I am mad, at myself. My partner and I are clearing from a run that I could have performed better. The call was for a 74 year old female difficulty breathing. The patient was really having respiratory distress and needed help. While my basic partner assessed vital signs, I placed the patient on the EKG. The initial rhythm looked like atrial fibrillation with raps ventricular response. I also noted ST elevation in lead III with depression in lead I. The proceeding 12 lead showed a possible anterior MI, and that’s what I decided to treat.
Transport decision was made, rapid to a hospital with a cath lab. The patient also had rales (crackles) bilaterally in the lower lobes.
Prior to the 12 lead I was looking to treat CHF exacerbation. I switched gears after the EKG findings. The patient’s only complaint was that the couldn’t breath. No chest pain but her pressure was 190/120 in the ambulance.
I followed my MI protocol and administered nitro and asprin. We already had high flow O2 going at 15 lpm.
What really bugged me was that I missed two EASY IVs. Why does this still bother me?
The ER doc compared the new 12 lead to an old one and decided that this was not new ST elevation, and treated the patients pressure and atrial fibrilation. My treatment modality helped as much as I am allowed to help (with the exception of lasix since I couldn’t hit the broad side of a barn with an IV).
Does anyone else still kick themselves for stupid things like missing IVs?
Post Script: This was written while we returned to the station from this run. We had been busy all day, I was tired and this just frustrated me. I want to be the best paramedic I can and sometimes my perfectionism blinds me. I will learn from my mistakes and continue to improve my techniques and knowledge. Thanks for everyones kind words. Last night almost never ended.