

“Get her in room 1 and on the monitors, STAT!” shouted my attending.

“Where is that saline??”
I had completely forgotten my meager task. I ran to the store room, but it was locked. I turned around and ran back to the nursing station. A friendly PA escorted me to the storeroom and got me the saline and tubing. I hustled over to room 1, spiked the bags, and hung them. I was proud of my minor contribution. I had learned how to spike bags in my hospital job last year.

Then I turned around; my heart skipped a beat.

One! Two! Three! Four! Five! Get those compressions up to 100 bpm!

I was frozen. With each compression I could see the patient’s body heave.

Stop compressions!

Analyzing rhythm. Shock advised, droned the AED.

“Everyone clear!?” shouted my attending.

“Clear!” came the response in unison.

Shock delivered.

Her body bucked off the hospital bed and landed with a thump.

Check for pulse. If no pulse detected resume CPR.

She was in ventricular fibrillation.

“Resume compressions” said my attending.

“Your turn” shouted the scrub nurse.

She was looking at me.

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