“Medic 25 respond to Pleasent Valley nursing home for right shoulder pain, nausea & vomiting”.
My partner asked if this was priority 1 or 2. Dispatch avdised to go ahead and make it priority 1. Being a curious and new medic I hand my iPhone to my partner and ask him look up rigt shoulder reffered pain. I think it could be related to the liver. After a little searching he finds it could be liver, spleen, heart and a lot more.
We arrive and find our patient, an 83 year old female experiencing pain in her back on and off all day. I asked the patient what made it worse now. She said that her doctor told her to go to the hospital. I leave the patient in the hands of my partner and seek the nurse. Asking my usual litany of questions I get a response of “we gave her phenergan three hours ago and it didn’t touch the nausea”. The nursing home staff had called the doctor for more pain management medication, the doctor said to send the patient to the emergency room.
I will admit that my first thought was “this is such a BS (BLS) run”. The patient was really in pain, you could see it in her face. After we got her into the back of the ambulance I decided that since she was going to get an IV at the hospital, I might as well start one. We were only 2 miles from our destination. My partner hops in back with me and starts to get vital signs. He first says he cannot hear a blood pressure, then he cannot palpate a pressure. He was unable to palpate a radial pulse as well. I switch positions with him as he applies the pulse oximeter, surely I can get a pressure. The cuff inflates to 180 and I slowly release the air. Watching the numbers fall past 110 I still cannot hear anything and I don’t see any needle deflection. Something is just not right. The pulse ox says her heart rate is 146. I attempt to ascultate a heart rate but I cannot hear the heart over her breathing and the background noise of the truck. My partner applies the electrodes as I attempt to find a vein. I glance up at the lifepak 12 and see a rate of 154. The rhythm looks like atrial fibrilation with rapid ventricular response. I give my partner the “time to leave pronto” hand gesture. “Code 3, hurry up”. I give a little oxygen and attempt the IV enroute with no success. I realize that something is not going well for this patient and I don’t have the means to diagnose or fix the problem. The hospital is packed with patients, a nurse comes over to triage us (we were so close I don’t think dispatch had time to relay the info to the hospital, they weren’t expecting us). My partner already has the BP cuff on and we are waiting looking at the machine. 78/60. The nurse is staring at paperwork, I politely interrupt her to point out the pressure. “I couldn’t get a pressure in the ambulance”. The nurse looks up, suddenly we move to the top of the list.
We roll into our room transfer the patient to the bed. I give the best report I can with the limited information I have. The patients pressure is now 61/40. The nurse is trying to get an IV, I step out of the room and mention to the registration lady that the patients pressure has dropped. Registration (she’s on our side) repeates the BP aloud and gets the doctors attention (she was trying to help us out and it worked). “Whos pressure is that?” asked the doc. Room 19, registration replies smartly. After a brief tine the doctor enters the room. The doctor thinks it might be a blood clot due to the recent abdominal infection (luckily he read her history). The patient is whisked away to CT after they administer a brief saline bolus to get the pressure up.
I want to thank my paramedic instructors. Seriously, I know many medics who would just BLS this patient nonemergent to the hospital. My instructors beat us over the head about not becoming complacient. I almost did, but changed my mind. Lesson learned. Thanks to them I might have saved somebody tonight.