A Medical ExperienceIt was the end of a normal day at the station. The medics are justgetting to bed after running a half a dozen calls for an assorted minor medicaland trauma problems. The paperwork was finished. The reports were entered intothe computer. The truck was even restocked. They were just about intodreamland but, as with most nights at this particular station, sleep was not tobe.
Several miles away, in a small, well kept apartment, Angie Briggs, aeighty-year-old woman awoke to the feeling that the life-giving air was beingdenied to her. She tried to sit up, but the feeling would not subside. Walkingmade it worse. She also noticed that, even though the temperature in her roomwas comfortable, she was dripping with sweat. The longer that she waited, theharder it became to breath. So, realizing the fact that her doctor was probablyasleep, she did the next logical step, she called her daughter, who lives inanother state. The daughter realized that her mother needed more help than shecould give over the phone, tried to persuade the mother to call an ambulance,which, of course, the mother refused to do, stating that it wasn’t necessary.
The daughter then took it upon herself to call EMS from her own house.
The medics were notified of the problem through the usual method, aseries of tones over a radio that cause a loud horn to blare and all the stationlights to come on, much to the annoyance of the fire lieutenant. This alarm wasimmediately followed by the dispatchers voice giving all the applicableinformation on this call.
“Med unit 2, respiratory call, 103 Royal Terrace Boulevard, apartment 7,in reference to a 80 year old woman with shortness of breath.”Not that the EMS crew were listening at this point. They are busygetting into their jumpsuits and putting their boots on. It does not matter ifthey are eating, sleeping, watching TV, or even taking a shower, they arerequired to be in the ambulance and en route to the scene within two minutes.
“Med Two’s en route.” Stated EMT Jennifer Meyers in a sleepy voice” Copy med 2 is en route to 103 Royal Terrace Blvd., apartment 7.” Nowthey are listening. “This is in reference to a 80 year-old female who is insevere respiratory distress. Received the call from her daughter that is out ofstate. Patient sounds very short of breath.””Copy””I’m pretty sure that it is in the first entrance into the apartmentcomplex. Should be the third or fourth building on the left”, stated DougMurphy the paramedic on duty.
It took only a few minutes for the ambulance to arrive at the scene.
After dispatch was informed of their arrival, Doug and Jennifer removed thestretcher that was already loaded with the monitor, the airway bag, and the medbox. As he approached the front door, Doug took notice of the condition of thewalkway, of the location of the bushes, and any outside furniture that mightimpede exiting the house with a stretcher loaded with a person. He did the samequick evaluation upon entering the residence.
After knocking, an elderly, heavy-set woman opened the door. The mediccould see immediately that she was is serous trouble. Her clothes were soaked,wet with sweat, every time she took a breath, a faint popping sound could beheard. The medic also could see the front of her neck pull in along with everybreath and that her general color had a faint, matted bluish color about her.
Doug knew that without immediate treatment, this lady would die.
Doug quickly lowered the stretcher and took the equipment off of it.
“Why don’t you sit right here.” Doug told Mrs. Briggs” I’m fine, really. I told my daughter that I would see my doctor inthe morning. I don’t know why she called you?” Mrs. Briggs stated. The medicwas surprised that she could talk at all.
“When did you start having trouble breathing?” Doug asked as he wasturning on the oxygen bottle”About an hour ago. I woke up and couldn’t catch my breath.” Pointingto the oxygen mask that the medic was placing on her face.”I really don’tneed any of that.”” I think you do. You need to let me do my job and treat you.Thiscondition will only get worse.””No, I think I’ll wait till the morning.””Listen, you don’t have until the morning. To be perfectly blunt, Idoubt you have a hour. You need to let me treat you now. Your lungs are fullof fluid.””How do know that?” asked the patient.
“I can hear it, even without my stethoscope.” retorted the medic. ” Ican take care of this problem with medicines, but I need to do it now.” Lookingat his partner. “How’s the blood pressure?”The medic’s partner had been busy taking the patients blood pressure andpulse, and was now in the process of applying the electrodes on the patientschest for the monitor.
“180/90, pulse 100 very irregular.” came the reply.
While his partner began to set up the IV bag, the medic finished puttingon the monitor leads. After he turned the machine on, he then began listeningto the patients chest, carefully listening to each lobe of the lungs, trying tojudge just how far the crackles, or rales, go up into the chest. This allowshim to determine how full of fluid Annie’s lung were.
“Your lungs are three-quarters the way full.” Doug then took a look atthe monitor. “Do you usually have skipped heart beats?” questioned the medic.
