codeblue1973

[codeblue1973]

GREG'S HEART FAILURE PART 3

Dave & Sara lift Greg's Broad 400-pound body and put bottom part of LUCAS under him and then attach the top and Sara straps his wrists to the side and Dave starts and it starts pumping Greg's Chest. As this is going on the baby is kicking Liza. She puts her hands on her abdomen and says "I know my little cub papa will be ok" Sara injects another round of epi into the IV as Dave brings the gurney over. Sara goes behind Greg head and Dave at his feet. Dave says on 3 we lift 1 2 and 3 as Greg is put on the gurney. The monitor and Defib unit put between his legs. Sara begins to bag Greg and push the back of the gurney as Dave controls the front. The neighbors watch as Greg is getting his chest pumped by the LUCAS and loaded into the ambulance. Liza asks please can I stay with him. Sara says, "Yes Mrs. Furlong normally we don't but with you being as pregnant as you are we don't want you driving." "Thank you" she says and climbs in. Dave says "Get us there ASAP" Sara nods and Dave stops the LUCAS for a pulse check and monitor shows VFIB. "Charging paddles to 300 keep bagging and talking to him" he tells Liza. Liza nods and strokes Greg's hair his brown eyes cracked open "Come on Papa bear your girl cub needs you" as she bags Greg and Dave place the paddles around the LUCAS "CLEAR" as Liza drops the bag and Greg's body twitches "No change charging to 360" Liza is beginning to think she will have to raise their Girl cub alone. "CLEAR" as the monitor goes back to asystole. "NO NO GREG" Liza shouts as Dave resumes the LUCAS. He injects epi and 300 amiodarone into IV as he notices a yellow stain on Greg's Sweatpants as Greg has urinated on himself. "HOW LONG" He shouts to Sara "3 Minutes I radioed ahead an ICU Code Team will meet us at the bay doors. As Liza bags her husband a pain hits her. Dave notices "Mrs. Furlong you, OK?" She nods yes "Please focus on Greg" "1 minute out Sara shouts as Dave stops the LUCAS and VFIB appears. "That's it Greg" Liza says "Charging to 360 and CLEAR" as Liza drops the bag. " No change again at 360 as Sara backs into the bay. "Come on Baby I can't lose you" The monitor goes back to Asystole as the door swings open. "Anything" Sara asks "No" Dave says as he restarts the LUCAS, we need to get him in there. The ER attending says "STATUS" Dave starts report "35-year-old male named is Greg History Stage 3 Heart Failure Collapsed at home. This is his 7-month Pregnant wife Started CPR and has AED on Scene Total down time about 20 minutes as they unload, and Sara starts bagging Greg and Liza tears now flowing follows them hearing the amount of time Greg has been without a heartbeat. She tries to follow into the resus bay but a nurse Maya stops her. "Please you need to give the Code team room to work Mrs.?" "Furlong" Liza says Seeing Liza is Pregnant "Mrs. Furlong come with me I want to take your vitals." I heard you gave your husband CPR that is hard on anyone but being 7 months Pregnant want to make sure you and baby are OK" " I am fine I don't want to leave him." "I know but Mrs. Furlong, he would want you to take care of the baby and yourself." Liza finally relents and is led away from the resus bay. " Ok on Three we move him over ER attending say 1 2 and 3 as they lift Greg LUCAS still pumping away onto the Resus Bay Bed. Pause LUCAS as one of the nurses turns it off and monitor still shows Asystole" " Resume and get him on out monitor" One of the nurses says, "He's already been down at least 20 minutes" The doctor says "We aren't giving up he has a pregnant wife out there and he received immediate CPR and AED. He still has a chance. How many epis in the field she asks Dave 3 as Sara continues to bag Greg. Ok give him another Epi and 150 amiodarone. "Come on Greg you can't leave that beautiful wife of yours who is about to your baby girl" "Drugs in" Med nurse says. "How are his pupils?" ER attending as Sara. An RT takes over bagging as Sarah shines her penlight in Greg's eyes. "Sluggish but reactive he's still in there" "2 minutes" Scribe says as the ER doc stops the LUCAS. "we got vfib"

[codeblue1973]

Illusory hope

Why am I in hospital? A white ceiling, the sterile smell of disinfectants, the hum of machines. There's an oxygen mask on my face... They've inserted a nasogastric tube. I'm hooked up to countless sensors, tubes, and catheters... Why am I here? Where have I been? Can't I remember...

It must have been a long time. Tubes, catheters, machines... Everything in this room is so perfect. No one must be looking for me. These IV drips... What kind of fluid is that? My vision is blurry. I reach out to touch it, but my hand is weighed down by sensors. My fingers tremble. I try to sit up, but my body barely responds. I'm too weak. I'm helpless.

So, I need facts... I've been looking for them... They were kidnapping comatose patients. Maybe they need them... for experiments. Did they kidnap me in the night?

I need to wait. I can already raise my hand. Maybe I can sit up? But what will they do to me? I can't quite make out the numbers on the monitor. Maybe my condition is stable. Is someone coming? I should close my eyes. There are two of them... And they're whispering.

"You were in the wrong place at the wrong time. We've been watching you. You've learned too much. And now we must act. Don't worry, we care about you. You're connected to the best equipment. We're giving you a lot of different medications. Paralytics, to keep your body still. Sedatives, to calm you down. You won't be able to escape, even if you wanted to."

I still can't see them clearly. It's a woman, and the other person... "We see you're trying to resist. But it's useless. You need to rest. Soon we'll send you to another hospital. You'll like it there." A needle pricks my skin. Numbness slowly spreads throughout my body. I feel like a doll...

I woke up. The noise. It's quiet, but I'm scared. I can feel something inserted in my throat. I slowly open my eyes – and see what they've done to me. This huge machine, these thick tubes, this tube inserted deep into my lungs. They put a neck brace on me to restrict my head movement. But why? I can't even lift my hand anyway.

Now I can see everything clearly. This room is different, darker. There's a lot more noise. There must be a lot of medical equipment here. I can't see it all, but I can feel these sensors, catheters. I listen to the sound of liquid dripping from the IV drip.

Now I'm paralyzed. I can't even breathe on my own. If they turn off this machine, I'll die immediately. Did they turn me into a plant? So, I would be helpless and weak. They could have just turned off the machine. Why didn't they?

Nurses come up to me. What are they doing? They're giving me an injection... I close my eyes. I don't want to see what they're doing to me...

I woke up again. This room is noticeably brighter. Did they take out the breathing tube? However, it's still hard for me to breathe. They put an oxygen mask back on me. Did I have surgery? That's why I was intubated... it makes sense. But what do they want to do with me? She gives me false hope...

I don't know what will happen next.

Jafaa (Episode 9)

Kasak (Episode 3)

[codeblue1973]

