Tuesday, April 07, 2009

Clubbing and Coding

Excitement, dear readers, excitement! And outside the hospital, no less ... read on.

In a rare weekend where I had both days off, I went with some friends out of town and then to a club (you know, to read the articles). At one point while I was busy talking, I noticed a large group of people huddled around something across the room.

Automatically I assumed that the "something" was a person so I darted over, pushed my way through the crowd, and then saw a young man collapsed on the floor. Instinctively I jumped in. I didn't even know I had such instincts.

A few muscle-headed security guards were also kneeling down, but I squeezed myself between them. I went straight for the collapsed guy's neck to feel for a pulse, when one muscle head barked that I could not help if I was drunk (which I was not). Normally when a bouncer-type person yells at me I shy away, but this time I barked back that I was a doctor and could help. Immediately -- satisfyingly -- he retreated.

I continued assessing the guy and performed some simple BLS (Basic Life Support). For some reason -- perhaps in the excitement of the moment -- I cannot remember exactly what I did the next few minutes, but I do recall one of the security guards pulling out some gloves from his pocket for his own use, and me snatching it from his hand. I put it on my own, and then he surprised me by offering the other.

Initially I thought the victim had no pulse, so the guards turned to me to see if chest compressions should be started. Just as I was about to nod we tried a sternal rub. The guy immediately started groaning and then he came to. I stepped back and left him to the guards and the newly-arrived medics.

The guy was then wheeled off and hauled away to an ambulance, slurring, belligerent, and all. Good ol' alcohol intoxication.

Any sudden and unexpected situation is an exciting one, but this scenario held special significance. Since medical school or early internship, I have had recurrent daydreams (fantasies?) where I imagine being in a public place when someone collapses, and I rush to the rescue. Whether I do this because of boredom, an overactive imagination, or a latent desire to be a hero -- in one of my dreams I order the pilot of our plane to make an emergency landing! -- this scenario has crossed my mind many times.

Sadly, when the real thing occurred, I wasn't nearly as graceful as in my dreams. In the heat of the moment I had to spend a few seconds reviewing BLS algorithms, and then later I was slightly hesitant to tell people to start chest compressions (which, as mentioned, ended up being unnecessary.) In addition, finding the victim's pulse was close to impossible with loud music pounding in the background and having multiple crowd members yell out idiotic comments does not help one's focus.

Regardless, my work and play don't often mix, so having these two worlds run into one another was definitely exhilarating.


Dr.Rutledge said...

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Grumpy, M.D. said...

Love that.

Once upon a time I used to be like that. Now, when I hear "is there a doctor around" I cringe and hide.

Anonymous said...

Number one cause of a code in this situation is tongue obstructing the

Strong jaw thrust (both hands behind angle of mandible driving his lower teeth anterior to his upper ones and extending the neck).

Ear over mouth to listen for breath sounds and eyes on body to assess respirations or any other movements.

While doing the above, take 10 seconds to assess the situation and make sure that a defibrillator is coming and 911 has been called.

No breath sounds in that time = bad news bears.
Go to B (assisted ventilations, watch for chest rise)
and CPR.

Shock ASAP. I think that's pretty much the most you can do.

I had a similar situation happen to me but nobody believed I was a doctor. I insisted, but was threatened with violence, so I left. Very very upsetting.

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