Wednesday, October 01, 2008

A Short Sleep

I keep saying that I should never predict how a tour will turn out because I'm almost always wrong. Last night into the early hours of this morning was no different.

Got called out at approximately 2130 for a head injury secondary to a fall down a flight of stairs. Arrived on scene to find a 27 year-old male sitting at the bottom of an outside landing. He slipped at the head of the stairs and went down the entire flight, approximately 15 feet from top to bottom. He didn't remember the fall and he was dizzy with tingling and numbness in his hands. Prior to our arrival he had crawled back up the stairs then down again. He denied neck pain or back pain but did have a headache. He did insist on walking out to the ambulance but we immobilized him once we got out there. Vitals were stable and we transported to CMC. They were annoyed that we brought him there, but it was his choice and it wasn't inappropriate as he didn't have any multi-system trauma. He did get a head CT for his trouble and was still there at 0030 this morning when we finally got to leave after the second patient we had.

We had just gotten our patient off of the stretcher and were getting the truck ready for the next one when our dispatcher hailed us and inquired as to whether or not we were good to go yet. Bear in mind we'd been there less than 10 minutes at that point, but just the same we saddled up and took off for the next one, a 55 year-old female who had overdosed on a unknown amount of Clonazepam. While we were on the way to the location, our dispatcher came on the air three times telling us that police were on scene and that we needed to step it up. My response was that we were moving as fast as we could - bear in mind that it was raining hard enough to be a problem and we were doing 45-50 mph on secondary roads. Faster than we should have been going in my judgement, but for them it didn't matter - we weren't there fast enough. When we did arrive it became apparent why the cops on scene were so freaked out.

She was unresponsive - breathing but totally unresponsive. No gag reflex. Total dead weight. When I saw her it was clear that we had to go right then and there. We scooped her out of the house and got her onto the truck. I had started bagging her in the house because she was initially having trouble maintaining her airway, and I initially seriously considered intubating her, but once we had her on the stretcher she actually was breathing spontaneously and regularly at about 28/minute. A little fast, but she had good air movement with clear lung sounds and maybe a touch of a wheeze (possible aspiration, maybe? I'm not certain). Sinus rhythm on the cardiac monitor with a slightly elongated QT interval. That got my attention, but her T waves were not spiked. Blood sugar of 141. Still totally unresponsive, though.

We did adjunct her airway with a nasopharangeal device, which she accepted with no difficulty. I was still seriously considering intubating her, but since she had a patent airway and was moving air without any trouble, I held off. However, I was certain she'd be intubated and placed on a ventilator once we got her to the ED, and I was right - that did happen.

Two IV's, one with fluid running, the other a saline lock. Constant monitoring on the way back to CMC. Total on-scene time was 16 minutes. Total transport time just under 10 minutes. Total time from dispatch to arrival at the hospital, just over 35 minutes.

My guys on the truck and the engine company that helped us did a great job. I wish I could say the same for the cops, however. Realizing that they are not medically trained, I still had to almost wrestle them for patient control. I wasn't happy about that.

Once we got her to the hospital, it was as I said: within 5-6 minutes she was intubated and on a vent. The doc (my friend Dr. V) intubated her without adjunct meds - because she was so gorked out she didn't need them, and she tolerated the tube being placed like I have never seen. That made me almost regret not intubating her in the field.

As far as I know, she is still alive. I checked before I went off shift - she was still being ventilated and her tox screen was positive for benzodiazipenes. She went to the ICU before I called the ED.

So I got almost no sleep until I got home this morning. And pretty soon I'm going back to bed. I'm nearly done.


Pete said...

Geez, do you ever take any time off?

Walt Trachim said...

Starting next week for the forseeable future I'll only be working 60 hours per week instead of the 80-90 that I have been working.

That isn't nearly as bad as it sounds; I'll work 24 on Thursday and Saturday, then overnight 12 in Goffstown on Tuesday. That will actually give me some days to rest and play catch-up around the house.