Repeat or Sequel in a Trilogy?
Things happen in cycles.
Its around half past midnight when we finally get to bed after bringing a diff breather who, in reality, just needed to calm down, to the hospital. I drift off to sleep in the recliner as the beds are not very comfortable.
Little more than an hour latter the phone starts ringing and I can hear my partner, Jay, in one of the bunk rooms fumbling around for the handset. I hear him answer it and then it starts ringing again. Apparently the caller keeps hanging up.
We go down stairs to try and catch the caller ID so we can have the cops check it out. It wouldn't be the first time some one called the firestation instead of 911 and needed help.
I don't think too much of the extra car in our parking lot untill the tones go off for a delta level chest pain in the parking lot. Still clearing the sleep from my brain I grab my flashlight and head outside while Jay pulls the bus out.
The woman's husband is smoking a cigarette, seemingly unconcerned that his morbidly obesse wife is vomitting in the parking lot and complaining of severe chest pain going into her left arm and her jaw.
"Wanna just go?" Jay asks and I nod, hastily spit out a "Yep" and we bundle her into the back.
"Hon, you have any cardiac history?" I ask as her husband starts climbing into the back with his butt still lit. "No, dude you can't ride back here." I tell him, more because his wife is so big I have barely any room to move than because of his cigarette. He shrugs and drives off in his car without saying goodbye or even telling us if he's going to the hospital.
"All I have is diabetes." We're moving now and Jay tells me he'll pull over when I want a 12 lead. The woman is pale, cool to the touch and covered in sweat. She's also dry heaving into a bucket and complaining of severe pain. I tell him to go as fast as he can safely go.
The monitor shows a sinus complex with severely elevated T waves right on the three lead, for those non medical people the whole squiggle is supposed to be fairly uniform. If it goes up at a right angle it usually means something very bad is either happening or had in the past. These elevations are more apt to show up on the 12 lead than the four lead, seeing them in the four lead is a bad sign.
She gets asprin and her blood pressure is at about 90/palp. She had told me she had a history of high blood pressure and with all the chest pain she should have been through the roof. I ask how long the pain has been going on for.
"Two hours, it just keeps getting worse."
Shit.
She's in the end stages of her MI, a piece of soemthing has occluded an artery in her heart and now she is about to die. Initialy the blood pressure will be very high, as they start to decline they are slipping closer and closer to cardiac arrest. The heart is no longer injured but dying. Despite the low blood pressure I give her a nitro which knocks her pain down to a six but unfournately her pressure drops to 80. I start running fluids because I want to get that nitro in her to drop the workload on the heart and buy some more time.
But her pressure stays low. Shes getting less and less coherent. I call her in as a status two and tell Concord to have a full team waiting for me.
When a person is having a heart attack, its a race from the onset of the pain to the cath lab. The cath lab is the only difintive treatment as they have to go in and unblock the artery in order to restore oxygenated blood flow.
The woman who showed up in the firehouse parking lot had already waited dangerously too long before seeking treatment.
I sigh with relief when we back into the ambulance bay at Concord. By now I have exhausted all I can do. She had her baby asprin and her nitro. Her pressure was too soft for more nitro and morphine was out because it too would drop the pressure. She was barely coherent now and I didn't want to totally snow her with Fentanyl.
Dr. Carter was waiting just inside the ambulane bay doors, he'd gotten to know me since I started at Northern and realized it was me coming in with a potential problem. I don't make it a point to call for a team for everything so he rightly assumed they should assemble.
I give a quick handover report telling him all that I did and showing him the 12 leads. His eyes go wide and he mouths "Oooo, shit." As we transfer her over to the hospital bed, the cath lab guys are showing up.
Then she slumps into full unconciousness, stops breathing and the monitor shows V Fib. Her heart stopped beating and was basically quivering.
We shove her over onto the hospital gurney, dropping the head of the bed and calling everyone to clear. She gets defribilated and the electricity shocks her heart back into beating, it also causes her a lot of pain because she screams. "Don't fuckin' do that again."
They end up shocking her twice more before she went up to the cath lab. I lost track of her after that and I haven't been back to the hospital since so I'm not sure how she made out.
On the ride back I remember what my father always said about strange events or deaths. "They happen in threes."
I could really do with him being wrong on walk in medicals.
Its around half past midnight when we finally get to bed after bringing a diff breather who, in reality, just needed to calm down, to the hospital. I drift off to sleep in the recliner as the beds are not very comfortable.
Little more than an hour latter the phone starts ringing and I can hear my partner, Jay, in one of the bunk rooms fumbling around for the handset. I hear him answer it and then it starts ringing again. Apparently the caller keeps hanging up.
