Monday, January 22, 2007

Hey, Is That ... ?

Friday morning, we're dispatched to a sick person. Not many details on the computer beyond "80s female, flu-like symptoms." We're a few minutes out when the fire engine slows us to code 1 (no lights/siren). Must not be anything serious.

* * *

We walk in to find the engine company (three EMTs, one paramedic) standing around a woman in a wheelchair. She looks a little out of it, but not bad on first glance. The fire medic says that she's been lethargic, a bit confused, weak. Seen at the ER yesterday for flu. Looks like it just got worse today.

Right then the last sticker for the heart monitor goes on.

My partner starts, as do I. We saw the rhythm from the second it appeared -- and that's a scary thing to see pop out at you! The fire medic is still talking to the patient, and my partner taps him on the shoulder.

"I don't know about you," he says with the hint of a grin, "but I'd call that v-tach."

The fire medic's face goes white.

* * *

We Georgia her to the stretcher in the living room. I get the patches on her chest. My partner looks for IV access, doesn't see anything good for the big line we may need, and goes to his favorite fallback: an external jugular. I draw up 150 of amiodarone for an infusion in a minute as my partner and a couple of the fire EMTs get BLS airway gear set.

When we're all ready, my partner pushes 5 of versed into the line. We've been talking to the patient and her husband all along, and now I turn to him.

"Basically, sir, like we've said, her heart is in a pretty unhealthy rhythm. We need to get that fixed, and how we're going to do that is by shocking her -- basically pushing the reset button and letting her heart start back up in a normal rhythm. So that's what you're going to see, in a second."

He seems taken aback -- who wouldn't be? -- but nods. We sync up, charge to a hundred, and I say "everyone clear," calmly but firmly.

Beautiful. I announce in the same calm voice -- at least, I hope it sounded calm -- "Looks like normal sinus, guys." I go to get the amio infusion ready, and the fire medic starts getting 12 lead stickers on, when my partner pipes up from the head.

"I think we've got a bit of a problem." All three of us medics huddle up. "The versed took her down too far, which isn't a bad thing, since we shocked her -- but now she's not really protecting her airway." The fire medic and I nod, and I rip the intubation roll out of the airway kit and start getting set up. She's a moderately difficult tube, and I've had issues with tubes lately, but a little help from my partner and we've got it in.

Back to what we were doing. I get the amio infusion -- 150mg over 10 minutes -- running, and the fire medic and my partner get a 12 lead going. She's not having a STEMI, which is one concern down. She has a heart history, we've found out, and in fact was already on oral amiodarone.

Just as it looks like everything is calming down, the faithful Lifepak cycles a pressure again -- 90/40. Crap. Down from what it was a few minutes ago. We open the line wide for a fluid challenge, but it's obviously cardiogenic shock, and my partner asks me to go get the dopamine out and call for orders. About the time they get her out to the ambulance, I've got orders from a doc, and I'm on the way to having the pump ready.

It was my partner's patient, so I give them a quick, smooth code 3 ride to the hospital. Her pressure goes up, and then back down again, to a low of 70/30, and they do end up starting the dopamine just before we get to the hospital. We turn her over to the ED staff, and she looks to be doing pretty good.

Outside, the fire medic apologizes -- "I never would have slowed you guys if I'd known!" and my partner (who's been a medic for twenty years) says, "Dude, never in a million years, I'd never have guessed. No worries. No worries at all."

* * *

Eight hours later we're in the ICU at the same hospital, and we check in on her. She's extubated. We talk to the nurse for a few minutes. The patient is tired, but awake enough to say hi briefly when we poke our heads in the room. She doesn't remember us, and we both agree later that this is a very, very good thing.

Talking later, we get laughing. My partner says maybe he'll quit being a training officer and just work with me. "After all," he quips, "I may be a sh*t magnet" -- something he told me on my first day with him, which has seemed pretty true -- "but together we're a storm."


Susan Palwick said...

What a story! I'm so glad she's okay -- and yes, it's probably good that she doesn't remember what happened!

Ambulance Driver said...

Good story! I'll have to visit here often...

penguinshrink said...

Even a med student can recognize that first strip! ;)