Saturday, September 12, 2009

Back To Back

We just got back from two calls that ran one after the other, both from one of our contracted facilities – the place I’ve referred to in the past as “my favorite nursing home” – to one of the Longwood hospitals. Both dispatched as priorities and only one really meriting that status.

First was for a 62 year-old male with an extensive medical history who had an onset of shortness of breath. It was significant enough to the nursing staff on the floor that we were contacted. When we arrived, we found him lying in his bed which was set at about semi-fowler’s (an approximate angle of 30 degrees) on low concentration Oxygen by a nasal cannula, in no apparent distress. He denied chest pain or shortness of breath at that time. His medical history was pretty significant for hypertension, and he’d had hip surgery approximately 3 weeks prior. A wound vac was being used on the incision site.

Lung sounds were clear with really light expiratory crackles. The nurse who gave me report made it sound like they were loud and it was causing him to be in distress; as I found, neither was true. So we loaded and transported him to the hospital. On the way I obtained vital signs. Other than his being in a mild sinus tachycardia at about 110, they were within normal limits. He had no other complaints; no chest pain, no dizziness or nausea/vomiting. He was stable. And he remained that way throughout our transfer of care to the ED staff.

While we were finishing up afterward (cleaning up and restocking the truck and doing documentation) one of our BLS trucks got sent to the same facility for a patient complaining of chest pain. My phone rang as I was going out to the truck and it was our dispatcher asking us if we were available if needed. I acknowledged that we were and we starting heading in that direction just in case.

While we were on the road we were upgraded to a priority 1 response for this patient who was having 8/10 chest pain with shortness of breath, vomiting, and hypotension. And this time it was my partner’s turn, not mine. So when we arrived we set up the truck with what we needed: two IV setups, the drug box opened, and the cardiac monitor put together with what we needed to obtain and ECG and to provide electrical therapy if it was needed.

The BLS crew brought the patient to us, a 75 year-old male with a history of colon cancer who was there for rehabilitation after placement of a colostomy. He had vomited just as the crew came through the doors and it was rather messy, so we dealt with that. He also had a PICC line which we needed permission to access. So I called medical control at the hospital and asked – we got it right away. It was a good thing we did as there was almost nothing for us to work with. But my partner was able to find a second line on, of all places, his knuckle, and he got it to work. It was slow, but it functioned. It was imperative that we got this access because his pressure was indeed in the bucket. So he got as much fluid as we could give him. He’d gotten aspirin prior to the BLS crew arriving, plus he’d gotten a bunch of nitroglycerin, which was likely the cause of his hypotension.

After we’d gotten him transferred, one of the members of the BLS crew had told me that the nurse who she talked with was pretty useless. When she described the nurse to me, it occurred to me that I knew who she was talking about, and I could sympathize with the way she was handled.

This brings me to another issue that I feel I have to talk about. Every time I’ve been to this facility – without exception – it has always been a horror show with respect to how sick the patient is. For whatever reason it seems that they have a habit of sitting on their patients for way too long. And it’s come back to bite them a few times.

You would think they’d learn not to wait so long. But they haven’t, and the risks I perceive continue to this day.

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