Monday, July 27, 2009

Moments

We're a out deep, the rural end of our district extending far, far away from the station, into the lonely backcountry land of two-lane state highways and national forest roads and long, long driveways.

"And then, when I went, there was blood in the toilet, a lot of blood, you know?" he says, calmly enough. "I was going to drive in, but when I went in the living room I got dizzy, and saw stars, and almost fell down, and I figured I'd better call you folks."

I nod, and glance at the volunteer EMT, kneeling by the patient, blood pressure cuff hissing down.

"It's good," she says, "124/76."

"Perfect," I reply.

A few minutes later, in the ambulance, starting the thirty mile trip to the hospital, I punch the NIBP button on the Lifepak.

112/64. No worries at all. I putter through the comforting routine of starting an IV, chatting to the man about what I'm doing and what's going on.

I punch the button again.

101/62. Huh. I inch the roller clamp on the IV tubing upwards. The slow drip-drip-drip in the chamber becomes a steady patter. His heart rate stays low, not even 70 -- but there it is on his med list, the telltale -olol holding his heart rate down.

I force myself to wait three or four minutes. A hundred cc's of fluid run in. I run my finger over the blood pressure button in a tiny, nervous motion before thumbing it.

89/62. I take a deep breath, smile at the patient, and stick my head up front. We're still ten or twelve miles from the nearest town, and the hospital is another ten miles past that.

"Okay," I say to my partner. "Let's get there a bit faster." His finger goes down on the big red switch at the same time his foot goes down on the gas pedal, and the rumble of the diesel rises to a throaty roar.

I scoot back to the patient, ask how he's feeling. Yeah, we're driving a bit faster -- your blood pressure is a bit low. Nah, I'm not worried, but we don't want to dally. Feeling a bit faint? Here, I'll lay you back. Any pain? Trouble breathing? All this as my hands quickly run through the motions of spiking a second bag of fluid.

Poking what is rapidly becoming my least favorite button on the monitor, I glance out the back window. We're a few miles outside of the town. I grab a big, gray sixteen out of the cabinet and wrap a tourniquet around the man's right arm. Kindness and grace, he's got a big AC. Maybe his pressure has come back up.

62/43. And his heart rate is slowing, ECG complexes stretching out, further apart, big yellow numbers dispassionate on the screen: 45.

I swab the inside of his arm with alcohol, and yell to my partner that hey, while we're in town, we should grab a friend. I've barely got the needle in when my portable radio, forgotten on the bench seat, starts quietly whistling tones.

"Tones for Fire District 17 ... Station 30, meet Medic 601, enroute to your station, code 3 and requesting personnel to assist ..."

4 comments:

medicblog999 said...

Bit of a nail biter there PDEXMT, looking forward to reading the conclusion!!

Nessa said...

My heartrate was 38 once, and they couldn't figure out why.

Anonymous said...

Wow...hope he made it!

Hailey said...

See? THESE are the calls that freak me out, man! I wouldn't be smooth and calm (and I don't have a monitor with a BP button, which may be a good thing in this case!)|