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Saturday, September 3, 2011

Lord Vader

If a call doesn't come in during dinner than it's bound to come in just as you sit down to eat your ice cream and watch a movie. Actually, my ice cream very rarely gets interrupted. But I do hate coming back to ice cream you can eat with a straw.

Photo by Frank Hnatek

As we walked into the home we found a an 85 year old woman laying down in bed struggling to breath. The family said that the breathing problems had started that morning and had steadily worsened. As we approached the patient the problem was easily identifiable. She had audible rales. While my engineer set her up on an oxygen mask I sat her up and got a quick pulse ox, which was 60.

While I continued questioning the family and getting my vitals my engineer then set up our CPAP. The family told us that the grandmother had had a heart attack 10 days before. While in the hospital they did an angiogram which determined that her arteries were too small for angioplasty. For some reason the family also said that my patient had not been a candidate for a CABG which meant that she still had the exact same blockages in her heart that she did 10 days ago. Not good. And to further complicate things she had developed CHF. After determining that her BP was good I gave her a spray of nitro right before put Darth Vader's mask on.

Once we got her on the CPAP her vitals started rapidly improving. Just a few short years ago the treatment for a severe CHF patient was barbaric. It involved lots of medication that did little in the short term and, depending on the severity of the patient, sticking a tube down their nose or mouth into their lungs to breath for them. At the hospital they would then have to be put on a ventilator. Sadly, a large number of those patients would never be weened off of the breathing machine.

AMR walked in just as I finished missing my IV attempt. I gave them a quick rundown with an updated set of vitals. The AMR medics must have completely ignored what I was saying because they immediately set up for a 12 lead EKG. Under normal circumstances I would have as well but because of her recent cardiac history I decided to put it on the back burner. What would it tell me? That she was having cardiac problems? No Duh. After shooting the 12 lead they decided that it wasn't clear enough so they did another one....and another one. After the 4th I stepped in and asked them what they were looking for since we already knew that she had major heart problems. About that time the lights clicked on in the heads and they got it. We loaded her up and started toward the hospital.

In the back of the bus (I went along because she was on our CPAP which isn't compatible with AMRs) I started the IV without a problem. I guess I just needed the sway of the ambulance going over speed bumps. We checked again on he O2 sats and she was up to 100%. CPAP is a God send.

At the hospital I gave my report to the doc. I then turned to the RN and gave her all the nitty gritty details. That same RN had worked up my patient 10 days earlier when she came in with the MI. While I was talking I heard the MD order one the techs to remove my CPAP. I jumped in and suggested that they have RT on standby which the all knowing doctor ignored. Within 2 minutes my patient started crumping (yes, it's a technical term). Her SpO2 went from 100% to 59% and the staff started getting excited. I just shook my head and walked out. I had done my part. Time to get into Big Red and go home.
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