A Day of Saving Lives-Call #1

Thursday, day shift, the last day in the last tour before a full eight days off. It is the day when everyone is the most tired and generally, the busiest. It all began at around 0830 when Sara and I got dispatched to a 'chest pain' at a local nursing facility. We arrived, get upstairs, and find 3 nurses and 2 doctors on the floor with our patient, who is also on the floor, supine, half in and half out of the bathroom. She is what EMS professionals call CTD- circlin' the drain. She is ashen, altered and still. There is no talking, moaning, writhing in agony. That's how you can always tell the really sick ones, they barely move, they don't scream, they are still, quiet, eerily quiet, as if they know it's coming and are preparing the position. The people that we find in this transitional point of pre-death death generally need us to get our asses in gear.

We get from the staff that the patient was last seen around 0830 and was fine. It is now 1000. On the monitor, SVT at a rate of 190. SVT is a rapid heart rate that occurs in the atria, the top 2 chambers of the heart. It can lead to other, more dangerous rhythms that require more invasive intervention. It can be the result of an overdose or a preexisting heart condition. In this patients case, it was the latter. The detrimental factor about SVT is that because the heart is beating so fast, it is not allowing the chambers of the heart to fill with blood, thus in the conclusion of a contraction, not pumping out enough oxygenated blood to her peripheral tissues. This causes her ashen color and listlessness. Physiology can be fun!

We check a blood sugar to rule out hypoglycemia, or a diabetic event. It is normal. We check a temperature to rule out sepsis, it, too, is normal. Everything points to SVT and a heart condition. The doctors in the room are crowding around the patient, holding her head and cooing to her like pigeons waiting to be fed. They are convinced the patient needs fluids, which is true, but getting her out of the SVT will bring her blood pressure up from 60 palp. She NEEDS Adenosine. Adenosine is the heart stopping drug that attempts to reset the pacing mechanism. It is very cool. Except, in order to give the drug, one must have IV access, which we were unable to get. We stuck her 7 times. We tried both arms, both feet and her external jugular vein. She was so hypotensive that all of her veins had collapsed. She's still taching along at 190, still altered and doctors still screaming for fluids and not getting out of the way. I literally had to put my hand on one of them and say: "MOVE!! My partner has to get in there to start an IV and you're in the way!" Maybe if I started speaking Greek, or Aramaic, or perhaps Latin. We had been trying to utilize the staff the entire call: "Can you run a 12 lead?" "No." "Can you start an IV?" "No." "Can you put the 12 lead on the patient?" "No." " Can you set up an IV line?" "No." "Can you get the fuck out of my way?" "No." It was ridiculous. These people have RN and MD after their names and they can't do anything but tell us to give fluids and hurry up. They're worthless. After numerous IV attempts, including a couple by the Fire Department, we decide to move her to the stretcher while we draw up IV Valium for sedation. We have decided to cardiovert her.

Cardioversion is like shocking, only it's designed for shock on a specific part of the heart rhythm to reset. It's electrical Adenosine. It's more invasive and it hurts like hell. It's only designed for people who can't wait for Adenosine. Who are too sick to wait for drugs. We are running out f time with this lady, she needs cardioversion and to survive, she needs it now. 5mg of Valium IM in her shoulder, followed by cardioversion at 75J. After the second shock, the patient looks over and says:"Please, don't do that again." It is pitiful and weak, but she talked and it made sense. GOOD sign. She also converted after the second shock to a Sinus Tachycardia at 120. MUCH better.

We take her in code-3 with a fire-fighter assist, who by the way, got an IV en route. It was a 22 gauge, in her foot, but it was an IV. THANKYOU Ruger. At Duke, we gave a couple of the docs report, who gave us a thumbs-up and a thankyou. "You did a great job." Dr. Hocker says to Sara and I. We did, didn't we?