Greg's Heart Failure Part 2

Push the orange button now the AED says, and Liza does. Greg's body twitching surprises Beth who gasps. Liza feels for a pulse and finds none. The machine recharging she gives Greg a few more hard and deep compressions and machine says to shock, and she does and after the shock it says resume CPR. She looks to Beth "I need you to take over compressing Greg's Heart". Beth says, "No no I can't Liza" "You have to Beth please I am exhausted" I will walk you through it interlock your hands like this in the center of his chest and press hard and deep. I need your help to save my husband. Beth focuses and does what Liza tells her to do. Meanwhile Liza tilts Greg's head back to open airway and takes the Red Ambu Bag and starts breathing for him. Liza tells Beth Sternly "Harder and deeper he has broadness to him, and it needs to reach his heart. Liza continues to bag and stroke Greg's hair fighting back tears she says, 'please don't leave me bear I can't raise our girl cub alone" They both hear sirens approaching. Beth hears a crack and says to Liza in a panic "What was that? It's ok you probably cracked a rib which means you are giving effective CPR. After 5 cycles Liza turns on AED to analyze. I hope I did it good enough Liza" "you did great" The AED says "shock advised" Beth stands back and Liza hits the shock button as they hear the paramedics pull up. After the shock Liza feels for a pulse "nothing" shocking again as she hears a female Paramedic announce their arrival. "In the living room' Liza shouts as the AED says resume CPR. Liza her emotions coming to the surface resumes CPR on her dying husband. "Come on Greg, I need you as tears run down her face. Sarah kneels down behind her "it's OK we got him" Liza doesn't want to stop "I GOT HIM" she screams. Beth struggles to pull her back "come on Liza let them evaluate Greg" as she fights but Beth manages to pull her away. Dave feels for a pulse and finds none. "Continuing compressions. Getting on monitor and IV started Sara says. She turns to Liza "Mrs Mrs ?" "Furlong" Liza says "Do you think you can be strong enough to bag Greg while I finish. "Yes of course" She immediately takes the Light blue Ambu bag from Sara and starts ventilating her bear. "Come on baby please come back to me" fighting back tears."" Ok he's hooked up stop compressions Dave" Sarah says. "VFIB" Dave says as Sarah grabs the paddles and Dave squirts gel on them as Liza says, "that's it bear come all the back to me" Sarah places the paddles on Greg's Broad Hairy Chest and says to Liza "stand back Mrs. Furlong and she backs away "CLEAR" Sara shouts as Greg twitches from the shock. Dave says "no change charging to 360" "ready and CLEAR" Sara says. The monitor goes into asystole. "NO NO'" Liza says. Dave says "Resuming compressions and Sara grabs an airway kit. "Mrs. Furlong, please try to remain calm" thinking the stress will cause pre-term labor. "I need to intubate Greg to protect his airway" Liza nods and stands back as Sara goes behind Greg and tilts his head back. "Damit Dave he's aspirating. She quickly grabs the portable suction unit and suctions Greg's airway. "Come on baby take the tube" as Beth says, "why are they putting that in his mouth Liza" "It's to help get him air Beth." "Ok I am in", and she attaches the Light Blue Ambu Bag to the ET tube. She looks up at Liza "can you bag him while I secure the tube." Liza nods and starts breathing again for Greg. She secures the tube with tape and injects another MG of epi and 150 amiodarone. Dave says to Sara think we better get him on LUCAS and move. Sara agrees and opens the LUCAS. She turns to Liza "Mrs Furlong this is the LUCAS we are going to attach it to Greg it gives good even compressions so we can transport and give constant CPR. Liza nods " I understand"

[codeblue1973]

The empty nester Janet’s Story

Janet started her morning as usual, the alarm sounded and she raised up from the bed. She took off her CPAP mask and immediately started 5-10 minutes of coughing. At 58 and the smoking through out her adult life was the culprit of her daily cough episode. She had long dark brown colored hair that flowed down past her shoulder blades. As her and her husband raised their kids, they’d shielded them from the smoking habit she had. She always smoked at work and when she could slip it in around the house. She’d always been a nurse and now was director of nursing for a mid sized hospital in a midwestern town. The stress of the job caused her smoking to increase and now her and her husband were empty nesters she was free to smoke at home about all the time. She started smoking more after her gastric bypass surgery two years ago. She had trimmed down 200 pounds and the skin hung off of her 250 lb. body. As she continued the coughing she went to the bathroom and urinated. Her plan now that her weigh lose had stabilized was to get the skin trimmed off. She’d already seen the plastic surgeon who wanted her to get a cardiac work up before scheduling the procedure. She stood up feeling a little dizzy and short of breath. She slipped on her Terry cloth robe which had her pack of cigarettes and lighter in the side pocket. What that cardiac examination would have shown them and she was clueless too was a how weak her heart true was. The dieting and fast weight loss had depleted her heart of muscle health. It was already some what enlarged from the years of obesity and now weakened. A simple 12 lead EKG would have shown long QT Syndrome. Then as per her normal routine slipped out on the screened in porch for the first cigarette of the day.

Out side the Dawn was breaking with a marked chill in the air and she inhaled deeply as the end of the long white cigarette glowed a bright orange. The white smoke filled her lungs bathing the respiratory tract with nicotine to which she was fatally addicted to. That first cigarette had gave a deceptive feeling of calm. She finished it and walked back into the kitchen where the coffee maker had finished brewing. She grabbed her coffee mug, ironically it had a graphic of a heart in asystole and then QRS complexes and read “I’m dead without coffee”. She pulled open the cigarette pack and slipped out another long white cigarette. She’d grabbed the lighter and in an instant she’d ignited the cigarette dangling between her lips. She exhaled the cloud of smoke and placed the cigarette in the glass ashtray by the coffee maker. Suddenly she felt dizzy and lost her breath. She felt an odd feeling come over her like a wave of water in the ocean. Janet’s legs buckled as she collapsed on to the kitchen floor. All the times she’d walked on it, she’d never thought she’d lay on it dying. She quickly slipped from consciousness her heart quivered deep in her chest causing the stoppage of blood flow through her body. Her brain began to die loosing its vest knowledge of personal and hospital management. As the cigarette smoldered in the ashtray Janet’s body continued in death. Cells all over her body were now not able to remove CO2 and take up oxygen. In the silence of that morning her body relaxed, her brown eyes were obscured by the dilation of her pupils. If her heart had been hooked up to an EKG the erratic heart rhythm was changing. It started with irregular spikes but then grew more faint and and flat. Finally it would have displayed a flatline. Her skin became pale fading to whitish gray. By the time the cigarette had smoldered almost to the filter tip Janet’s husband found her lay face day on her side. He rolled her over as her body made a loud groaning gurgle. Her shook her and called out. No response was gained from her several minutes now into death. Her lips were purple blue and her eyes stirred fixed into space. He got down on his knees and felt her cold neck for a pulse. His fears were confirmed as he had hoped to feel anything.

As he started chest compressions he called 911. The EMS system was activated, bring Janet closer to the inevitable out come. The system would respond the FD and EMS to bring care to Janet. A lady they would all know from previous work together. The husband pushed down hard on her sternum at first a little slow but then about as it should be. He counted each downward stroke until he got to 32 and then he bent over. He sealed his mouth against Janet’s and gave her two deep breath’s of air. He was horrified how cold Janet’s blue colored lips were. Her chest rose both times and he then restarted the chest compressions again. After several cycles he began to weaken and the compressions weren’t the quality it took to push blood out of the heart. The whole time Janet lay on the kitchen floor stirring expressionless the cardiac arrest having already done its damage.

On board the EMS unit the two crew members were exhausted from the non stop calls volume. Their discussion on the way was that if this call was as the dispatch said a 58 yoa female in cardiac arrest was probably already deceased. If they hooked her up and got asystole on the monitor they would pronounce her.

The FD arrived first and took over Janet’s resuscitation continuing the CPR and adding their BLS tools and skills. One EMT tore the front of Janet’s night gown exposing her torso with its excessive skin rolls. He applied the Defib pads to her chest as the other EMT place the bag mask over her face giving her two ventilations. Her chest rose as a barking noise was heard, a common occurrence in cardiac arrest patients. The other EMT had started CPR until the AED said to pause while the unit analyzed Janet’s heart rhythm. After a few seconds it said No Shock Advised and to continue CPR. The FD command radioed dispatch that they were doing CPR and the AED advised no shock.

That massage was related to the EMS responding to the call. Continued to look forward to pronouncing this patient, figuring with that update she’d already dead. All they’d need was a 3 lead strip for 30 seconds in asystole.

