As I moved to the trauma bay to throw a body bag over the stretcher, I thought that if there was ever a good time to code, it would be a witnessed arrest in the back of a ALS ambulance only minutes away a major trauma center. Unlike the majority of coding patients who arrive already dead or close to it, this guy had a fighting chance, and we knew it.
The triage nurse had the ambulance bay doors open and the attending stood outside, waiting. I primed some fluids, resuscitation meds were drawn up, Respiratory was paged and the defibrillator stood charged and ready.
As the ambulance peeled in with sirens wailing, the rear doors opened to reveal a second attempt at intubation underway. Unable to get the tube, the medics ran the stretcher to the trauma bay while doing one-handed compressions.
Clothes were cut, leads placed, a second line started and the airway secured. Nurses pushed rounds of meds while techs cycled through compressions and the attending calmly called out orders. After the third defib, the patient regained his pulse. An ICU team arrived with a cooling unit to induce hypothermia, and not more than 20 minutes after arrival the patient was on his way upstairs.
Talk about a rush. Job well done, all.