Another night at Medic 82
Trip Start Sep 14, 2008
21Trip End Nov 01, 2008
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A few routine calls, a few big calls. Our first big one was a patient who was at an allergy clinic having tests done to figure out what she was allergic to when she, here's a shocker, went into anaphylaxis from one of the antigens she received. This lady was allergic to everything. She was even allergic to Benadryl! Oh my god. Seriously? You're allergic to an anti-histamine... an allergy medication! Not unheard of, to be sure. There's a few people I've talked to who are allergic to benadryl, but not many. Because of her allergic reaction, the doctor present at the clinic gave her 0.6mg of epinephrine, 1:1,000! That's twice the dose given in a severe allergic reaction. Did she stop there? Oh no. No that would be too easy... she gave her a Singulair dose, a dose of benadryl (which, if you remember correctly she is allergic to) as was in the process of giving her an albuterol treatment when we arrived. This lady was taching along somewhere in he 130's! She said she felt like her heart was about to run right out of her chest. I'm not surprised. We get her to the hospital, which is just right around the corner, and her doctor follows and starts fawning all over her. Seriously, it was disgusting. You could totally see this doctor was trying to suck up like nobody's business. Ah well, the epi wore off soon but the shakes still remained.
Later that night, we get a call for an unconscious patient with snoring respirations. We arrive and I immediately reposition her airway and, imagine this, she breathes clear! Woo! She's completely unresponsive, but has a pulse, and I can smell wine pretty heavily on her breath. Her SpO2 level is at 56%. She's got a dark red stain running down her nose. I listen closely to her breathing now and I can still hear some crackles in the lungs - it sounds like she aspirated some wine. I put an OPA in, both to open her airway and test for a gag reflex - no response at all. I put her on a non-rebreather since she has decent tidal volume, and her sats quickly climb up to 98%. Woo!! Her blood glucose is 109 - so this isn't diabetic related. I try even more painful stimuli - still no response. She is out. You know what that means, right?
Aspiration + inability to control own airway + no response + Absent gag reflex = Andy gets to tube you, baby!.
Oh yeah, it's time to intubate! We get her moved onto the gurney and into the ambulance with her boyfriend watching. I don't want him to see me shove a tube down her throat, so I ask one of the firefighters to get inside and close the door. This poor firefighter can't be much older than 19... and he's losing his mind! I had to really struggle to keep from laughing. He's an EMT Intermediate and either doesn't get to practice much (not surprising) or just graduated from EMT class and this is one of his first real patients (A likely case is both). I've been an EMT for a little over a year, but I ask myself if I was that scared when I saw my first patient? I'll ask Sarah when I get home, she was with me as an EMT 1. Anyway, I tell him to start a line for me while keeping eye contact so he'll maybe calm down a little. I get my intubation gear ready and tell the attendant to pre-oxygenate for me (we don't say hyperventilate anymore! Haha!). The firefighter, who is working on the line, looks up and his eyes get as big as saucers when I went in. She didn't even flinch. Her heart's still tachin along at 120, but is regular. No cardiac issues that I can see.
We get her tubed after a try, and he unfortunately misses the IV. He was a little nervous to say the least. Everything's going great, though. We put her on the port-a-pac to free up a hand. Buy this time we're running code to the hospital. We re-assess her LOC. Thankfully Patrick had a line on the other arm, so I wasn't worried about the firefighter missing his IV. The poor kid really felt like he let everyone down - he was almost on the verge of tears. Everyone reassured him it's okay, we cleaned up headed back in service.
Another busy night. Lots of other calls, but nothing really as good - but still no sleep. Though we did have this lady in her 90's who had a bradycardic rhythm with a bigeminy of PVC's. It was freakin weird - her blood pressure was normal, her mentation was normal, everything was normal. She did complain of a slight headache, but said it had started this morning. No one could figure out exactly what was going on and it was eventually decided that she'd probably been living with this for a while.