They continued to care for her with the airway management EMT prepping a I-gel airway for 200+ pound adult. The AED counted down from 1 minute as the EMT slid the gelled lubricated airway into Janet’s mouth. He pushed it as far as it would go and the airway pushed up inside the trachea. He then quickly connected the securing strap to keep in place. The AED announced to halt CPR and side by as it analyzed rhythm. They responders stayed clear of Janet’s still clinically dead body nude in the kitchen floor. The unit announced Charging……. Making a high pitch tone. The aggressive chest compressions had gotten Janet’s diseased heart to begin an erratic quiver in her chest. A first responder pushed Shock when prompted and Janet’s body quaked as the electric shot through her body. The unit called for CPR to resume and one of then restarted the compressions. Another attached a bag mask to the airway jetting from the patients mouth. He them gave it a squeeze as Janet’s torso moved slightly outward. Another minute passed and the AED counted down to zero. This time it said to continue CPR. Another several ventilations and rhythm check the unit prompted Shock advised. One of the responders pushed shock and she repeated from reflex movement. One of the other responders was getting the relative medical first from the husband. He said she’d had the gastric bypass months ago. He went on to say she was hypertensive, type 2 diabetic, and had severe sleep apnea.

The EMS unit arrived and proceeded to assume care of the patient. The FD commander updated the medics and much to their surprise Janet’s heart had gotten the AED to shock her. Enough cardiac activity to require the resuscitation to the hospital. The FD assist as the medic plugged the pads into the manual defib monitor unit. The other medic was carrying the Lucas device which he set up to use on their latest cardiac arrest victim. An EMT pulled Janet’s torso as the medic placed the bottom of the Lucas under her. Then he snapped the top portion into the bottom. Pushed start and off the Lucas went plunging away on Janet’s chest. The other medic watched the monitor screen as wide QRS complexes spiked erratically about 20 a minute. He felt for a cardioid pulse which wasn’t present until the Lucas started. The EMT squeezed the large round blue bag attached to the airway. Janet’s chest would expand and the air made a wheezing noise as it was exhaling. Her eyes were open with the empty look of death. The medic attached the capnography wire to the bag mask. The other medic watched the Zoll x screen as it traced a thin blue line flatly across the screen. Both medics were aggravated at having to work Janet but it was protocol. As the one medic drilled an IO into Janet’s arm. The other medic got her history and realized it was the hospital’s director of nursing. The firefighters got the cot from the ambulance and positioned it in the living room. The kitchen was too tight for it and the patient. They would have to lift and then carry her to it. The medic set up the IV and hooked it up to the IO. The D5W dripped through the micro set flowing into Janet’s arm. He then pushed an amp of sodium bicarbonate and 5 ml. of epinephrine. As each responder lifted Janet the Lucas continued pump away on her chest. The flabby folds of skin hung loosely. Laid out on the cot the medic checked the IV to see if it was still running and the monitor. The Zoll still didn’t detect any electrical activity in Janet’s heart. They rolled the cot out and carried it down the steps. Janet’s body moved moved around laying on the mattress. They rolled the cot into the brightly lite ambulance.

Now in the back of the ambulance the medics and firefighters continued their efforts. Janet’s eyes were half open and even her pupils were large and round. Now she laid clad only in her wet panties as the Lucas pumped away on her chest. The capnography wave form was rather flat for a patient with advanced airway in place. Her long brown artificially colored hair flowed off the cot toward the floor. One medic aggressively rotated his patients head rearward and inserted the long straight laryngoscope blade into her throat. He then detached the I-gel secure strap and pulled the airway out of Janet’s airway. He inserted the ET, withdrew the cold steal blade, and inflated the securing bladder. He then connected it to the bag mask. As he squeezed the bag he watched Janet’s chest rise and listened intently as the oxygen flooded her tar stained lungs.

As the responders continued to treat Janet they began the transport. As in most case this time was a maintenance phase of the resuscitation. Janet eyes open empty of life, the Lucas pumping away on her chest. Her arms had been strapped to the sides of the Lucas and fingers relaxed cause them to look like she was making a fist.

As a firefighter began driving the ambulance toward the hospital the medics in the back continued their begrudgingly futile efforts to save Janet’s life from the death that she had so subtly worked toward through out her life. The one medic assembled a syringe of sodium bicarbonate and emptied it into Janet’s IV. Now with the ET tube Janet was making a high pitched barking noise in inspiration and a gurgling on expiration. As medic 2 squeezed the bag ventilating her the other injected another EPI. The Zoll monitor began to display a few wide complex spikes. The EPI was causing Janet’s heart to respond but this wasn’t enough of a response to be considered successful. Just a few cardiac cells still alive enough to organize an impulse. The heart muscle that would actually use that impulse had dead minutes ago. The heart monitor still displayed 20 three spike impulses of PEA. They continued to treat her pushing more Epi as the sirens blared the sounds in the patient care compartment were the plunging Lucas and the hiss of oxygen flowing into the bag mask.

The medics continued to push cardiac drugs, atropine, more epinephrine with no change in her dying empty expression. In this case they could have pronounced Janet because their efforts had only cost money and time.

At the ED Janet had been moved to the resuscitation room, the staff continued resuscitation as work traveled through the hospital hallways that Janet was in the ED, being resuscitated, and the prognosis was bad. The resuscitation room continued to fill with horrible staff. All watching the staff trying to reverse their colleagues condition as she lay naked brightly lite by the ED overhead treatment lights. The doctor running the coded asked the nurse to stop the Lucas. The heart monitor displayed PEA as he felt for a femoral pulse he then grimly took the head of his stethoscope pushing it around Janet’s chest. He listened as intently as he could, the only noise in the room was the hiss of oxygen. He looked at the records clerk and announced the time of death for Janet.

[codeblue1973]

Greg's Heart Failure Part 1

Greg & Liza were 35 years old and High School sweethearts. They have been married for about 5 years and Liza is 7 months pregnant with their first child a baby girl. Life would be great for the couple except that Greg is in Stage 3 Heart Failure. He has Cardiomyopathy which has only gotten worse as he has gotten older. He has other heart conditions Left Ventricular Hypotrophy and Aortic Stenosis. All these conditions have slowly been getting worse as he gets older. At this point Greg's heart is only working at about 40% and he has been on the heart transplant list for a year. Greg requires oxygen to sleep at night and is constantly short of breath. Liza has been trained in advanced cardiac life support, and they have an AED at the house as well as Ambu Bag. One night they were entertaining Liza's sister Beth who was visiting from out of town. They are all sitting in the living room when Greg starts to get short of breath more than usual. Liza notices and asks, "Greg honey what's wrong?" Greg sits up on edge of couch and says, " I I can't catch my breath or take any breaths in Liza". Beth starts to panic "WHAT'S HAPPENING TO GREG"? she says in a panic. Liza says to Beth "Greg is having trouble breathing and he needs his oxygen. "It's Ok Beth we have been through this before" "Can you go into our medical supply closet and get the small portable tank of oxygen that's in there?" Beth nods and runs to get the tank. Greg gasping for air says "baby I am scared" as he grimaces and clutches his chest in pain. "It's ok Bear I got you. On a scale of 1 to 10 how is the pain?" 'Nine" Greg struggles to say. Liza feels Greg's Neck for his pulse, and it is racing. She yells "BETH I NEED THAT OXYGEN NOW" as Beth comes in with the portable oxygen tank. "I need you to call 911 now Beth" Beth nods and calls. Liza takes the oxygen tank and puts it on the floor next to Greg and takes the mask and tenderly puts in on Greg's face. "Here bear take slow deep breaths" as she puts it up to 10 liters. Liza gets up and says to Greg 'Can you slide onto the floor my Bear?" Greg nods and slides off the couch onto the Floor." Paramedics on the way. God Liza is Greg, OK?" Beth asks as she has never seen Greg struggle before. " I hope so Beth, I need you to remain calm and focused. Hand me a pillow for his head." Beth hands Liza the pillow and she tenderly puts it under Greg's Head. "There you go my love still with your precious girl"? Greg weakly nods and looks up at Liza and takes down oxygen mask and says " I I love you Liza and our baby girl as a sharp pain hits Greg and his eyes look up at Liza and then his head turns to the side. Liza says "Greg Greg can you hear me" rubbing my chest. My brown eyes wide open and not responding to her. She feels my neck for a pulse and finds none. Beth says, "WHAT HAPPENED"? Liza takes a deep breath and says to Beth "Greg has gone into Cardiac Arrest. Run to the closet you just came from and grab the AED and Ambu Bag. Beth runs to get the equipment, and Liza rips open Greg's Button-down shirt and starts hard and deep compressions on Greg. "Come on Bear you can't leave us now you need to meet our baby girl. Beth says in a panic voice "What are you doing Liza?" "Trying to keep his blood circulating to his brain and vital organs. Beth listen to me please I need your help open and AED and place the Pads as the instructions say on Greg's Chest." Liza says already getting winded from giving Greg CPR for 3 minutes added to her being 7 months Pregnant. Beth nods and follows the diagram putting one above Greg's Right Breast and one below Greg's Left Breast. 'Pads on" Beth says, "OK good no plug the connector into the AED" Beth does as she is told, and the machine comes to life "Analyzing rhythm everyone stand clear" it says as Liza stops compressions and out of breath herself trying to get the love of her life heart beating again. "Come on baby please stay here' she says trying to stay focused. she is relieved when the machine says "Shock advised everyone stand clear. She motions and says to Beth stand back.

