READ!: I passed my AEMT hooray, the story is not only finished but revised if you want to re read it. other than that here you go!
Chapter 4
Death Comes Ripping
Hideki's sternum was sinking and rebounding under Hiro's hands who compressed at a rate of one hundred beats per minute. Tensin, having worked many critical calls with the man, automatically began setting up the vent system and would pull from its assembly to administer two rescue breathes every thirty compressions.
Mizu looked back at the horrendous sight of her father being sustained artificially. She had never seen CPR being performed in real life before and for her first time having it be her father was more than she could handle.
"DAD!" she screamed.
Sakura, becoming lethargic yet alarmed, asked Sitoshi, "What's going on…?"
"I…I don't know…" he stammered.
He arose to help until she grabbed his arm weakly. Seeing her pale and ashen face she sickly said, "I…I…think….I'm…dying…."
Her eyelids fluttered shut and she stopped moving. Sitoshi shook and called her name with no response.
He overheard Tensin talking to Hiro, "Let me know when you're going to intubate and we'll make the switch."
Tensin delivered two more breathes then took over compressions as Hiro whipped out a multi lumen airway device, lubed it up and inserted it down Hideki's throat, secured it then hooked it to the bag valve mask and continued artificial ventilations after the next set of thirty compressions.
Sitoshi backed away from his dire patient who lay there lifeless, "Hey guys, I need some help…" he said.
"Not a good time kid." puffed Tensin as he continued to work.
Hiro was able to set the lumen up to the vent circuit so ventilations could be administered automatically, then analyzed the heart rhythm on the monitor.
"He's gone into V-fib, I'll get the fast patches on him and see if we can shock him out of it.
"Hey something's wrong with Sakura…" trembled Sitoshi, 'I don't know what's…"
Tensin, under enormous stress, snapped, "You studied for the job, you wanted the job, you got the job, NOW DO THE FUCKING JOB!"
His body went numb and his mind was going frantic, but suddenly, when left on his own he started to calm and think critically. He was going to re asses and treat all any signs and symptoms in his power.
She was not breathing properly therefore he switched her cannula out for a non rebreather and upped the dosage to 15ml a minute after adjusting her airway. He checked the pulse, the radial was absent but the carotid was quick and thready, her skin pale and clammy.
Perhaps she was bleeding internally from the broken pelvis so he synched the pelvic binder tighter then noticed the traction splint with a suspicion in mind. Lifting the blanket he found the flesh of her inner thigh polluted with hideous blacks and blues.
The bleeding was in the leg, most likely due to the broken femur severing the femoral artery but occluded it at the same time. Then when the traction splint straightened out the bone ends the pressure was taken off and the artery began bleeding freely.
He snatched a tourniquet and applied it as high up the thigh it could go then tightened it with all his strength. As with the loss of blood, he would have to provide fluid therapy fast. This would mean he would have to establish an IV.
He applied a tourniquet to her arm and pulled it tighter than normal for finding a vein, for the loss of fluids make them very difficult to find. Running his fingers across her mid forearm he found a slight bump that rebounded when pressed.
It was as good as any, he took the needle, re checked the vein's location then sent it through. He missed.
Wiping the sweat from his forehead he adjusted and sent it in again, the needle nicked it but the vein rolled. One more time, he pulled traction, steadied the bevel then quickly gave another poke. He got flash back, the needle was in!
Rapidly he advanced the catheter all the way in, retracted the needle then hooked it up to the saline bag and opened it up all the way. He even took the liberty of squeezing the bag to flush the bolus in immediately.
When that bag was depleted he hooked up another one and felt her radial pulse again, it was present. Her eyes began to open and she started looking around.
"Sakura can you hear me?"
She nodded and moaned weakly, "Hmm mm."
Hiro, who finished putting the fast patches on Hideki's thorax and gave him one shock on the automatic defibrillator, called to him, "Sitoshi do you still need help?"
With a warm feeling of pride he said, "No, I'm good."
The proud feelings were cut short when Mizu pointed and screamed, "That thing is back!"
Tensin looked through the windshield while continuing compressions, the battle had knocked Alucard closer to there location which required immediate vacating of their post; however this would mean Hideki's care would be interrupted.
