‘Medic 20 do you have a vent?” The first break in radio silence in a a few hours. My partner and I are just leaving a thanksgiving dinner at his family’s house. Medic 20 responded and said they did not have a vent but they were still close to the station and would return to get a ventilator. Dispatch told them to hurry, there was a patient at Regional Respiratory Hospital that was found on the floor. My partner and I look at each other, he states the obvious “We really should take that run for them”
“Medic 23, Control, we already have a vent we can take that run” Dispatch asks how close we are to the hospital. We are 5 minutes from the RRH, dispatch says “Good, hurry”. We take off lights and sirens wondering what a patient on a vent is doing on the floor. My partner, thinking ahead, calls dispatch and asks to have medic 20 bring a bariatric stretcher. My service has the contract with this hospital and many of the patients here are morbidly obese.
We arrive in four minutes and load up our cot. 4th floor here we come. The room is the furthest from the elevators. The room is full of people and the crash cart. The patient is on the floor supine. The gaggle of hospital staff are all standing around. One person is kneeling next to the patient. She looks up and says she got a doppler pressure of 40. A gentelman from the corner walks over to me, introduces himself as the doctor.
“The patient was found face down on the floor. She was in asystole, we ran three rounds of epi, three rounds of atropine and she went into PEA. We got a pulse back, but were unable to get a pressure. We just got a doppler of 40. I’m really concerned about cervical stabilization.”
I start to put the story together in my head. The patient somehow rolled out of her bed, landed on the floor, her vent tubing came off. The ventilator was making noises and eventually someone came in to check the vent to see what was going on and found the patient on the floor, unknown how long, not breathing. Stop breathing long enough and your heart will stop beating.
My turn, I walk over the the patient and palpate a radial pulse. I can’t feel a damn thing. The patient’s neck has fat rolls so trying a carotid pulse is unlikely to be productive. I go straight to auscultating an heart rate. I hear a faint beat in between the lung sounds. Confirmed that the heart is actually beating, just not all that well. The doctor is ordering a levophed drip. The patient has already had 1 liter bolus of saline. I ask the respiratory therapist what the vent settings are, and get my LTV 1000 set up. I asked the doctor if I can take the patient off their monitor and place the patient on my lifepack 12. Junctional rhythm rate around 70. Medic 20 arrives with the big boy stretcher (which is a good thing since out patient is about 5’2″ and 450lbs). With the hospital staff assisting we get the patient on a back board (somehow we managed to get a cervical collar on the patient) and get the patient on our cot. The Levophed drip arrives and the nurse is attempting to set the pump (she says that she’s never set a levophed drip on the pump before). I tell the doctor I can just take the drip without the pump if that’s easier. They opt to fight with the pump. Three nurses finally get the pump set for 10mcg/kg/min. The doctor says that if I need to increase I can go up to 15mcg/kg/min. My partner asks me if I want the other medic in back and him (my partner) to drive. I nod yes. Off we go. Getting all this equipment in to the ambulance was some sadistic yoga. We eventually got all the appliances (LP12, LVT 1000 vent, IV pump with 2 IV drips running). The other medic says he can now feel a radial pulse. I check the BP and get 122/70, levophed might be working. We take the patient, code 3, 2 miles down the road to another Hospital ER.
Just another day on the streets.