[codeblue1973]

The tail of two Jessica’s Part 2.

At 0315 Jessica Burkes vitals were crashing and her monitor at the nurses station was showing Ventricular tachycardia. The charge nurse entered Rm 3. Jessica was barely responsive ashen color and diaphoretic. She’s was pull at her gown breathing was distressed and to repeat and shallow to count. The nurse tried to calm her and elevated her bed.

Sudden Jessica set up in bed grabbed her chest and let out an audible grown. Her body went immediately limp and her body relaxed back in the bed. The nurse was feeling for a carotid as she pushed the Code Blue alarm. The nurse lowered the head of the bed flat and began CPR. The other staffed flooded Jessica’s room, two were pushing a crash cart. Jess’s nurse paused CPR for two other nurses to left Jess’s limp torso as a third slide the jumbo sized cardiac board under where her back would lie. The jumbo board was specifically designed to accommodate the anatomical size of patients like Jess. As soon as Jess was laid back her nurse snapped and pulled down the hospital gown. The CPR board caused her chest to arch and the breasts to roll toward the side a bit. Her head flexed back to assist with airway management. Her nurse began CPR compressions, her hands rested against Jessica’s cool pallor chest. She pushed as hard as she could and as fast too. She caused Jess’s whole body to push down on the mattress even on the resuscitation board. The ward clerk called Jessica’s pulmonologist and the on call cardiologist as well as the intensivist. She also paged the lab for a lab technician. One of the other nurses plugged Jess’s chest leads into the heart monitor defibrillator unit. It was already on with a flat blue gray line tracing across the screen. The chest compressions displayed on the screen as a wide wavy line. The charge nurse asked the nurse preforming CPR to pause for a moment to get a rhythm check. As soon as the nurse stop the wavy line flattened showing asystole. The nurse continued CPR, a respiratory therapist arrived and start artificial respirations with the bag mask. They noticed Jessica’s eyes were open and they had an empty gaze.

She held the mask firm against Jess’s chubby cheeks which inflated as she squeezed the bag. Jessica’s chest rose and retracted slowly. The air made a wet gurgling noise as respiration continued. Jessica’s skin color didn’t improve with the intervention being administered.

The intensivist and cardiologist arrived together. The Charge nurse made her report. Jessica Burke 44 yoa female full code being treated for pulmonary embolism. Significant pulmonary, cardiovascular, and reproductive disease. She had stabilized vitals until she code 5 minutes ago. The cardiologist told a nurse to apply defibrillator pads and get a 12 lead EKG. The ICU doctor asked for a rhythm check and again the wavy line went flat wince the nurse stopped compressing Jess’s chest. Both doctors were concerned with the lack of skin color after 5 minutes of CPR. The cardiologist ordered 5mg. Of epinephrine which the nurse connected the syringe with a luera lock and emptied the medication. They noticed intensivist told the lab tech to draw for a BMP, Cardiac Enzymes, and ABG’s. He then told the clerk to call her family in. Jessica’s cardiac arrest continued unabated with these interventions.

Both doctors were concerned and discussed their fear that Jessica’s embolism had fragmented and lodged in her pulmonary vein. This type of cardiac thrombosis was always fatal. All the monitor alarms were sounding, no BP, no Heart rate, SpO2 low, ETCO2 low, and Jessica’s skin color was still gray. The nurse paused CPR and the heart monitor showed the same flat line. The doctor got the new obese size Lucas device out, nurses pulled Jess’s torso allowing the Lucas bottom to be positioned and the doctor locked in the top. Now in position the doctor pushed start button and the Lucas began CPR compressions. The intensivist snapped together a laryngoscope and retrieved a 7.0 ET tube from the crash cart. He slide the blade into Jessica’s mouth observing thick maroon to tary colored phlegm in her trachea. He asked the RT to hand him a hard suction catheter as she turned the wall mounted unit on. He continued to suction with the laryngoscope still down Jess’s throat. Her head moved slightly as the strokes of the Lucas pumped her chest. After a minute he was able to get the airway in place. He check the her lung sounds after having the Lucas paused and the cardiologist got a monitor reading which showed continued asystole. The cardiologist ordered the nurse to administer 1.0 vasopressin push and follow with 3 ml atropine. The doctors continued to be concerned with Jessica’s color and lack of good ETCO2. The lab tech had take the labs and lab called back the results. The ph was 6.6, elevated lactate, and ABG showed marked acidosis, cardiac enzymes were also elevated. The doctor told the nurse to administer an amp of sodium bicarbonate and 5mg. Of Epi and hang a norepinephrine drip. Minutes continued with each rhythm check Jessica’s heart remain to have no electrical or mechanical function. The RT noticed it was getting markedly hard to ventilate Jess’s. The ET tube would fill with dark red foamy sputum which pulsated as the Lucas compressed her chest. Ever ventilation Jessica made a barking noise on inspiration and a gurgling on exhalation. The staff continued resuscitation but Jessica had been clinically dead for thirty minutes and the whole time her heart had not responded to the resuscitation efforts.

Jessica’s mother arrived, the cardiologist and pulmonologist both met her in the waiting room. They took her back to Jessica’s room. Jessica lay naked as the Lucas pumped her chest and the code team worked on Jessica. Her mother asked the doctors to stopped Jessica’s resuscitation which the doctors knowing Jessica was dead consented.

The doctor pronounced Jessica Burke dead at 4am. Her cause of death was listed as Sudden Cardiac Arrest secondary to Pulmonary Embolism. Her body was cleaned up and she was prepared for her family to say there byes. She was dressed in a fresh gown and the sheet was pulled up with her arms out so she looked like she was asleep.

[codeblue1973]

The Tale of Two Jessica’s

Jessica Ramey 38 year of age female. Mother of 2 with a weight of 200lbs and 5’ height. Hx. of hypertension, obesity, asthma, chronic alcoholism and depression. Past history of chronic drug abuse for several years including cannabis, cocaine, meth, and opiates. Patient currently smokes 30-40 Salem Light 100’s a day and works in a bank. Jessica has an undiagnosed myocardial hypertrophic heart disease and early onset mild heart failure both attributed to prior drug use and COPD from heavy smoking. She also has an undiscovered mass in her left breast.

She is chronically non compliant in daily medication for her medical conditions. Her blood pressure runs in the 199/100 range.

Two days prior Jessica was transported via ambulance after a syncope episode followed by grand mal seizure and vomiting. She had complained of a severe headache prior to this episode.

The diagnosis at the ED was Massive Cerebral Hemorrhage causing several neurological did function.