We go down stairs to try and catch the caller ID so we can have the cops check it out. It wouldn't be the first time some one called the firestation instead of 911 and needed help.
I don't think too much of the extra car in our parking lot untill the tones go off for a delta level chest pain in the parking lot. Still clearing the sleep from my brain I grab my flashlight and head outside while Jay pulls the bus out.
The woman's husband is smoking a cigarette, seemingly unconcerned that his morbidly obesse wife is vomitting in the parking lot and complaining of severe chest pain going into her left arm and her jaw.
"Wanna just go?" Jay asks and I nod, hastily spit out a "Yep" and we bundle her into the back.
"Hon, you have any cardiac history?" I ask as her husband starts climbing into the back with his butt still lit. "No, dude you can't ride back here." I tell him, more because his wife is so big I have barely any room to move than because of his cigarette. He shrugs and drives off in his car without saying goodbye or even telling us if he's going to the hospital.
"All I have is diabetes." We're moving now and Jay tells me he'll pull over when I want a 12 lead. The woman is pale, cool to the touch and covered in sweat. She's also dry heaving into a bucket and complaining of severe pain. I tell him to go as fast as he can safely go.
The monitor shows a sinus complex with severely elevated T waves right on the three lead, for those non medical people the whole squiggle is supposed to be fairly uniform. If it goes up at a right angle it usually means something very bad is either happening or had in the past. These elevations are more apt to show up on the 12 lead than the four lead, seeing them in the four lead is a bad sign.
She gets asprin and her blood pressure is at about 90/palp. She had told me she had a history of high blood pressure and with all the chest pain she should have been through the roof. I ask how long the pain has been going on for.
"Two hours, it just keeps getting worse."
Shit.
She's in the end stages of her MI, a piece of soemthing has occluded an artery in her heart and now she is about to die. Initialy the blood pressure will be very high, as they start to decline they are slipping closer and closer to cardiac arrest. The heart is no longer injured but dying. Despite the low blood pressure I give her a nitro which knocks her pain down to a six but unfournately her pressure drops to 80. I start running fluids because I want to get that nitro in her to drop the workload on the heart and buy some more time.
But her pressure stays low. Shes getting less and less coherent. I call her in as a status two and tell Concord to have a full team waiting for me.
When a person is having a heart attack, its a race from the onset of the pain to the cath lab. The cath lab is the only difintive treatment as they have to go in and unblock the artery in order to restore oxygenated blood flow.
The woman who showed up in the firehouse parking lot had already waited dangerously too long before seeking treatment.
I sigh with relief when we back into the ambulance bay at Concord. By now I have exhausted all I can do. She had her baby asprin and her nitro. Her pressure was too soft for more nitro and morphine was out because it too would drop the pressure. She was barely coherent now and I didn't want to totally snow her with Fentanyl.
Dr. Carter was waiting just inside the ambulane bay doors, he'd gotten to know me since I started at Northern and realized it was me coming in with a potential problem. I don't make it a point to call for a team for everything so he rightly assumed they should assemble.
I give a quick handover report telling him all that I did and showing him the 12 leads. His eyes go wide and he mouths "Oooo, shit." As we transfer her over to the hospital bed, the cath lab guys are showing up.
Then she slumps into full unconciousness, stops breathing and the monitor shows V Fib. Her heart stopped beating and was basically quivering.
We shove her over onto the hospital gurney, dropping the head of the bed and calling everyone to clear. She gets defribilated and the electricity shocks her heart back into beating, it also causes her a lot of pain because she screams. "Don't fuckin' do that again."
They end up shocking her twice more before she went up to the cath lab. I lost track of her after that and I haven't been back to the hospital since so I'm not sure how she made out.
On the ride back I remember what my father always said about strange events or deaths. "They happen in threes."
I could really do with him being wrong on walk in medicals.
posted by Nick Stabile at 11:21 AM
4 Comments:
Hey Nick, thanks for the comment on my blog this morning. After seeing it, I zipped over here to read yours. Good stuff. I added you to my blog roll and I look forward to reading more.
Strong work Nick! Things do come in threes, you're all set. It started with the DKM on St. Paddy's day. If their show doesn't stop your heart for a while you're already dead!
That's like being dispatched for a public assist and finding a major CHF episode going on... Been there... Sucks, don't it?
Nice work on the call, Nick. At least she survived the ride in, and if she was talking before she went to the cath lab, you can't ask for much more....
Damn. That was a hell of a dice roll with the nitro. Not sure I'd have the stones to try it, not gonna lie.
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