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....

1st of many

Hi there, let me take this opportunity to introduce myself. I am, well i'm me. You probably don't know me and for your sake, hopefully we'll never meet. I am at your service, a public servant if you will. Employed by your local government to serve you. Educated for the past 3 years for no reason other than to answer to your beck n' call. If you do me one favor in your life, please don't abuse me, because it happens quite often. So if you've taken it upon yourself to read this far, your probably asking, just who is this guy? or girl as it may be. I'm your local firefighter/paramedic. I've worked as an EMT for the past 2 years and I'm just about through with paramedic school and my associates of science degree in Emergency Medical Services. I'm one of many like me across the country and even the world. Often overworked and under appreciated but always there when needed. I've only been employed by a municipal Fire Rescue agency a short time and in that time have become wise beyond my years, seen things I would never wish upon another, seen things you'd never believe and laughed to the point of tears. I love what I do and I wouldn't trade it for the world. So in my relatively short tenure as a health care professional/fire protection engineer/slave to the masses I've run my fair share of fairly interesting, sometimes devastating, occasionally hilarious but never dull calls. Therefore I've decided to keep a journal of said calls. Each call run, however insignificant in the scheme of things is a lesson learned, a red light run , and a soul touched. So sit back, grab the beverage of your choice and enjoy the roller coaster this is sure to be. For several reasons, (many of which are legal, in addition to protecting the confidentiality of patients and crews) this blog will be kept anonymous, names will be changed to protect all those involved. But please feel free to comment!
till the tones drop...
- at your service