Jessica Burke 44 year of age female. 388 lbs. 5’8” mother of 1 child. A 40-50 cigarette a day smoking habit which had progressively worsened as her health declined. She’d been smoking Marlboro Light 100’s for 30 years. Hx. Of hypertension, chronic bronchitis, emphysema, CHF, polycystic fibrosis and ovarian disease. Patient has suffered 2 prior transient ischemic mini strokes and hospitalization for pneumonia. Jessica also has undiagnosed atherosclerotic heart disease with prior myocardial infarction and multiple cardiac artery spasms with ischemic damage. Jessica B. Also has chronic anemia from ovarian and reproductive disease. On two prior occasions she suffered coronary damage from low iron levels. These have caused Jessica to develop heart failure and hypertrophy.

Jessica is currently on disability from nursing due to chronic health issues. 2 days ago she was admitted to hospital due to shortness of breath and chest pain. Chest radiograph studies showed pneumonia. The X-ray revealed a shadow which was a suspected pulmonary embolism. Due to her history with strokes she was not a candidate for heparin or blood thinner.

Mrs. Ramey lay in ICU bed 4. She was completely comatose with a GCS of E1V1M2 and had dropped from 6 in the last 24 hours. Currently her vitals were Bp 90/40, pulse of 120, SpO2 90 on total mechanical ventilation. ETCO2 was 30. At admission to ICU her long brunette hair had been shaved for the installation of ICP monitors and hemispheric pressure drains. On the heart monitor she was in sinus tachycardia with occasional PVC’s

Mrs. Burke was currently in ICU bed 3 on O2 nasal cannula and receiving 4 hour interval breathing treatments with albuterol. She was conscious somewhat alert. Her pulmonologist her on steroid therapy. She was making odd comments on her social media and uncomfortable. This was a consequence of low oxygenation with a SPO2 of 91. Bp 160/100, pulse 120, Respiration was 24, and ETCO2 was 38. Her heart monitor was showing sinus tachycardia with short runs of Ventricular tachycardia and multi focal PVC’s’.

[codeblue1973]

Heart attack

Aku ingin seseorang menyetrum nippleku dan membuatku kritis seperti ini.

[codeblue1973]

After countless surgeries, I'm still paralyzed. My neck is still encased in a medical neck brace. It's rigid, yet surprisingly comfortable. For a long time, I was tethered to a ventilator. It was terrifying, of course. The constant hum of the machine... And the sensation of that long breathing tube inserted into me, it felt like I had been transformed into a plant, dependent on artificial sustenance.

When they extubated me, I felt a slight dizziness. Finally, I could breathe on my own. But the joy was short-lived. Every breath required effort, a constant reminder of my recent dependence on the ventilator. Seeing my struggle, the doctor, without a word, placed an oxygen cannula on my nose to support my breathing. For the next few hours, the doctors monitored my condition closely. Since my breathing was still unstable, they decided to run additional tests to rule out any complications.

The test results confirmed my worst fears. My heart sank as I awaited the bad news. The doctor slowly uttered, "We'll likely have to return to mechanical ventilation." I looked at her with a silent question in my eyes. 'Isn't there another way?' I wanted to ask, but the words got stuck in my throat. I tried to take a deep breath, but each inhale caused pain in my chest. It felt like I would never be able to breathe on my own.

I didn't even know what would happen next. I'd probably wake up, reconnected to the machine. "How long could this last?" I asked weakly, feeling my heart pounding in anticipation of the answer. The doctor shook her head. "It's hard to say." She gave me an injection, and I started to lose consciousness...

My eyes slowly opened. I lay motionless, strapped to the bed by countless tubes. I could feel the hard breathing tube in my mouth. Again, that familiar hum that reminded me of my helplessness. Before me stretched long tubes through which the ventilator rhythmically pumped air into my lungs, sustaining my breath, my life. The light from the lamp cut into my eyes, and the smell of disinfectants filled the room. Tears rolled down my cheeks...

I lay motionless, helpless, and felt forgotten by everyone. Now, I'm fed through a tube inserted directly into my stomach. The sensation of a foreign object in my abdomen causes constant discomfort. A sterile catheter inserted into my urinary tract underscores my vulnerability. Changing the catheter has become a part of my hospital routine, and though I tried to get used to the unpleasant sensation, I would close my eyes, wishing it would end quickly.

Nurses and doctors were constantly around me. They checked the equipment, asked me questions that I could only answer with a glance. My condition was gradually deteriorating, and I relied more and more on the machines that kept me alive. The doctors informed me of the need for a tracheostomy, which caused a new wave of anxiety. I imagined the breathing tube in my throat and felt panic. Would I ever be able to speak again? Would I ever return to a normal life?

Before the procedure, the nurse prepared me for the surgery, checking all the necessary equipment. Her hands were soft as she gently stroked my hand, trying to calm me. "I understand you're nervous," she said in a soft but confident voice. "We're going to make a small incision in your throat and insert a tracheostomy tube. This tube will allow for more effective mechanical ventilation." I realized I had forever lost control of my body...

After the injections, I fell asleep. I must have slept for a long time. I can't even open my eyes. However, I can feel that the breathing tube is no longer in my mouth. Instead, I feel a slight wheeze in my throat. I try to breathe through my nose, but hardly any air gets in there. All my breath is focused on the tracheostomy tube. The incision on my neck is a reminder of the surgery that changed my entire life. A large medical collar is placed around my neck. This is another change I must adapt to. I'm no longer who I used to be.

I still can't speak. Those long days spent with a tube in my throat seem like an eternity. This breathing tube has become a part of me. I feel like an empty shell. Only my body remains, supported by artificial machines.

The white ceiling, the monotonous hum of the machines – that's all I see and hear. I've already realized that I'll just lie here in this bed, a vegetable. But deep down, I still believe that one day I will be able to at least speak again, hear my own voice...

[codeblue1973]

Rehearsal Dinner

There is a rehearsal dinner taking place at a restaurant across from the hospital. Its crawling with people. You are in between calls when you run into the resturant to grab something to eat when one of the guests collapses unexpected. You immediately call for help and approach her.

She’s barely responsive as they come and you lift her into the gurney. As you lift her, she goes limp. You prob her neck for a pulse, but her heart has stopped and you begin CPR.

Straddling her immediately beginning several minutes of hands only CPR. You pump her chest hard and roll towards the hospital as her body bends and shakes beneath you.

The ambubag is prepped as they roll her into the ER to pump much needed air into her lungs. Doctors and medics swarm to care for their patient.

The sheers are picked up, the cold metal tearing into the fabric of her purple, lace dress desperate to get to her chest and continue the work to save her life.

Her dress lays open and CPR continues before the wires are even attached in an attempt to keep her alive. Her chest is battered as they work.

The wires are connected… the faint line of vfib on the screen. The defibrillator is charged and the shock delivered. No change.

They grab the bag and force air into her lungs before trying again….

They shock, but there is no change….

Two more shocks are delivered in rapid succession.

Her body jerks than stills. Her head falls to the side. They fail to restart her heart as she lays limp on the bed….

Create your own ending to her story….

[codeblue1973]

Mystery Patient - Part 1

The emergency room was especially busy as he prepared to leave work after his shift. He was changed, on his way to the gym before dinner with his wife. He walked through the ER and was almost at the door when an intern called to him and asked for help. He had a patient that he didn’t know what to do with. They had no information, not even her age. A cab had dropped her off and simply left. She had collapsed as she stumbled in. Now she was barely responsive. He relents and walks toward the room unable to leave them alone. They must have just moved her in…. they had only had time to remove her tshirt.

As he walked in, her head turned this way and that listlessly as a nurse called to her. He makes his way to the side of the bed as he looks down at her. She is flushed, but there us a layer of pale underneath the creeping flush. There are soft whimpers from the back of her throat. The nurse moves aside for him as his hand comes to rest on her stomach.

“Ma'am,” he calls gently trying to get a response from her that is more than a whimper as he begins the examination.

Her lips are slightly blue as the lack of oxygen begins to take its toll. The doctor watches her chest barely rise and fall.

“Let’s get an O2 mask on her,” he orders as he gently removes her glasses. “Run it at 100%, maybe it will help her come around.” He puts his hand on her abdomen as he begins to assess her condition. He orders a battery of tests…. CBC, Chem7, a tox screen for drugs and alcohol. Her skin feels warm under his hand.

