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Monday, July 29, 2013

Frequent Flyers Have Actual Emergencies Too

We have a household in our jurisdiction that is a hive of frequent flyers. It's an elderly couple and their son all of whom have medical problems. We respond for a variety of reasons, most of which are legit.

Last week we heard the computerized voice say their now familiar address. At that point we play a guessing game: Him, him or her? This time it was her. Our update from dispatch informed us that the mother wasn't acting right, possible drug overdose.

Hmmm. That didn't seem like her and this wasn't one of the usual reasons we get called.

We arrived to find Mrs. Smith laying on the bed. She was alert and talking....sort of. I asked her if she was in pain and she said, "Yes." I asked what hurt and she said, "My bathroom hurts."


I asked her a few more questions and she was able to get out about 75% of the answer. The other 25% was either the wrong word as in the case with her 'bathroom' hurting or just unintelligible gibberish. We checked her grips, pushes and pulls which were all equal. We also had her go through the Cincinnati Prehospital Stroke Scale. She passed with no problem.

Unfortunately for my patient she appeared to be having a stroke. One in which the speech center of the brain (Broca's area). This caused her to have expressive aphasia. This means she was unable to talk (or write) normally. There is also receptive aphasia in which a patient can not understand what is being said by others. 

Before AMR showed up we had placed the patient on oxygen to keep her O2 sats above 95%. We did a blood sugar check and had an IV going. The EKG was normal and we were just setting up to do a 12 lead when the ambulance arrived. We gave them a quick run down on the situation and they transported the woman to the stroke center.


The following week at work we were toned out to the same address (I did mention that they're frequent flyers right?). My patient was back to normal. This time she was experiencing a migraine. While waiting for the ambulance I asked her about the stroke. She said that she had been diagnosed with a TIA and had spent 3 days in the hospital. She had woken up on day 2 and had no idea where she was or how she got there. She also had no recollection of me coming to talk to her.

She dodged a bullet....for now.

Sunday, July 21, 2013

Treat Your Patient

Treat your patient, not the monitor is something that most medics have heard (and hopefully most do).

We had a call for a syncopal episode. The 70 year old man had been mowing his lawn when he started to feel too warm. He went into the kitchen and sat down to take a break. He promptly passed out for about 15 seconds according to his wife who witnessed the entire event. After regaining consciousness the patient vomited rather violently.

Upon our arrival the patient was pale and very diaphoretic. Now sitting on the couch, he related the story of what had just happened to him (with his wife filling in details that the old man either forgot or didn't think were pertinent). While he talked we worked.

He was a touch hypertensive at 160/92. His heart rate was in the low 90's and his breathing was non labored. His sugar was 201 (which he blamed on his wife's homemade apple pie). He was in NSR on the monitor (for you ER RN's out there that panic if we medics don't get a pulse ox it was 99% on room air).

My patient was overweight, a diabetic, had high blood pressure and high cholesterol. He denied any chest pain or discomfort at any time  as well as any difficulty breathing. The man kept saying he was just feeling week and sweaty.

Before AMR rolled up we shot a 12 lead. The patient had a LBBB and ST elevation in leads V1 through v4. I know right now some of you are yelling that a LBBB is a STEMI imposter. Or at least in can be. According to Sgarbossa's criteria an AMI can be diagnosed if there is ST elevation ≥5 mm in a lead with downward (discordant) QRS complex. Our patient only had 4mm of elevation.

However, I am one to treat my patient, not my monitor. The patient was still pale, sweating profusely and weak. We transported him to a STEMI center just as a precaution. At the ER the MD met with me and the AMR medic and went over the 12 lead. He reaffirmed what we saw and didn't think that this guy was having and MI but agreed that his presentation was such to make a medical professional worry a little. As if on queue the patient started throwing up again and seemed to get weaker.

Not my patient any more.

Friday, July 12, 2013


We were toned out for a 35 year old male with cuts to his hands.

As we pulled up to the scene just after midnight we could see our patient leaning on the back of a car holding a towel on his hand. There was also a small knot of people on the sidewalk looking on.

Approaching the man I could tell he was inebriated. I stayed a couple feet back (because I don't trust drunk people) and asked what was going on. The man explained that he had been drinking and got angry. Not angry at anything in particular but just angry. In his fit of rage he decided he would take out his frustrations by hitting the bedroom window.

I then had the man remove the towel. His hand was covered in dried blood and there was a little but of fresh blood still dripping from his pinky. Wanting to know how much blood he had lost I did a quick walk through of the house. The entire time the man's uncle mumbled and complained about how his nephew was a drunk and never did anything. Inside the scene appeared to be something that Dexter would love. The guy had, after discovering that his finger was bleeding, decided to walk through the entire house shaking his hand essentially throwing blood on the floor, walls and ceiling in each room.

Outside the ambulance and PD had arrived. With the help of a garden hose the medic had washed off the hand to find that the patient had a decent size cut to his pinky but that was it. After a quick bandage the patient refused transport. We explained that he still needed stitches. The drunk said that he would drive himself. We quickly pointed out that he was too intoxicated to drive. Evidently still not wanting to go to the hospital the drunk turned to the closest cop and pointed at him saying, "I'll get a ride from him."

Without missing a beat the officer grabbed the outstretched hand, twisted it behind the back of the belligerent man and cuffed him. That pretty much ended my call.
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