Monday, November 08, 2010

When Things Go Right

I don’t get to talk about many noteworthy calls these days. Most of the time they simply don’t happen. But this one that happened a few days ago is one that makes me glad I do this job.

We were dispatched early this past Thursday morning for an 84 year-old female that fell. We were updated on the way that there was possible injury and that the person was having trouble breathing.

Arrived on scene to find this person on the floor between her bed and a hope chest that is positioned up against the inside wall of the room. The bed had a hand rail installed on the wall side – it was used, I suspect, as a help for her to get up and down more easily than she would otherwise. Her husband had met us at the door and told us where she was. A police officer was already present on scene, one we know well, and he was able to help us when we first arrived.

I found she was conscious and alert, but her gaze was a little bit strange. She was not looking at me when I was talking with her; rather, she was sort of looking past me. I found out from her husband a little bit later that she is legally blind, which explains the look. She had no complaints of injury, but she told us she was on her way to the bathroom when she fell. She told us she hadn’t been feeling well at all that day.

On first glance I didn’t realize how large she was. From the waist down she had very thick legs. There appeared to be significant edema from the knees down, which got both my attention as well as that of my partner, Eric. As it turned out, she has a history of CHF and A-fib, which confirmed my suspicions based on what I found were her regular medications. Plus, she’d been hospitalized 4 days previously with an episode of CHF exacerbation.

The first question he asked me was, “do you want me to start an engine company?” My answer was, of course, to do it – it was pretty obvious that we were going to need help getting her out of the room and, ultimately, out of the house. It turned out to be a really wise decision in the long run to get help – I’ll talk about that shortly.

Before the pump arrived, we were able to at least get her off of the floor and back on to the bed. It was then that we found our first sign of trouble. She was quite cold to touch in all of her extremities, and she was rather pale. I noted this right away, as did Eric. He immediately went to check her vital signs as I was asking her questions about what had happened.  She wasn’t really clear in her answers, and Eric’s face, by the look he had on it, told me that something was not right. He couldn’t find a radial pulse and was having a great deal of difficulty finding a blood pressure.

By that time, the engine company arrived on scene, and the crew was in the house asking us what we needed. We initially opted for a long board to extricate her on, but as we found out there was no room to turn once we got out of the bedroom. Plus, she wasn’t tolerating being on the board at all. So we got her off of the board (back inside the bedroom) and put her on our stair chair instead. That proved almost to be disastrous as she was leaning to one side. With her weight, and the position she was in, we had to make sure she didn’t fall out. So we used extra caution and secured her incredibly well. We were able to get her into the living room where she was moved onto the stretcher, then we got her out of the house.

Once she was on the ambulance, we were able to get a blood pressure that we could actually find. It was 84/58, and she had a corresponding heart rate in the 30’s. Our cardiac monitor initially showed us what looked like a rapid A-fib, but that turned out, not surprisingly, to be artifact. So we adjusted where we had electrodes placed on her. We discovered that she was in what at best was an idioventricular rhythm – a bunch of escape beats with no discernable regularity to what made up the complexes we were seeing. And she went ashen-gray – Eric caught that first and warned me.

It was at that point I realized we had a tiger by the tail. With everything we’d found to that point, it was clear that she was in serious trouble.

We didn’t waste any time getting on the road. We took two of the firefighters with us – one to drive, one to help us in the back of the truck. Eric was getting IV’s started while I got pacer pads on her and started pacing. Before this, she was telling us that she wanted us to let her die - “just let me go”, and “I want to die” – there wasn’t any way we could or would let that happen willingly.

It wasn’t a long ride to the hospital, maybe 10 minutes. But it seemed like it took forever. I called the hospital to let them know we were coming, and I must have sounded like a total idiot on the radio. I don’t even remember what I said, and it was tough because we were doing everything all at the same time I was talking. When we got there, we brought her inside the emergency room, and the nurse who met us asked us, “is she okay to go into a regular treatment room?” I don’t remember what I said or how I said it, but we immediately brought her back to Trauma One. We were met by two more nurses, one of the techs, and the docs working the overnight, and immediately one of them started giving me the third degree and pulling the pads off of her. I remember yelling, “what are you doing?” as the pads came off. A few seconds later he said, “I don’t have a radial, but I have an intermittent carotid at best.” They were at least able to find a femoral pulse, but that didn’t matter because they were seeing exactly what I was seeing on their monitor. And the pads went back on.

A few minutes later I was talking with one of the two docs, and he asked me what had happened. I told him the story, and he apologized for not listening the first time.

Before we left, I found out that Cardiology was on their way to install a wire-driven external pacemaker before she got shipped to the ICU. I went to see her before we got back into service, and it was like talking to a different person; she was alert, she was more comfortable, and she felt better than she had. She grasped my hand and said, “thank you so much for what you did.” I told her that we were just doing what we were supposed to. I also told her that she gave us quite a scare, and she laughed and apologized for that. I took a minute to chat with Tracy, one of the nurses, before walking out, and while we were talking, our patient was talking with her husband on the phone. She said, “these people were wonderful. They saved my life.”

Tracy’s eyes welled up. So did mine.


TOTWTYTR said...

Strong work. Symptomatic bradycardia like that is fortunately rare, but unfortunately it can catch us totally off guard.

I think I can guess which hospital that was, and I'm not surprised.

Deege said...

You teared up, and so did I reading this. Good job! Thanks for all you do. said...

Now that's a good day at work...