He calls for a temperature check based on a gut feeling as he continues his assessment. He begins to gently steth her chest, listening to the beats cascade against the bell at a rapid pace. It was very fast.

“Possible ventricular tachycardia. Let’s get her on a monitor now!”

As he turns to get the ekg leads to get her on the monitor, she moves ever so slightly. Her hand hovers lightly over her right side before falling to rest against her side.

“Her temperature is 104.1,” one of the nurses calls out as he grabs the stickers to put them on her quiet, barely moving chest.

As he gets ready to attach the wires, her body goes still on the bed. He rests his hand momentarily over her mouth but there is no air moving in and out of her lungs. She is fading fast as they reach for the ambu bag to begin bagging her.

Sealing the plastic over her mouth, he begins to force much needed oxygen into her body. Her heart beats in a staccato rhythm when he presses his fingers down into her artery and orders her bra to be cut.

“We need her on a monitor now!”

The mask is put aside as sheer begin to bite through the pale pink cotton of her bralette. Her chest is still. She lays unmoving in the bed as the wires are attached to the white leads dotted across her chest and abdomen. The monitor is switched on. The line on the screen shows clear v-tach as it comes up on the monitor and one of the nurses continues bagging. He knows that the rapid beating of her heart isnt effective at the moment.

“Let’s cardiovert her now!” He picks up the paddles and spreads conductive gel over the smooth, cool, metal plates. He runs them together over her chest.

“Charging to 100.” He presses the charge button and listens as the unit charges. “Everyone clear!”

Her body jerks a bit…. the monitor beeps…. and the. Loudly sounds as his patient goes into v-fib.

To be continued…..

[codeblue1973]

Hotel Overdose part 3

You watch as the paramedics all pause momentarily for another shock to her chest. They have the defibrillator charged to 360. “Everyone clear!” Her body reacts as you watch.

The shock stops the fibrillation and her body goes still on the bed. She lays there as her heart beats once… twice…. and then flatlines.

“Fuck! We had it and she is gone again.” They rip open the pack for the intubation kit as his partner starts CPR again. He puts his hands in the center of her chest over her white lace bra and pumps as hard as he can. Her breasts rock as you watch and her belly dances with the force while you watch.

He holds compressions long enough to let him get the tube down her throat. Before continuing CPR. The bag is attached and they pause to force air down into her lungs as compressions are held.

“Give another round of epi. She has been in cardiac arrest for 15 minutes.” You know she is running out of time as they inject syringes of medication into the IV in her arm as round after round of bagging and CPR continue. 2 or 3 minutes after the drugs, you hear a change in the monitor tone.

“Charge the paddles to 360!” This could be her last chance to come back you realize. “Everyone clear!”

You watch her body bend and react but the shock fails to restart her heart. They are desperate. They jam a needle down into her chest full of epi. “Prepare for back to back shocks! Charge!” He puts his hands on her chest and pumps the epi injected into her heart around. “Everyone clear!!!”

They shock her several times and then pull away. Ahe lays motionless on the bed.

The monitor beeps slowly as her heart comes back to life.

You sigh thankful to see her heart beating again as they prep her for transport to the hospital.

The end….

Sorry that took so long…. life got in the way.

[codeblue1973]

The Next Morning

..................................

The fluorescent lights in the emergency room buzzed softly overhead, casting a harsh glow over the sterile space. Sarah sat with her best friend, Emma, her arm wrapped tightly around her. They had been out drinking the night before, but something was wrong. Emma wasn’t just hungover; her skin was pale, and her body seemed to be shutting down. Sarah couldn’t shake the feeling that something was terribly off.

"I don’t feel right," Emma had whispered earlier, wincing from the pain in her head. "This isn’t a normal hangover."

Sarah’s heart raced as she explained to the triage nurse what had happened, pleading for her to take Emma seriously. "She’s really not feeling well. We were out drinking, but this isn’t normal. She can barely sit up, and she keeps saying her head is splitting."

The nurse, an older woman with a dismissive tone, didn’t even look up from the computer. "Sounds like a typical hangover to me," she muttered. "Fluids and rest will do the trick."

Sarah’s frustration boiled over, but before she could argue further, the nurse finally gestured for them to follow her into a treatment room. "Fine, let’s get her back and have a look. But honestly, it sounds like she overdid it."

Once they reached the room, the nurse handed Emma a pale blue hospital gown. "Change into this," she said as she began preparing an IV. Emma could barely stand, and Sarah had to help her get undressed and into the gown. Her movements were slow, almost robotic, as if her body was betraying her.

The nurse inserted the IV with a quick, "Just a little pinch," then attached sticky leads to Emma’s chest, monitoring her heart rate and oxygen levels. The soft beeping of the machines filled the room, and Sarah’s anxiety only deepened.

Emma groaned, her face twisted in pain. "My head… it feels like it’s going to explode."

The nurse, still indifferent, glanced at the monitors. "Her vitals are fine," she said dismissively. "I’ll start her on some oxygen, just in case." She placed a nasal cannula under Emma’s nose, the soft hiss of oxygen beginning to flow.

"I’ll be back in twenty minutes to check on her," the nurse added before leaving the room.

The minutes dragged on, and Sarah sat by Emma’s side, watching her friend struggle. Emma’s breathing had stabilized slightly, but her face was still pale, and she seemed disoriented, her hand never leaving her throbbing temple.

"Em, you feeling any better?" Sarah asked softly.

Emma’s eyes fluttered open briefly, her voice barely audible. "A little… breathing’s easier, but my head… it’s still pounding."

When the nurse returned, her expression was more serious. She glanced at the monitors, noting a slight decrease in Emma’s vitals. "Her heart rate’s down a bit, but nothing critical," the nurse said, though the worry had finally started to creep into her voice.

Just then, the door opened, and Dr. Warren stepped in, a tall man with graying hair at his temples. He introduced himself with a calm, steady tone, quickly assessing Emma’s condition. After listening to her heart and lungs, he asked a series of questions.

"Emma, can you tell me what happened last night? Anything unusual?"

Emma winced, struggling to focus. "I went to the bathroom at the bar. I felt dizzy, really dizzy, and then… I blacked out. I woke up on the floor."

"Do you think you hit your head?" Dr. Warren asked, his concern deepening.

"I don’t know," Emma whispered. "I didn’t feel anything at the time, but my head’s been killing me ever since."

Dr. Warren nodded, his expression unreadable. "I want to get a CT scan, just to rule out any head trauma. We’ll make sure nothing serious is going on."

The nurse quickly made arrangements, but just as she was about to wheel Emma out for the scan, an alarm rang through the ER. The PA system crackled, "Code Blue, Room 14. Code Blue." Another cardiac arrest.

As the team rushed to respond, Sarah watched in helpless horror as an elderly woman was wheeled past the room, a nurse straddling her on the gurney, performing aggressive chest compressions. The woman’s body jolted with each push, and the sound of the compressions echoed down the hall. Sarah’s heart pounded. The reality of the situation hit her hard—this was life or death.

Dr. Warren apologized as he and the nurse ran off to assist in the resuscitation. "We’ll get the CT done as soon as possible," he said, his face grim as he disappeared with the team.

Fifteen minutes later, the nurse returned. Emma’s vitals had decreased slightly. Sarah, still shaken from seeing the elderly woman, couldn’t help but ask, "What happened to her?"

The nurse sighed, her face softening. "She didn’t make it. By the time we got to her, there wasn’t much we could do. Her heart had stopped for too long."

Sarah’s stomach twisted as she processed the nurse’s words. She glanced at Emma, who was barely hanging on, her breathing shallow and her hand still pressed to her head. "We’re not giving up on your friend, though," the nurse added. "We’ll get her that CT scan soon."

Emma was finally taken to CT, and Sarah was left alone in the room, her mind racing. The minutes dragged on as she anxiously waited for her friend to return. But then, another alarm blared over the PA system, echoing through the halls.

