Trust Your Heart Monitor?

We got a call during our morning check out for a 26 year old female having chest pain. I'm pretty sure that everyone on my crew was thinking the same thing...BS.

As we pulled up to the apartment building we were greeted by close to a dozen kids all excited to see the fire truck stop at their place. We walked upstairs and past the kids to apartment C. The front room was totally bare with the exception of 3 pregnant women. One of them pointed towards the back bedroom.

As I walked in I found my patient laying down in bed. As reached for her wrist I asked her what was going on. While talking to her I noticed that I couldn't feel a pulse. My engineer quickly got her on the heart monitor and started working on a blood pressure. I assumed it would be low since I could get a pulse at her wrist. My patient told me that she woke up with this chest pain and that it had happened once before. It was a tightness in her chest that didn't radiate. She wasn't able to rate her pain but it appeared to be in moderate distress. No history of recent illness or recent stress. The pain did not increase on palpation or inspiration.

She was supposed to be on some medications but didn't have them. Last time she felt this way she was transported to the hospital where they gave her something to make the pain stop. The patient was also experiencing shortness of breath and general weakness.

The rate is wrong but this rhythm strips show basically what I saw.

On the heart monitor she appeared to be in SVT at a rate of about 230. Her systolic blood pressure was in the low 70's. Shocking. As I started an IV my engineer shot a 12 lead. AMR showed up just as I finished starting the IV. I gave a report and my engineer finished up the 12 lead. My heart monitor was telling me that my patient was in atrial flutter not SVT. It didn't look that way to me. Since we don't carry anything in my county that would work on atrial flutter part of me wanted to go ahead and give the Adenosine and see what it would do.

Once again the rate is wrong but this is what the monitor was telling me it saw.

And for the record, I did have the patient try a couple of Valsalva maneuver but those didn't work.

I ended up trusting the heart monitor. I recently read a book about the mistakes we make in medicine. It talked about a study in which a cardiologist went head to head against a machine in determining which patients were having an MI. While the computer was not correct all the time it did better than the cardiologist...and faster. I have to assume that my heart monitor was able to read things in the 12 lead that I just couldn't pick up on with the naked eye which made it determine it was a-flutter and not SVT.

I should have followed up on this patient and found out what they did for her in the ER.

So just curious, would you have given the Adenosine?

There's Only Room For One Rooster

We recently had a call at a local clinic.Local clinics are not on the top of our favorite places to go although  every once in a great while you can get a good call out of one.

As we entered the rear of the clinic we were greeted by one nurse sitting in a chair and 9 others gathered around her. As I approached my patient my captain asked what was going on. What he got for an answer was a cacophony of answers from all 9 nurses. He immediately started clearing the room of all but one nurse for questioning.

I let my captain deal with that. I went straight to the source. My patient was a...and I assume still is a woman in her early 50's. Being a nurse she was able to give me just the sort of answers I needed during my assessment. She told us that she had been driving in when all of the sudden she felt some chest pressure and shortness of breath. We quickly followed our guidelines and treated her chest discomfort.

By the time AMR arrived we had just finished with our 12 lead ECG and and a line established. A fairly straight forward call, once you let the nurses know who was in charge.

Feelings of Helplessness

As a firefighter/paramedic there are not many situation in which I feel helpless. My crew and I are highly trained for all manner of emergencies and, if we can't fix it, generally know someone to call that can.

Just before dinner we were toned out for a woman in labor.Several things go through my mind on a call like this....in random order.

"S**t! Do I remember how to deliver a kid?"

"It's a BLS skill, let the EMT do it!"

"Women have been having kids forever without help, how hard can it be to play catcher."

"I was right there when all of my kids were born, it's not so bad. I got this."

"Hehehe! This could be a fun call."

Like I said, some variation of these thoughts went through my head on the way to the call as well as the actual procedures for delivering a newborn.

When we arrived on scene we found a 34 year old woman laying on a couch in the garage surrounded by her family. First impression, she's not far enough along to be in labor.

She informs us that she is 21 weeks and 4 days along and that she was just discharged from the hospital 4 hours prior to our arrival. She had started dilating prematurely and had had to undergo surgery to put a couple of sutures in her cervix. She called us because while she was going to the bathroom she felt a rush of fluid. Sounds like her amniotic sac ruptured. She wasn't complaining of any pain or desire to push. She had no abnormal bleeding.

After running a quick set of vitals and a thorough assessment there wasn't a lot we could do. And AMR still wasn't on scene. Enter the feeling of helplessness. My engineer started a line on her since she would need one in the hospital.

Still no AMR.

We explained why we were just waiting and she understood. She had taken an EMT course and now worked for a hospital. She was amazingly calm.

Still no AMR.

After what seemed like an eternity AMR finally showed up. We gave them a quick report and got her on the way to the hospital.

There was nothing for us to do except be caring and supportive. This poor woman was probably losing her baby and we were completely incapable of help. I hope that everything turned out well for her. Maybe her amniotic sac didn't rupture and a couple of months from now we can go back to deliver the little girl.

No Gear Left Behind

One of the firefighters at my station left at the end of his shift for a 10 day vacation. In his excitement (an assumption on my part) to get away he left his turnouts right next to the rig. Seeing as how firefighters are such a helpful and friendly lot someone decided to hang them up for him.

Hang them way up.

They made me laugh every time I saw them.

Bad Dinners

I recently read a post by another blogger that talked about some less than stellar meals at the firehouse. It immediately brought a couple of meals to mind....from the same "chef."

The first time I had his cooking the firefighter decided to cook meatloaf. His variation on a theme called for string cheese to be placed in the center. When asked how long it would be until dinner was ready he replied that it needed to cook for 20 minutes. That was our first warning. 25 minutes later he was slicing the meatloaf...

...which looked nothing like this. It was completely raw in the middle. So much so that the string cheese was still cold. Due to the late hour of the failed feast, we went out to eat.

The second (and last) time that we let the "chef" cook he said he was making stew. He put everything together and let it slow cook in the crock pot. During the meal the "chef" informed us that the mystery meat (at that point what we did not want to hear was that there WAS a mystery meat) was Elk.

 It actually didn't taste that bad. But, my guess is that the elk was a little too old because within 30 minutes of dinner every one of us was in the bathroom.

I'm just glad that we didn't get a call right then. He never got the chance to redeem himself on our shift.