Tuesday, July 19, 2011

A Black Cloud

Jokingly, that is what my friends are telling me that I am these days.

Over the past few weeks, whenever I’ve shown up for work it has been bad news, in terms of calls and patients. I worked this past Sunday night in Goffstown on a swap – I need this coming Thursday so that I can work on the Komen medical crew, and one of the younger guys was going to the NASCAR event up north so he couldn’t work. All things considered, it was just as well that I did work Sunday; we had double-medic coverage with myself and my friend Cheryl. I don’t get to see her very often, but she and I have been friends for a long time, and she’s one of those that I learned my trade from as she’s been a Paramedic for a little over 16 years.

I trust her completely. And we have always worked well together; it’s funny when you don’t see someone for a while and you still click…

The best part was that she didn’t know I was working Sunday, so it was really funny when I walked into the firehouse and I was greeted with this “Faux Frenchman” chortle that we’ve always hailed each other with. Just think of Pepe Le Pew in some of the old Warner Brothers/Looney Tunes cartoons, a little bit of Lumiere from “Beauty and the Beast”, and John Cleese in “Monty Python and the Holy Grail” when he’s up on the wall in the French castle (“your mother was a hamster, and your father smells of elderberries!”) and you’ll get the idea.

 

About an hour into our tour we were dispatched for a medical alarm activation in East Goffstown. Now, in terms of area, Goffstown is about 70 square miles in size. Not that big, but when you think about the roads and the layout of the town, to get from where we are posted at the Village Fire Station to the address we were sent to, it’s not a straight line. 

An update while we were on the way was that it was for a party that was in respiratory distress and couldn’t speak between breaths. Not good – the pucker factor increased substantially in a very short time.

We had an engine company dispatched from the firehouse at that end of town, and they arrived on scene a little before we did. They had to travel a little less than a mile, and we had to travel approximately six. When we arrived on scene, we found that there was also a police officer present. Turned out the house was locked up solidly; the only access was through the bulkhead into the basement of the house, and even then it had to be forced. Once we got inside, we found our patient, a 58 year-old female who was in big trouble. She was sitting on her bathroom floor, barely conscious – a good descriptive word for her would be “obtunded” – and she’d been trying to give herself a nebulizer treatment but it was doing no good as she was sitting on the tubing. A quick assessment revealed severely diminished breath sounds, a respiratory rate of 8-10 shallow breaths per minute, and a radial pulse of 120. We got her up and out of the bathroom and onto our stair chair, which was really easy since she weighed just over 100 lbs., extricated her out of the house, and loaded her onto the ambulance. By this time her mother and brother arrived on scene plus we had additional help as one of the off-duty Paramedics arrived, and we were able to get her going pretty quickly.

We got a working breathing treatment started, got vitals and put her on the cardiac monitor. She was in Sinus Tachycardia with a rate of 116, no ectopy showing. A 12-lead was unremarkable, which turned out to be significant later on – I’ll get to that shortly. We got IV access and gave her a dose of Solumedrol while we were en route to CMC. During the transport she perked up considerably, became alert and able to speak in full sentences. She was oriented properly, but she was a little confused about the time of day as she was surprised when I told her it was 7:15PM. She thought it was the next morning. At about that time she started coughing – she brought up some brown sputum, an indicator that she has some sort of infection in her respiratory/pulmonary system brewing. Found out her history was significant for emphysema; her brother told us she was a two pack per day smoker and had been most of her life. That didn’t surprise me; her 79 year-old mother looked to be not only about the age that her daughter was, but was also in much better physical condition.

We arrived at the hospital, were greeted with “you cured her!” when we brought her into the treatment room, transferred her over, then restocked and got out.

About an hour after we returned, we got dispatched to the opposite end of town for a 21 year-old female having an asthma attack. That was about when the “you’re a shit-magnet” complaints started to roll in… We got to the scene of this call and found Mom and Dad at the car with the daughter, our patient, sitting in the back seat in severe distress. Dad was planning on driving to the firehouse with her in back – I had a word with him after all was said and done, basically telling him that his wife did the right thing by calling 911 and staying put, but he wasn’t listening to me until I told him that if he had just driven off he could have killed his daughter.

That made him stop and think, but I’m not sure it changed his mind.

In any case, our patient had gone for a hike earlier in the day. She is also allergic to animal dander and the family has two long-haired dogs. With no real air movement in the house, it’s likely that this kicked off an attack. So we got her out of the car, onto our stretcher, and into the ambulance. I made a quick call to our medical control physician giving him a heads-up and doing a quick double-check to make sure he had no problem with us giving her a dose of Magnesium Sulfate to relax the smooth muscles in her respiratory tract. He had no issues, so we did that as well as doing the rest of what we needed to (Duo-Neb, Solumedrol, and Epinephrine).

It’s nice to see medications work as advertised. And in her case this was no exception. We were able to turn her around and save her from certain intubation. She was much better when we arrived at the hospital – she went into the room next to the patient we’d brought in earlier, which brings me back to her. We were notified that her Troponin levels were through the roof, even though nothing showed up on the 12-lead that we did. She had an NSTEMI, or a “Non ST-Elevation Myocardial Infarction.” Also called a “Silent MI”, or “Silent Heart Attack.” We surmise that this probably happened because of the amount of time she wasn’t getting Oxygen to her heart.

But it doesn’t end – we got sent out a 5:00AM the next morning for a fall with unknown injury (and our tour ends at 6:00AM). Again, no access to the house. Fortunately, the police department was able to get in touch with one of this party’s family members who told them where a key was located. So we were able to get access to the house, and found an 81 year-old female who fell out of bed, landing on her bottom. Happened while she was putting on a housecoat. At the same time, two other calls came in for the town: another fall (who turned up the gravity?) and a standby for a Psychiatric evaluation. So we picked her up and evaluated her – she complained of hip and knee pain, and she wanted to be seen. Probably a good idea, considering she didn’t have the pain prior to the slide off of the bed. We transported her to the hospital – a much easier transport than either of the others that we did during the tour.

When I walked out of the firehouse at 8:00 yesterday morning, I realized that I hadn’t had a shift like that in town for all of four days. It was a near replay of the previous Thursday. And that was a replay of the Wednesday night prior in Newton.

So maybe I have become a black cloud. We’ll see what happens at the Komen; maybe if I stay away from patients it won’t be a problem. To be honest, however, I’m really not convinced.

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