Hiro guided him off and said, "Get us out of here, Sitoshi can help me with this."
Tensin jumped back into the driver's seat and accelerated down the road.
As they were heading down, Alucard hit the ground with such force that it shifted an F-15J fuselage wedged in a building and nearly landed on top of them if not for a quick maneuver of the driver.
Meanwhile Hiro was instructing Sitoshi on their next plan of action, "Alright when I say 'when,' you're going to take over compressions for me, got it?"
"Yeah I can do that."
"Ok, now!" he instructed while letting off allowing Sitoshi to jump in and resume compressions.
Hiro rifled through the far compartment and retrieved the Lucas device and asked, "You ever hooked someone up to this before?"
Sitoshi shook his head in which he responded, "Well you're going to learn."
With rapid instruction they slid the strap under Hideki's back, positioned the piston over his sternum, secured the hands and strapped it around his back. Hiro activated the piston which began compressing the chest on its own.
Hiro analyzed the electrical activity of the heart, it was a fibrillating, disorganized mess of impulses minus the artifacts. He began digging into the drug bag shortly after.
"Oh I'm in pain!" moaned Sakura.
"Hang on, we'll be there soon." reassured Sitoshi.
"It's my stomach, it hurts!"
He then noticed the crotch of her pants becoming wet, her water had broken.
He moved to assist while informing, "You're going into labor."
"B-but the doctor said I wasn't due for another two weeks!"
"It's most likely trauma induced. Your body has been put under too much stress."
Tensin looked back and called to him, "There's no way we're delivering a baby in this ambulance!" then began to accelerate.
Putting his eyes back onto the road he found a section of Alucard's body collapse bringing a group of nearby buildings with him. Tensin banked hard to the right throwing both men in the back to the left and braced against the bulkhead. The tires chirped on the one side as they lifted up but before the unit could topple he straightened out then came to a screeching stop when the dust obscured his vision.
"Tensin can you find us a way out?" asked a recovering Hiro.
Checking the side mirrors he said, "The rear just got blocked and there's nothing on either side."
"What about straight ahead?"
"I'm waiting for the dust to clear and we'll see."
Mizu then began panting, "Wait, are we trapped?"
"We might be." responded Tensin.
"What if we are? What will happen to my Dad and Sister?"
Trying to find the right words he suddenly went white, "Oh…shit…"
Realizing he was responding to what was ahead she froze in fear. Alucard's face was laying right in front of them.
"Hiro turn off the box lights and nobody move."
The whole interior of the ambulance went dark along with the headlights.
The beast was motionless, within the large case of glass found at the crest of its head was the man in black, who seemed to be piloting the creature from there. Everyone in the ambulance was deathly silent save Sakura who inquired, "What's taking so long?"
Sitoshi cupped his hand over his mouth and whispered harshly, "If you're not quiet we'll wind up dead!"
The man in the case was coming to, then as he was looking around, set his deadened gaze right on unit 1076. Tensin's eyes bolted around trying to find a way around but there was none. The monster was alerted to their presence.
The man gave them an evil smile and directed the beast to shuffle and arise.
Tensin put his hands up in a surrendering notion and said near pleadingly, "Please…we're just trying to get home…."
That is when, in this moment of certain doom, a miracle happened. The entire panorama of their respective horizon suddenly became illuminated with a bright light from behind the rig. The sinister being piloting the beast set his attention to it while everyone else turned around and saw a pillar of light shooting forth behind a series of buildings.
"What the hell is going on now…?" muttered Tensin.
"Whatever it is,' commented Mizu, 'I think that thing likes it."
They witnessed the monstrous face of Alucard rise up which, as soon as there was enough clearance, Tesnin bolted through to freedom.
As they passed, Hiro turned his attention back to Hideki whose condition was worsening. For each moment his heart wasn't beating his cells were dying from oxygen deprivation.
Hiro took the epinephrine and filled the syringe, "Tensin we need to get Hideki to the green zone now!" then administered it through the line.
Sakura, still groaning in pain, pled, "Please don't let him die, I didn't mean what I said!"
Hiro remained as calm as one who had been in these situations countless times, "We're doing everything we can for him."
