"An Equitable Trade"
Chapter Ten
Another ambulance arrived on scene. Its driver parked right alongside of Squad 51.
The rig's back doors popped open and two people in white appeared.
Doctor Kelly Brackett exited the ambulance and then helped RN Dixie McCall climb down.
Station 51's captain and senior paramedic stepped up to greet them.
Roy was about to ask the pair how they'd managed to get there so fast, when he recalled that Rampart's ER is equipped with its own fire department radio.
"I brought a surgical kit and a bone saw, in case—" the physician didn't finish his sentence.
John's partner mentally completed it for him,'—we need to amputate.'
Dixie held up an insulated canvas satchel. "And I brought some warm IV solution and some warm blankets."
The doctor turned to address Roy's other boss. "What's the time-frame on this?"
"The building collapse occurred at 16:02 yesterday afternoon," Hank obliged.
Kel glanced at his watch. It was now 04:38 the following morning. The right corner of the doctor's mouth twitched—twice.
Johnny's 'Golden Hour' had come and gone nearly 12 hours ago.
E.J. had to purse her lips to keep them from trembling.
J.R.'s respiration rate was becoming increasingly rapid and shallow, and he hadn't spoken two words in the past ten minutes.
She needed to keep him talking. Recalling how passionate the paramedic was about his work, she picked it as the next topic for conversation. "Do you need to breathe into your helmet again?"
J.R. shook his head. "Not…hyperventilating."
"Then why are you breathing so fast?"
"Tachypnea."
"Which is…?"
"A respiratory rate…above 20."
"Which is indicative of…?"
The paramedic took a long time to respond. "Shock."
"All those Advanced First-Aid courses I took…" E.J. wistfully whispered. "The Red Cross trained us to treat peoples' injuries, to try to prevent them from going into shock, but they never once explained what shock is. What, exactly, is 'shock'?"
"Shock talk…does not…exactly…make for…pleasant conversation."
"You said I could handle any situation, if I were prepared. So…prepare me."
J.R. managed an amused gasp, and promptly complied. "Shock is a situation…of relative hypoxaemia…due to failure of the circulation…to deliver and distribute…enough oxygen…to the body's cells."
His feisty companion was un-amused by his textbook reply. "I'm afraid you're going to have to prepare me a whole lot better than that."
J.R.'s mouth was almost too dry now to speak. And he was breathing way to fast.
Perhaps they both needed to be prepared.
The paramedic got his tongue unstuck from the roof of his mouth and did his damnedest to regulate his breathing. "Shock is hypoperfusion. Hypoperfusion is a medical emergency where the body's organs and tissues are not receiving an adequate flow of blood. Hemoglobin carries oxygen throughout the body. An insufficient level of hemoglobin deprives the organs and tissues of oxygen and nutrients and allows the buildup of waste products."
Try as he might, he could only manage to get a few words out between gasped breaths. "There are three stages of shock.
In Stage I, the body detects a low blood flow and takes all these really cool steps to compensate for it. The body tries to regulate blood gases and raise the blood's pH level. It releases epinephrine and norepinephrine to increase the heart rate and blood pressure. The heart starts beating faster, blood vessels throughout the body begin to constrict, and the kidneys start transferring more fluid into the circulatory system.
While this additional fluid helps to maintain blood pressure, and maximize blood flow to the vital organs, it also dilutes the blood's hemoglobin, or oxygen carrying capacity, causing further hypoxaemia.
Symptoms of Stage I shock are: Blood pressure within the normal range, with a normal respiratory rate between 12-20 breaths per minute. The patient is mentally alert but may be displaying some slight anxiety. Skin is a little pale, but capillary refill is normal. If properly treated, at this stage, the progression of shock can be completely halted.
In Stage II, the body's compensatory mechanisms begin to fail. Sodium and potassium levels get all out a' whack. The heart rate becomes so rapid, it doesn't allow the heart's chambers to fully decompress between beats. Blood pressure begins to drop. Decreased oxygen to the brain causes the patient to become confused and disoriented.
Symptoms of early Stage II shock are: Tachycardia—a heartrate above 100 beats per minute. Tachypnea—more than 20 respirations per minute. Narrow pulse pressure—systolic blood pressure is maintained and diastolic pressure is increased, so the gap between systolic and diastolic pressure narrows.
Pale, cold, and clammy skin, caused by blood being diverted from the skin's surface to supply the heart, lungs, and brain. The patient is becoming increasingly anxious and restless. Capillary refill is delayed.
Symptoms of late Stage II shock are: Systolic BP falls below 100. Marked tachycardia—a heart rate over 120 beats per minute. Marked tachypnea—over 30 respirations per minute. An altered mental status. Sweating with cool, pale skin and delayed capillary refill.
Even at this late stage, the progression of shock can be halted and reversed…" The lecturer realized he was growing woozier by the second. It was becoming harder and harder for him to see. Either their flashlight's beam, or his vision, was rapidly growing dimmer. "The definitive treatment we administer in the field is geared to prevent shock from reaching a NRP—Non-Return Point…"
The sounds of the men working below seemed to be getting closer.
Perhaps?
"E.J.?"
"Yes, dear?"
"I may have to…close my eyes…for awhile…But, don't worry…My firemen friends will be here—"
"—before the batteries go dead," E.J. finished for him. "I don't give a rat's behind about the batteries, J.R.! Your firemen friends need to get here before you go dead!"
Her rescuer managed another amused gasp. Whether they did, or didn't, John Gage was at peace with the fact that he had sacrificed his life for such a remarkable woman.
The fireman's faint, and slightly crooked, smile slowly faded from his face and his helmeted head flopped lifelessly forward.
His arms had also gone completely limp, but the buckled belt did its job and kept E.J. from falling.
She shoved the young fireman's helmet back on his head a bit and soothingly stroked his cold, clammy brow. "That's it….You rest now, J.R. But don't you dare go doing any damn trading!" she sternly admonished.
The Advanced First-Aider took note of the time and then used the second hand on her watch to get a heartrate.
Her patient's heart was hammering away so loudly, she could hear it without having to press her ear up against his chest.
'21 beats in 10 seconds. 6x21=126 beats per minute.'
A heartrate greater than 120 bpm was marked tachycardia, and marked tachycardia was—
J.R. was right. Shock talk could be extremely unpleasant.
Her young rescuer's condition was rapidly approaching Stage III.
'NRP. Non-Return-Point…'
E.J. clenched the front of her young rescuer's smoky fire coat with ice-cold fingers and began praying…and crying.
The exhausted old woman sobbed herself to sleep.
TBC