Actually, more accurately it should be the other way around. We dealt with both yesterday – not as bad as it sounds, though. Just somewhat interesting.
The “Vent” refers to what was dispatched to us yesterday afternoon as a vented patient going to rehab. An 81 year-old female, status post cardiac arrest due to a sub-arachnoid bleed. And she wasn’t on a ventilator; she did have a tracheostomy in place and was being oxygenated by a venturi mask over the trach site. From what we were told the arrest was witnessed; family started CPR prior to EMS arrival, and it appears that this saved her life. She was being transferred to the Whittier Rehab Hospital in Haverhill for further care from the SICU at the BI. I’m really familiar with the Whittier, and while the care and treatment is fine, the staff is another issue. Some of the nursing types have never impressed me over almost 10 years of transporting patients in and out of there, and it is no different now. We needed a little bit of help moving our patient onto their bed, and we asked twice – neither time did any of the three nurses in the room lift a finger to help. On the third time when we were attempting to actually get her off of the stretcher, I made a comment under my breath which, of all people, the doc in the room heard. She jumped right in and helped us out.
I thought that was a rather telling gesture, myself.
The drunk we had was dispatched to us at 0330 this morning. Brought in at 1730 Friday evening, presumably by Boston EMS. A 50 year-old male with a history of alcohol issues, wasn’t initially tested for a BAC because they were more concerned about the tachycardia (rate in the 140’s) that wouldn’t come down after three liters of fluid and medications. They finally got around to checking his BAC at around 2300, and it was over .300 at that time, nearly 6 hours after being brought in. When we got to him he was probably in the mid .200’s – best guess, depending on how well or not he was metabolizing the alcohol he had on board. In talking with him, he was surprisingly pretty coherent. He was able to tell me as we talked during the ride across campus that he was having a lot of trouble getting a handle on the problems he was having with his drinking. I got the impression that he’s at least trying, but all things considered I have to take what I hear with a grain of salt most of the time.
Then there was the chest pain who we were dispatched for at the Mass. General in Chelsea going to the MGH ED. A 65 year-old male, extensive cardiac history including multiple bypasses (he’d had a CABG x 5 in 2002) and a bunch of the common risk factors. The problem was he had symptoms for 2 days before going to be seen. I can only wonder how much muscle he lost if he indeed had another MI (this would have been his third since 1985). No way to know, however, without labs; his ECG’s looked really good; slight sinus bradycardia in the mid 50’s with a borderline first degree block. And even with the labs, it’s likely that his Troponin levels went back to within normal limits over time.
A difficult situation at best for this patient.
All in all, though, not a bad shift. And I didn’t need much sleep when I got home. Just coffee. And it’s off to a retirement party tonight. That should be fun.