The Night the Codes Kept Coming......

In emergency medicine there are certain patients who are rare. In the field this is especially true of cardiac arrest. One Sunday night not long ago, I ran two in the space of 4 hours, at the slow station.
The first was dispatched as difficulty breathing. When we got up to the apartment I found a patient lying on the bed obviously not breathing. I immediately transmitted a working code. The patient's roommate stated that she had begun having difficulty breathing approximately 10 minutes prior to calling 911. As the only paramedic on scene it was officially, cowboy-up time. The initial rhythm was Asystole. With IO, ET tube, Vaso, and Bicarb on board we achieved ROSC at a rate of 48 and a BP of 82/P. I started the first epi-drip for the department (the protocol had been added the week previous) and maintained a pulse into the ER. The patient made it up to the ICU.
The second came just as we cleared the hospital from an ETOH call. It was surreal. Unlike the first this was declared code-99 at the time of dispatch. We I arrived the engine crew was already doing CPR and had dropped a King tube. This gentleman had been up talking to his wife when he collapsed. Just like the previous code the rhythm was Asystole.  It took Vaso, 2 Epis, D50, Calcium Gluconate (also a first time push for the department) to achieve ROSC. As before, the patient's pulse came back slow with a low BP and so an Epi-drip was started. The patient made in the doors of the ER and coded again. We again got a pulse back with an Epi dose. Just after achieving ROSC for the second time, A nurse yelled across the ER that a patient had just coded. The ER doc left me in charge of my patient and took off with several of the engine crew to work the code on the other side of the ER. Unfortunately neither my patient nor the one on the other side of the ER survived.
As, I was talking to the ER physician a short time later, he told me that they had 6 codes (including my 2) in the last 12 hours. It was a night that I will not soon forget. Although neither of my codes survived to discharge, the night taught me an important lesson, rule out H&Ts early and aggressively (just don't push sodium bicarb and calcium gluconate too soon after each other as happened with the ER code).
The adventures continue to give me insight and I know one day they will make a difference, first in the field and eventually as a physician. Until next time.....