Sarah froze, her blood turning to ice.

Before she could react, a team of doctors and nurses rushed past the door—Emma was on a gurney, being pushed frantically toward the trauma room. Sarah’s heart stopped as she saw the nurse straddling Emma, performing CPR.

"Emma!" Sarah screamed, bolting out of the room to follow them. Emma’s limp body jolted with each compression, her face pale and lifeless. The nurse pressed down hard on Emma’s chest, her entire body moving with each rapid thrust.

Sarah chased after them, her feet pounding the floor, but the team was too focused, too intent on saving Emma’s life to notice her. They reached the trauma room, the doors swinging open with a sense of finality as Emma was rushed inside.

Sarah stumbled to a stop just outside the trauma room, her breath catching in her throat as she stared at the chaotic scene unfolding before her. Doctors and nurses crowded around Emma’s bed, shouting orders as the nurse continued the relentless chest compressions. The defibrillator was charged, the paddles pressed to Emma’s chest.

"Clear!" the doctor shouted.

Emma’s body convulsed violently as the electrical shock surged through her. Sarah flinched, tears spilling down her face as she watched, helpless and terrified.

The nurse resumed CPR immediately, her hands pressing down hard on Emma’s chest, forcing her heart to pump. "Come on, Emma," Sarah whispered, her voice breaking. "Please… please don’t leave me."

"Push another round of epi," the doctor ordered, and a nurse quickly injected the medication into Emma’s IV.

The room was filled with urgency, but to Sarah, everything seemed to slow down. She watched in horror as the nurse continued chest compressions, her best friend’s body rocking under the pressure.

"Charging to 300," the nurse called out again, preparing for another shock.

"Clear!"

Emma’s body jerked once more, and Sarah’s heart broke as she watched, praying for any sign of life.

For a moment, the room held its breath. The monitor stayed flat, the steady, haunting tone of the flatline filling the air.

Sarah sank to her knees outside the trauma room, her body shaking uncontrollably. Tears streamed down her face as she whispered, "Please, Emma… don’t leave me."

The trauma room was tense, the air thick with the weight of time slipping away. The clock on the wall showed that over 20 minutes had passed since Emma had gone into cardiac arrest. Sarah stood at the foot of the bed, her legs weak and trembling, watching helplessly as the team continued their relentless efforts. Her heart pounded in her chest, the sound of the flatline and the desperate compressions blurring into a nightmare she couldn't escape.

Emma’s body continued to shake violently under the nurse’s compressions. With every push, her chest caved in, her ribs flexing unnaturally. Sarah’s eyes were drawn to Emma’s bare chest, her breasts swaying with each compression, then jolting upwards as the defibrillator shocked her lifeless body. It was like watching a machine, Emma’s body responding to the mechanical force of resuscitation but with no spark of life behind it.

"Push another round of epi," the doctor ordered, his voice now carrying a harder edge, determination cutting through the exhaustion. He leaned over Emma, checking the monitors, then motioned for the nurse to prepare another shock.

"Charging to 360," the nurse called out.

"Clear!"

Emma’s body arched off the bed as the shock hit, her chest lifting sharply, her head lolling to the side as the electricity surged through her. Her feet jumped, and Sarah winced, her stomach twisting at the sight. But when Emma collapsed back onto the bed, the flatline persisted, the monotone beep droning on.

A charge nurse, her face lined with exhaustion and experience, stepped forward, glancing at the clock. "We’re beyond 20 minutes now," she said softly, though her voice held a note of finality. "We’ve done everything we can."

Sarah felt her heart drop, her eyes widening in shock. "No…" she whispered under her breath, her hands shaking. This couldn’t be it. Not now.

But before anyone could say more, the doctor raised his hand sharply. His eyes were fierce, his jaw set in defiance. "No. We’re not stopping." He looked down at Emma’s body, frustration tightening his features. "We should have caught this earlier. If we had… she wouldn’t be here right now. We’re going to keep going."

The charge nurse hesitated, glancing between the doctor and Emma, then gave a small nod, stepping back.

The nurse resumed compressions, driving her palms into Emma’s chest with renewed intensity. Sarah watched as Emma’s body shook with each push, her breasts trembling with the force, her ribs straining under the relentless pressure. The team worked in silence, the grim reality of the situation hanging over them like a cloud, but no one was willing to give up just yet.

"Come on, Emma," the doctor muttered under his breath as he prepared the defibrillator again. "We’re not losing you."

Another shock was delivered. Emma’s body jolted, her torso lifting off the bed once more, only to fall back down in a lifeless heap. The flatline continued its haunting wail, and the nurse immediately resumed compressions, her hands pressing deep into Emma’s chest, causing her body to rock with each life-saving attempt.

Sarah’s breath hitched as she clutched the edge of the bed, her knuckles white. Every part of her wanted to scream, to demand that Emma wake up, but all she could do was watch as the team fought to bring her back.

At the thirty-minute mark, the room was filled with the sounds of relentless CPR, the rhythmic thuds of compressions, and the beeping monitors. The desperation in the air was palpable as Sarah stood, frozen at the foot of the bed, watching Emma’s lifeless body move mechanically under the force of each compression. Her best friend—so full of life just hours ago—was now a pale, still figure on the trauma bed, her body convulsing only with the shocks and the desperate attempts to keep her heart beating.

"Let’s get a cardiac ultrasound," the doctor ordered, his voice sharp with urgency but laced with a grim undertone. He was still refusing to give up, but even Sarah could see the fatigue in his eyes, the way his hands trembled slightly as he signaled for the nurse to bring the equipment. He had been pushing hard, refusing to stop, but there was a tension in the room now—an understanding that they were running out of time.

As the ultrasound machine was wheeled in, the compressions were momentarily paused. The nurse removed her hands from Emma’s chest, and for the first time in what felt like an eternity, her body lay completely still. Her chest no longer rose and fell, her limbs were limp, and her face was slack. Sarah’s gaze drifted to Emma’s half-open eyes, staring blankly at the ceiling. They were lifeless, glassy, fixed in place, and dilated.

The doctor quickly applied the ultrasound probe to Emma’s chest, the cold gel smearing across her skin. The room fell into a tense silence, every eye watching the screen, hoping for a miracle—hoping to see something, anything, that would give them a reason to continue.

But the screen remained empty. There was no flicker of movement, no hint of cardiac activity. The dark, unmoving silhouette of Emma’s heart filled the screen, completely still, devoid of the pulsing that everyone had been praying for.

"She’s in asystole," the doctor said quietly, his voice flat, his eyes glued to the monitor as if willing it to change. He moved the probe around, checking again, hoping for some sign of life, but there was nothing.

Sarah’s breath caught in her throat, her knees buckling slightly as she held onto the bed rail for support. She had heard the word before—asystole, the absence of any electrical or mechanical activity in the heart. The flatline on the monitor had already told her, but seeing it confirmed with the ultrasound felt like a punch to the gut. Her friend was gone.

The charge nurse stepped forward, placing a gentle hand on the doctor’s shoulder. "Her pupils are fixed and dilated," she said softly, almost in a whisper. "There’s no response."

Sarah’s eyes filled with tears, her vision blurring as she watched Emma’s empty gaze stare upwards, unseeing. The pupils were wide, unmoving, a sure sign that her brain had stopped responding long ago.

The room went silent. The compressions ceased, the frantic energy dissipated, and all that remained was the cold, unrelenting truth. Emma was beyond saving.

The doctor stood up straight, removing the ultrasound probe and wiping his hands on his scrubs. He let out a long, slow breath, his shoulders slumping with defeat. "We’re calling it," he said quietly, turning to the team. "Time of death…"

But Sarah barely heard the rest. All she could focus on was Emma, lying so still, her body motionless after what felt like an eternity of fighting. The tears fell freely now, and Sarah collapsed against the bed, her hands clutching the sheet as she whispered, "Emma… no, please…"

The room began to empty, the trauma team stepping away one by one, their heads low, their faces grim. But Sarah remained, frozen in place, her world shattering around her as she realized the person she loved most in the world was gone.