Mizu looked back when hearing the conversation, her lip trembled then turned back and asked of Tensin, "My Dad is going to make it…right?"
He paused, rubbed his lips then replied, "Hey, we have a clean shot to the green zone where we can get your dad and sister the help they need, want to do something for me?"
"Umm sure…"
He pointed to the module adjacent to the center console and said, "You see that button that says master control?'
'Yes.'
'Go ahead and press it, then hit primary flashers."
She did as instructed then looked around to see the nights air and window reflections of passing buildings becoming lit up with the unit's flashing emergency lights.
"Alright now look down the module, you see that dial?'
'Yeah…'
"Switch that over to wail."
She switched it over and the sirens began to signal out loud and clear.
"Good job, we're going lights and sirens now!" he encouraged.
"Yeah that's pretty cool." she commented, faintly relieved.
While the sirens wailed, Hiro made his next intervention, "Ok stay clear, I'm going to try and manually perform a synchronized cardioversion and push more epi as needed. Starting at fifty jules."
He punched in the commands on the monitor then waited, 'Stand clear of the patient."
"Sitoshi, you clear?"
He backed away as Hiro waited for the correct complex and pressed shock. Hideki's chest and body flinched in a bolt then went limp again.
No sustainable rhythm could be discerned.
"Alright let's push another round and go for one hundred jules." he said while recalibrating the monitor then flushed through another dosage of epinephrine.
The monitor let out a long whine as it charged then, when the time was right another jolt, twice as great, shot through Hideki's chest.
The ambulance was screaming down the road with ungovernable haste. Sitoshi was trying to keep Sakura in a position of comfort while she claimed her contractions where getting closer to each other. This presented great danger to a mother with a broken pelvis who was about to have a child pass right through it.
"Hang on we're getting close to the green zone I can see it from here!" yelled back Tensin.
Hiro then said, "Ok, we're charging and going for one hundred and fifty jules."
He pushed another dose of Epinephrine and said to himself quietly, "Come on Hideki, you got two daughters and a grandchild on the way, come back to the light."
The ambulance made way into the crowd of people who were astonished to see a pulverized unit rolling through.
Another shock snapped through Hideki's body as before. Hiro watched and waited while Mizu could see a team of emergency personnel running to them. Sitoshi then saw Hiro sigh and pound the countertop lightly then shut the machinery off. The piston came to a stop and the oxygen ceased flowing.
"What's going on?"
Hiro, while withdrawing the multi lumen said, "It's done, he's A systole."
Mizu looked back, "What does that mean?"
Hiro looked at her sorrowfully then said, "It means that your father has died."
"NO!" she shrieked while jumping into the back to assess her father, tears dripped over his bloody face while she cried, "Dad please, I love you, don't go!"
By this point Tensin got out and opened the back of the rig while the relief crew demanded, "What do you have?"
He answered, "We have three patients, the first is trauma 1 and in labor, the other is walking and talking with minimal injuries…and a third died one minute ago."
As they were pulling Sakura out she looked up at Sitoshi and said, "You told me everything was going to be alright…"
He grew frightfully pale, looked upon the grieving girl mourning the loss of her father and at the monitor showing a continual straight line.
Hiro motioned for them to take care of Mizu,
Another crew member jumped in and escorted her out who protested and cried terribly. There was only silence after that.
Another member of the relief party asked, "We have some tents and a doctor on site, do you want to take him there ?"
"I guess it couldn't hurt." said Hiro as he was ripping the EKG and defib patches off.
They slid the stretcher out, dropped the carriage, placed a linen over Hideki's corpse and wheeled him over to the clinic.
Sitoshi, with a heavy heart, began cleaning up the mess in the box. Then, after only a brief period, threw his collection of supplies on the ground, screamed and punched the bulkhead repeatedly.
…
The doctor thus mentioned was examining Hideki's body while recounting the details from Hiro who explained the events leading up to death. The doctor palpated the body's abdomen and remarked the amount of stiffness and discoloration he beheld. For an extra measure he gelled up the torso and put an ultra sound to it. After some searching the doctor pointed out on the feed.
"With all this blood in his abdominal cavity, I'm willing to guess that he also suffered an abdominal aortic aneurysm."
Hiro sighed, "No kidding."
