Sons
We're pulling into the parking lot of Dunkin' Doghnuts when the tone drops. Its the long, drawn out almost dramatic buzz of the county dispatch system and we instantly know we are in for a ride.
"ALS 9 Respond to Nursing Home, report of a high fever with slow respirations from staff. Staff reports patient is stable."
"ALS 9 to County Ops, enroute."
We drive with lights and siren for about twenty minutes before arriving at a dumpy little nursing home in the middle of nowhere, just south of Mt Monadnock. Once inside we find a fat sweaty man with a combover standing nervously with a CNA whose first language is some sort of clicking dialect.
"She has been hot since about four this morning, breathing around 6 times a minute." It is now 11 in the morning.
"Why did you call the County and not the local 911?"
"All of the fire department trucks are busy."
The patient is a small, ancient woman with sunken, unseeing eyes and skin the color of concrete, the staff had thrown a simple facemask on her and left the oxygen flow at about 4lpm, too low for such a device. I pull the mask off and plop a non rebreather on her at 15lpm as the CNA tells me that the fat guy is her son.
"She was a DNR but he revoked it when he arrived here earlier." The woman had paperwork in place that said, essentially, If I die, let me go. At 95 years old its probably not a bad idea but the son, being her son and loving his mother decided to revoke the orders and allow me and Josh to give her the full work up should we need to.
"Sir I need to ask you a very tough question. Please don't be offended." He nodded and I continued. "If your mother stops breathing, if her heart stops do you want me to breath for her and pump her heart." He nods vigorously and whispers an affirmative.
We transfer his mom to the cot and Josh tells him he can follow us to the hospital. "Sir," I interject. "Its best if you drive at your own pace they can give you dirrections to Concord here, its dangerous to follow a bus with all the bells and whistles going."
And with that we are off. In the back of the truck, my intemediate Josh gets an IV, a nice 18 in the left AC. I start assisting the woman's breathing with a BVM, a device used to push oxygen into people's lungs. She gags and fights it but soon we both find a rthym and I am able to breathe for her. The monitor has her in a wide complex sinus brady and her vitals are in the toilet with A pulse of 40,BP of 60/20 and unassisted respirations at 3 to 4 a minute. I tell Josh to fly as I pop a small curve of plastic into the unresponsive woman's mouth to keep her tongue from falling over her airway.
As we race toward Concord I try to intubate, her gag reflex bucks the tube but not the laryngoscope. I bag more, feeling for a pulse every few minutes and fully expecting not to find one. I try for the tube one more time on the twenty minute transport, this time getting it all the way to the chords before she starts to reject it.
"Concord Hospital, Concord Hospital, Rockingham ALS 9 inbound with Status One Notification"
I patch through to the hospital and when they respond I rattle off. "Good morning, Concord, Red Team activation on a 95, Nine Five, year old female. Patient was found with a high temp this morning and low respirations, wide complex sinus brady, vitals as follows BP 70/30, pulse 30, respirations assisted at 14 with no intubation, patient has intact gag reflex. Sugar is 99, 18 in the left AC. Five minutes from your door. Questions, comments concerns?"
"Red 1 on arrival, Concord out.
"Red 1, Rock 9 out, thank you."
We push her through the hall to the trauma room where the doc and his team are waiting, I give essentially the same report all over again and he looks at my EKG strips. "I thought she was a DNR?" I nod.
"Yeah, she was but the son revoked it this morning." As I say that, the son is ushered in by a nurse. He hugs me, hugs Josh and starts to sob. I make some lame execuse about paperwork and bolt from the room as the doctor tells him his mother will likely not make it and be on a respirator for the rest of her life.
The last thing I hear as I am leaveing is the doctor saying. "We'll make her comfortable with morphine and bring in a chair for you."
"ALS 9 Respond to Nursing Home, report of a high fever with slow respirations from staff. Staff reports patient is stable."
"ALS 9 to County Ops, enroute."
We drive with lights and siren for about twenty minutes before arriving at a dumpy little nursing home in the middle of nowhere, just south of Mt Monadnock. Once inside we find a fat sweaty man with a combover standing nervously with a CNA whose first language is some sort of clicking dialect.
"She has been hot since about four this morning, breathing around 6 times a minute." It is now 11 in the morning.
"Why did you call the County and not the local 911?"
"All of the fire department trucks are busy."
The patient is a small, ancient woman with sunken, unseeing eyes and skin the color of concrete, the staff had thrown a simple facemask on her and left the oxygen flow at about 4lpm, too low for such a device. I pull the mask off and plop a non rebreather on her at 15lpm as the CNA tells me that the fat guy is her son.
"She was a DNR but he revoked it when he arrived here earlier." The woman had paperwork in place that said, essentially, If I die, let me go. At 95 years old its probably not a bad idea but the son, being her son and loving his mother decided to revoke the orders and allow me and Josh to give her the full work up should we need to.
"Sir I need to ask you a very tough question. Please don't be offended." He nodded and I continued. "If your mother stops breathing, if her heart stops do you want me to breath for her and pump her heart." He nods vigorously and whispers an affirmative.
We transfer his mom to the cot and Josh tells him he can follow us to the hospital. "Sir," I interject. "Its best if you drive at your own pace they can give you dirrections to Concord here, its dangerous to follow a bus with all the bells and whistles going."
And with that we are off. In the back of the truck, my intemediate Josh gets an IV, a nice 18 in the left AC. I start assisting the woman's breathing with a BVM, a device used to push oxygen into people's lungs. She gags and fights it but soon we both find a rthym and I am able to breathe for her. The monitor has her in a wide complex sinus brady and her vitals are in the toilet with A pulse of 40,BP of 60/20 and unassisted respirations at 3 to 4 a minute. I tell Josh to fly as I pop a small curve of plastic into the unresponsive woman's mouth to keep her tongue from falling over her airway.
As we race toward Concord I try to intubate, her gag reflex bucks the tube but not the laryngoscope. I bag more, feeling for a pulse every few minutes and fully expecting not to find one. I try for the tube one more time on the twenty minute transport, this time getting it all the way to the chords before she starts to reject it.
"Concord Hospital, Concord Hospital, Rockingham ALS 9 inbound with Status One Notification"
I patch through to the hospital and when they respond I rattle off. "Good morning, Concord, Red Team activation on a 95, Nine Five, year old female. Patient was found with a high temp this morning and low respirations, wide complex sinus brady, vitals as follows BP 70/30, pulse 30, respirations assisted at 14 with no intubation, patient has intact gag reflex. Sugar is 99, 18 in the left AC. Five minutes from your door. Questions, comments concerns?"
"Red 1 on arrival, Concord out.
"Red 1, Rock 9 out, thank you."
We push her through the hall to the trauma room where the doc and his team are waiting, I give essentially the same report all over again and he looks at my EKG strips. "I thought she was a DNR?" I nod.
"Yeah, she was but the son revoked it this morning." As I say that, the son is ushered in by a nurse. He hugs me, hugs Josh and starts to sob. I make some lame execuse about paperwork and bolt from the room as the doctor tells him his mother will likely not make it and be on a respirator for the rest of her life.
The last thing I hear as I am leaveing is the doctor saying. "We'll make her comfortable with morphine and bring in a chair for you."
posted by Nick Stabile at 12:45 PM
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