code heart

As far as medical calls are concerned theres few scenarios in which we in the field can actually perform to make a difference in the patients final outcome. Acute Coronary Syndromes is one of those. A few months ago I ran my first "cardiac alert", in my area when a patient meets certain criteria we in the field call a "cardiac alert" and transport to the nearest facility with a cath lab, In the ER we have a team waiting for us. We ran a call for a chest pain and as we entered the back of the warehouse this gentleman was in obvious distress, completely soaked in his on sweat, clutching his chest and having some very obvious difficulty breathing. The medic I usually work with and myself like to get the patient in the truck as soon as possible and assess there, its just easier to work that way. So we throw a non-rebreather on the guy give em 2 asaprin and load em up. Once in the back of the truck we get vitals and start a line. 88/46 pulse 46. No nitro for this gentleman and the LT orders atropine. We call for an engine company for someone to drive us into the hospital. As my medic partner is pushing 1mg of atropine I do a 12 lead. Massive ST elevation in lead II III and avf. as the 2nd mg of atropine is being pushed I do a quick V4R and theres elevation there as well. Withhold the atropine I say this is right-sided, We need fluids and pacing. We opened up the IV and I gave the guy a quick shave and applied the pads, 2 of versed later and were ready to pace. However at this point the atropine has kicked in and his rate is 66, OK lets go our driver is here and we take off to the hospital (on scene time about 6 min total). Start a second IV enroute wide open. By the time we get to the hospital his rate is still in the 60's and we've given about 750ml of fluids, his bp is in the 110. He's in the cath-lab within 12 min of our arrival. Found out later the guy had a complete blockage of the right coronary artery, at which point a nurse looks at us and says "you guys saved his life, good job" which is nice to hear as this is often a thankless job. However, every call is a lesson learned and in this case that lesson is to do a 12 lead before you start pushing meds. Thankfully this all worked out for the better, but if we had done the 12 lead first, withheld atropine and went straight to pacing would it have made a difference? who knows? But the guy did make it....