My first EJ

The call came in about 1615 hours to respond to a man that can't breathe. As we enter the house the wife lets us know that her husband was just seen by the doctor this morning and was diagnosed with sever bronchitis and possible pneumonia. When we get to the bedroom we see a 51 year old man that looks like death warmed over. He's only breathing about 8 times a minute, is pale, cool to the touch, sweating profusely, and only responsive to painful stimulus. Not good. We quickly get him on oxygen and check his oxygen saturation level. Normal is 97% and up. We start to not like it below 95%. His was at 51%! We now have him sitting up as best he can, and have him on oxygen so we continue with our assessment. His lungs sound like they're filled with junk and tight so we put him on an albuterol (breathing) treatment. His heart rate is off to the races at 120 or so but there doesn't seem to be any problems on the ECG. His BP is a whopping 230/110!

As I try to get an IV started in an arm the wife tells me that no one can ever get one. As I search in vain my partner looks at his neck and says "he's got great jugulars." I decide to try once to get the IV in the arm and then go for the jugular. Of course I missed the IV in the arm! At this point we load him up on the gurney and take him out to the ambulance. As we're loading him up my preceptor noticed something I missed. Our patient is taking Methadone, a narcotic pain reliever. Once we're in the rig I start my IV...in his neck (more correctly his External Jugular veins or EJ's)! That was a cool procedure. I then grab the Narcan (used to reverse narcotic effects such as in an overdose) and give him 1mg. Enroute to the hospital we give him another breathing treatment. The Narcan did its job and our patient started coming around. We asked him if he took more than the normal amount of his Methadone today. He affirms that he did.

By the time that I finished the paperwork at the hospital he was looking almost normal again. It was nice to be able to tell have a good day and to have him thank us for helping him. I have to admit though; I was still jazzed about getting to start an IV in someone's neck!