[codeblue1973]

Cassie Codes in the ICU

Nurse Farah watched quietly as Cassie's chest rose, then fell, as the ventilator breathed for her. There was an intermittent whoosh-click that came from the vent each time Cassie's breasts rose. Farah could not remember how many times she had checked on Cassie today, and she knew this would not be the last.

A quick succession of sounds from the vitals monitor shook Farah out of her reverie. Bip-bi-biiip-bipbipbip-biiip. Cassie's heart was threatening arrhythmia again. Instinctively, Farah placed her finger against Cassie's neck, feeling directly for her pulse. The skin was cool and a little clammy. Farah felt Cassie's heart trying to push blood, but she feared that Cassie would probably fall back into arryhthmia and, from there, into V-fib again.

Just as soon as it began, Cassie's cardiac rhythm corrected itself.

Farah pressed a button on the monitor and began a blood pressure reading. She heard the familiar sound of the pump, grinding away inside the monitor. She saw the cuff bulge on Cassie's slim arm - bruised and sweaty from the abuse - and heard the pulling and straining of the velcro as the cuff reached its limit. With a few deflations, and a long beeeep, the machine deflated the cuff.

102/70. Cassie was not doing well. Her pressure has been dropping and her heart wasn't doing its work. Cardiomyopathy? Some kind of rhythm problem?

The attending physician had told Farah that Cassie had come in to the Emergency Department the previous night complaining of light-headedness, headache, chest pains. Naturally, they processed her immediately as a potential cardiac case. Slim, 22, possible anorexia…the case almost wrote itself. Her low blood pressure wasn't unusual for a woman her age and build, but a 5-lead EKG gave some ominous signs. They shifted her to a 12-lead and got her a bed. After several hours in observation in the ER, it seemed that she was stable, although still weak and hypotensive. The arrhythmia was already obvious.

Then she coded. For the first time, at least.

It was unexpected and very sudden; Cassie's cardiac deterioration was very rapid - she complained of a flutter, which was probably A-fib, and then she lost consciousness and seized briefly. After a short round of CPR and a 120 J cardioversion, they had a rhythm and she was breathing on her own, although she was not conscious. They decided to move her to ICU.

That's when I first saw her, Farah thought to herself. Farah had immediately found herself suddenly fond and protective of Cassie. Maybe more than other patients; she couldn't be sure.

Still unconscious during Farah's morning shift, Cassie coded again, briefly. Farah performed CPR this time. They got her back on rhythm again and decided to intubate for safety, given her uncertain condition. The ER team had left her in her bra and panties; when Farah's team decided to put in a Foley, she decided that she would leave Cassie as dressed as possible.

Farah looked away from the vitals monitor and its terrible information, and looked down at Cassie, her body uncovered for observation.

Cassie was reclined in the ICU bed, slightly head-up for postural circulation. Her arms were laid away from her body. She was on a vent, the tube holder creasing her face where it had been quickly strapped in place. Her hair fell in disheveled curls out of the bouffant cap they had put on her. As her chest rose and fell, Farah ran her eyes slowly down Cassie's body, thinking about how she looked. EKG electrodes pressed quickly to her chest, IVs in her wrists. The thick yellow cath clumsily running out of her panties to the collection bag.

They had done all the necessary things, and now Cassie was totally transformed from how she was when she came in. Farah's fascination was deep. She found herself staring at the catheter bulge in Cassie's panties.

"Farah?" Nurse Yasmin's greeting startled Farah, and it probably showed. She tried to stifle her gasp, but she was unable to hide her blushing.

"H…hi, Yas. What's up?" Farah smiled at the junior nurse.

Yasmin looked briefly at Cassie, then up at the monitor. "How is she?"

"Same. BP is down some, and she's still throwing PVCs." Farah sighed. "What's up?"

Yas looked at Farah. "Attending told me to tell you that we should put an AED on her and prep for corrective cardioversion. The team is on the way."

Farah looked at Cassie again. Here we go.

"Can I help out?" Yasmin asked.

"Of course," Farah smiled. "Let's get her prepped."

=====

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[codeblue1973]

ICU

Where am I? What happened? I was lying on a hospital bed in a large white room, surrounded by various medical equipment. My neck was immobilized by a medical cervical collar.

I lay on my back, staring at the ceiling. An attempt to raise my hand was unsuccessful. My body was completely paralyzed. The room smelled too strongly of... medicine. The quiet beeping of the machines created a monotonous background, reminding me that I was chained to this bed. These tubes... What are they for?

I couldn't even speak... In my mouth, I felt a cold, smooth plastic endotracheal tube that restricted the movement of my tongue and cheeks. Could I not breathe on my own? It seemed so. This large blue plastic holder on my face... to keep me from pulling out the tube? The air supplied by the ventilator had a constant temperature and humidity. Each ventilation cycle was accompanied by a characteristic click of the valve opening and closing, allowing air into my lungs.

I looked at the ceiling, trying to distract myself from these unpleasant sensations, but to no avail. Finally, a nurse came in. I tried to give a sign, but she didn't pay attention. I at least wanted to understand why I was in the hospital. And why was I connected to a ventilator. But she only adjusted the IV drip with a mechanical movement, as if I were just another object in the room. The nurse's gaze slid over me indifferently. In her eyes, I saw only another patient.

A lot of time has passed. The doctor came in, glanced at the monitor, and said, "The condition is stable." I still didn't understand what was happening to me. "Can you hear us well?" she added, but there was no warmth in her voice. "Of course you can't speak, but try to blink if you hear me," the doctor continued, watching my eyelids.

“Your body is paralyzed, so we are providing you with mechanical ventilation, enteral nutrition through a nasogastric tube, and parenteral drug administration through intravenous catheters. In addition, urinary catheter is used to maintain body hygiene. This is a complex of measures necessary to support your vital functions. We will regularly conduct examinations and adjust treatment depending on your condition.”

The doctor left. Tears rolled down my face, but I couldn't wipe them away. I waited again. I waited a long time. Suddenly, the door opened, and a young nurse entered the room. The nurse paused over my tests and frowned slightly. "We have some news for you," she said slowly.

Could it be worse? I can't move or breathe. I'm connected to medical devices. The white ceiling, the colorless wall, the hum of the machines – all this reminds me of the hopelessness of my situation. The nurse uttered this phrase as if pronouncing a sentence. "Soon you will have a new operation. Of course, you will be connected to a ventilator. You will have a tracheostomy. But at least you will be able to speak in a whisper." My eyes were dry from crying. What will it change? I will still be chained to this bed…

[codeblue1973]

Run

I just woke up. Something’s strange... Something’s wrong with my throat. I’m trying to remember how I got here. The last thing I remember is... No, I can’t remember anything.

I’m almost completely paralyzed. There’s a medical sensor and a bracelet on my wrist. So, I’m definitely in a hospital. And what happened to me?

No! This is horrible! They’ve put a breathing tube down my throat: long, plastic, and clear. I can feel it going down my throat deep into my lungs. I can’t breathe on my own. Every breath in and out is accompanied by an unpleasant sensation.

I see these tubes and the ventilator. I try to move, but my body won’t respond. The machine is breathing for me, but I feel like it’s taking a part of me away. I’m helpless, tied to the bed like a doll.

So, I’m paralyzed and hooked up to a ventilator. Every noise in the room seems loud and threatening. I’m afraid something will go wrong, and I’ll be like this forever. Now I’m stuck in this bed, and all I can do is stare at the ceiling.

I feel so alone. I want to call for help, but my vocal cords won’t obey. I’m thinking about what will happen next.

They’re going to connect me to other medical tubes. I’m afraid I’ll be stuck in this bed forever, unable to live independently. Does this mean I’ll completely lose control of my body? That I’ll become dependent on doctors and machines? I'm immobilized in this bed, feeling completely helpless.