“Yeah, it’s been like that for a while.” answered the patient.
He then asked the patient. “Have you ever had an IV before?””Yes. Do I really need one now?””Yes ma`am, you sure do.” answered the medic. A rubber tourniquet wasplaced around the patients arm tight enough to stop the return blood flow, orvenous blood but not too tight enough to cut off the arterial blood flow. Hethen looked for and found a vein in her wrist, prepped the site with alcohol,and stuck a needle that was covered by a thin catheter into the vein. After heremoved the needle, leaving the plastic catheter in the vein, he took a sampleof blood from the site and connected the IV line. He then released thetourniquet and opened the IV line to make sure he had a good flow. The driprate was set so it would only drip once ever few seconds. After he taped theline down to the patient’s arm, he finished this particular procedure by makingsure that all the dirty needles were safely placed in a sharps container. Hedidn’t want any accidental needle sticks.
“Ma’am, are you allergic to any medicines that your aware of?””No, not that I can think of.””OK, This is what we are going to do. First, I’m going to give you someNitro with a spray. What I need to you to do is open your mouth and put yourtongue at the top of your mouth” Stated the medic.
Mrs. Briggs complied, almost. She opened her mouth and kept her tongueat the bottom of her mouth. “Tongue up.” The patient complied.
“Good, now take a breath in.” When she did, the medic sprayed the Nitrointo her mouth. Having her inhale when he sprayed the Nitro kept it from goingback into his face.
Talking to the patient “Ma’am, I’m going to give you some Lasix thoughthe IV line. Hopefully, it will pull some of that fluid out of your lungs andback into your bloodstream. Is that oxygen helping?””A little.””Good” The medic replied. He then proceeded to slowly give the Lasix.
The standing orders that he works under (after all, a non-physician cannot givemedicine without a physician willing to assume responsibility for it) allows hima dosage range up to 80 mg. for Lasix. If the patient was not in such distress,he would have opted for double of the home dosage. However, this time he chosefor the full eighty.
After being secured in the ambulance, Jennifer went back to make surethat the residence was locked up. Doug then retook the patients blood pressure(which had not changed) and listened again to her chest, detecting a slightclearing of the lungs.
“Ma’am, I need to ask you again if you are allergic to any drugs.””No, I’m not.””Have you ever taken Morphine before.””No, why?””Because I’m going to give you some in a minute””Why? I don’t hurt anywhere.””We’re going for another effect that it has. It helps pull that fluidout of your lungs.” Seeing a look of confusion in the patients eyes, Doug asked”Do you understand what is happening?””No””For some reason, your heart cannot keep up with the flow of bloodcoming into it.” The medic explained as he drew up the Morphine from the vial.
“When this happens to the left side of the heart, the blood backs up into thelungs, causing the blood plasma to leak into the tiny air sacs in your lungs.
This is what is causing you to be short of breath and to have that cracklingnoise when you breath. All the medicines I am giving you cause your bloodvessel to dilate, or get bigger. The Nitro causes this all over the body. TheMorphine does it in the arms and legs. And the Lasix pulls it out of the bodyby making you have to pee a lot. The Morphine will also help you to relaxsomewhat. Just let me know if you start felling nauseous.” Doug took a alcoholwipe and cleaned the injection port of the IV tubing, then inserted thesyringe’s needle into the port. “I’m giving you the Morphine now.”By this time, Jennifer had finished locking the apartment.
“You all set?” She asked, sticking her head in the back of the truck.
“Yup, let’s go.”On the way to the hospital, the patient started improving; her bloodpressure and pulse were going down, and the patient was breathing a lot easier.
The rales were even noticeably diminishing. The medic had called the hospitalover the radio notifying them of the patient that he was bringing in and hercurrent condition. The patient, due either to her finding it easier to breathor due to the Morphine, began talking.
“How long have you been a fireman?” The patient asked”Never have been, I’m a paramedic.” The paramedic retorted. “We have adual system in this county. We work with and are stationed with the firedepartment, but we are under a different chain of command.””What does that mean.””I don’t put out fires, they don’t give people needles.”By the time that the ambulance got to the hospital, the patients lungswere almost clear of any rales that the medic could hear. And, as expected, thepatient requested a bedpan as quickly as possible.
“Which room would you like us in.” Doug asked a nurse.
“What’ch ya got” came the reply.
“Heart failure.””Room 10 will be fine.””Thanks.” responded the medic as he wheeled the patient into thetreatment room. While the nurse went to get her paperwork, the medic and hispartner lifted the patient onto the hospital stretcher, transferring the oxygentubing