"Yes, my theory is that when his chest hit, it threw his heart forward and strained the great vessels, then as you were working him it tore completely open."
"Not much more could be done with that."
"Too true, it's not uncommon for patients suffering a triple A to die on the operating table. There's only a 2% survival rating, plus with all the other things thrown into the mix, his chances were next to none."
Hiro removed his gloves and shot them into the trash but said nothing more. The curtain separating the tent from the outside whipped open proceeded by a young man in scrubs, "We need help next door."
"What do you need?" asked the doctor.
"The young girl in labor, we need to do an emergency C-section."
"Alright I'll be there in a minute."
"And hey…?' called out Hiro
Then young nurse stopped.
'Can you get me a body bag please?"
He nodded and left.
Hiro followed the Doctor out and offered, "Do you need help? That young lady was in my ambulance it might help if I'm there because she knows me."
The doctor nodded and smiled, "You're more than welcome to…"
His words were cut short by a series of distant booms and pops sounding off towards Minato Murai. The blinding light was gone and in place was the great monster faltering from what appeared to be two beings with wings punching devastating holes in his body whose radius was so large they blasted the monster into pieces.
Those who were watching cheered and applauded at the sight of the abomination being rent to pieces. Hiro let out a slight gasp of relief, "Thank God it's down."
Before they proceeded through to where Sakura was being treated the doctor looked beyond and replied alarmingly, "Don't thank Him yet…"
His eye reset on the horizon and beheld the remnants of flesh swirling upward and reorganizing into a hideous combination of flesh and bone. The people let out shrieks of hopeless despair and terror at the sight of the ugly blob of tendrils and pulsing tissue while Hiro's eyes softened with that sense to abandon all hope.
The nurse stuck his head out the tent and called, "Doctor?!"
They turned and rushed in.
Fantasy Vs. Reality
-Not all ambulance companies carry a Lucas device but they sure can be handy.
-Sitoshi should have done fluid therapy the second he found out her systolic blood pressure was under 100.
-If you think Tensin snapping at Sitoshi was harsh and unbelievable, well believe it. Nothing frustrates and pisses an EMT off more than another one who can't do the job when they absolutely need to. Corrections can and have been done then and there on scene in front of patients and it can be that harsh.
One of my friends who was doing his paramedic ride alongs had a basic with him while they were working an ALS call, my friend asked the basic to put the patient on oxygen while he was prepping a drug. He had to ask him again because he wasn't doing what was asked. Finally the proctor, a no nonsense firefighter paramedic said, "Hey dip shit, he said put fucking oxygen on the patient, so put oxygen on the fucking patient!"
-I can't comment much on Hideki's arrest because I haven't gone on an arrest...yet. It's mostly accurate according to the information I've taken from my paramedic buddies who've run these calls. The only inaccuracy is the first shock with the AED. If you're going to shock the patient and your scope of practice allows manual defibrillation, then move to manual.
-Never tell a patient, friend or family that everything is going to be ok. You can't guarantee that so you say that you're doing everything you can and leave it at that. What you say can have a big impact.
-Essentially with Hideki's arrest is he was suffering from two things. One was a cardiac contusion (bruising of the heart muscle) which can cause abnormal electrical activity in the heart such as V-Fib. The other as explained was an aortic aneurism. You have three major vessels connected to the heart; the inferior and superior vena cava which returns blood to the heart, and the aorta which oxygenated blood exits the heart. Think of veins and arteries like roads, some being surface streets, residential and such. They all have different sizes of traffic that move at different speeds. Well the aorta is like your six lane freeway moving at 75mph (110-120kmph). That thing ruptures you're pretty much screwed.
What makes the Aorta much more lethal than the Vena Cava is that it's carrying oxygenated blood to the rest of the body at greater pressure. You're losing blood at a faster rate and your tissues are getting starved of O2.
So with Hideki having both a cardiac contusion causing V-Fib and an aortic aneurism, his chances were next to none.
-On that same note, Hiro would have actually noticed the stomach distention, one it'd be hard to miss the discoloration and two, any medic of forty year tenure would be checking for that considering the significant mechanism of injury in the first place. Basically the blood is spilling out and pooling in the stomach cavity.