Sunday, March 04, 2012

Going Back Wasn't So Hard...

I went back to work yesterday for the first time in seven weeks. It was possible to do this because I was cleared for light duty by the orthopedic surgeon who repaired my bicep. Because of the recovery, I have all kinds of restrictions on my activity, mostly with respect to lifting; I can't pick up of handle anything weighing more than 10 lbs. with my right arm.

In itself, this sounds extremely limiting. Under the circumstances, however, it is both necessary and extremely important because I don't want to undermine the integrity of the repair work done on my arm. Also, I was advised, even though it isn't absolutely necessary, to wear the brace whenever I leave my house. This is simply to remind me not to do anything foolish when I'm outside. It also, when I'm at work,  ensures that I don't try to lift a patient on a stretcher. Which brings me to the following story...

Yesterday I was checking with the crews working - all were extremely happy to see me, I have to say, which warmed my heart. While I was with one of the ALS crews a dispatch went out for one of the BLS units for a fall to a location not too far from where we were. Not long after the initial tone, ALS was requested because the subject was having trouble breathing. It was the unit that I was with that was being called up, so I decided to tag along to see what was going on. When we all got there (irony was that the ALS unit got there before both the BLS unit and the engine company that were dispatched) it was for a 72 year-old female who was not as much having trouble breathing as much as she appeared to be having some difficulty with her mental status; the place we were sent to was a sub shop and this woman was an apparent regular. The people working there told us that she was "not acting right" when her fall, it turns out, was a syncopal episode. She passed out then immediately regained consciousness. It happened twice before EMS was even requested and twice more while we all were on scene. Also, her speech was unintelligible (turned out she has a speech impediment; neurologically she was intact) which led the medics down the wrong road at first. Once they got past that they were able to see what was going on a little bit more clearly. Her heart rate was up and down as was her blood pressure, and while she had an unremarkable 12-lead ECG, prior to them obtaining it she threw 4-6 PVC's in a span of about 90 seconds. Plus she was warm to the touch and diaphoretic, which resolved itself once they were on the road.

Certainly there was something going on with this patient. I can't say what because I truly don't know. However, there are some clues that at least lead to a few possible differential diagnoses. One is that she was indeed having some sort of cardiac event; possibly a non ST elevation MI. I'm putting that out there because I've been bitten by this one myself, and it is always something that I'm suspicious of whenever there is no clear sign of an infarct. The medics were unable to get a set of orthostatic  vital signs, so I can't say whether or not there was a volume or hydration issue at hand,  although it's possible. The third possibility is the beginnings of some sort of infection; one thing I didn't mention is that she had a rather productive cough. She was bringing up secretions that apparently were multi-colored (green, brown, and bright yellow are what I was told), so I have to wonder if she was maybe brewing a pneumonia or some other pulmonary infection.

The part that made me glad I had the brace on was when she went down in front of the medics, they caught her, and I nearly jumped in with them until I remembered that I wasn't supposed to do things like that. Initially I got a little bit angry with myself and the situation, then I reminded myself why I couldn't be stupid about it. Otherwise I'd find myself back where I started, and that would be no good. And I had a number of people tell me that they didn't want me near a stretcher for that very reason.

Ultimately I didn't act on my instinct, but it was tough not to do that. Because of this, I've decided that I'll stay a few extra steps away from the activity next time I go on one of these.

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