Tuesday, February 24, 2009

We've all been there

The job is for an 'altered mental status' at a local nursing home. The BLS gets there first and radios us to set up in the back of their bus. As they're coming down the elevator, they again radio us that this "could be cardiac related."

Relaxed, my partner throws a few new stickies onto the 12-Lead wires, and I continue scribbling the location details on the chart. As if by magic, the EMTs appear when they throw open the rear doors. "Nursing home staff found her this morning at 10AM, but they thought she just wasn't speaking because she was in a sullen mood, I couldn't feel a radial pulse or get a blood pressure" the quite petite and quite cute, young EMT tells me: Mr. Medic.

I glance at my watch: 4PM.

My partner puts the EKG leads on, and we both look at the monitor at the same time -- idioventricular beats only, at a rate of 20 bpm. Not good. In case you haven't guessed yet, this patient is completely unresponsive. Here we have the 85 y/o female who waited six hours for medical attention, and all of a sudden, now we are all springing into action. My partner and I move with the certain speed and grace that only a life hanging in the balance can instill in a man.

Oxygen. Intubation. Intraosseous Access. Assisted Ventilations. Fluids. Atropine. Pacing.

Our first line medical treatments... not a dent, not a change. We've run out of Standing Orders.

We call the doc and and let him know what he's about to get hit with. By this time we're racing away with every light and every siren blinking and yelping at full bore. "DOPAMINE!" the doc yells over the din. Barely time to look at the drug and we're pulling into the ER. A flock of nurses, a young, quiet Attending, us - the medics, a mass of people. More medical procedures the do, more hands flying around in a blur. Then calm. Order sets in. The routine kicks in again...
A nice stable blood pressure gradually sets in. The ventilator is hooked up, blood work gets sent, the medics go on their next job.

The following day I speak with the quiet young Attending physican. " A Save!" says he, but to what end? Only a stopgap in death. A crumbling levee against the tide of the inevitable. The doctors, can't wean our patient off the dopamine. Physically, she's probably moderately strong, but too long a hypoxic brain. Too much injury. The family makes their grandmother DNR. Six hours.