Dizzy

We get called to a doctor's office for a person feeling dizzy. We're in the absolutely loudest ambulance in the company. When you step on the gas, the diessel is so loud it completely drowns out the radios, so you have to have the radios up, which just increases the racket. The address isn't that far away and traffic is moving well, so I tell me partner to ease back on the siren. "I can't take the noise. It's killing me," I say. "I am going deaf." And you figure how bad can someone be if they could make it to their doctor's office on their own. We arrive a few minutes after dispatch with no delay from traffic.

The doctor tells me the woman came in to have her foot examined, but she has been feeling dizzy and they can't get a blood pressure. She is also a diabetic and her blood sugar is critically high. She is alert, but looks a little pale.

I put her on 02 and run a quick strip. The quality of the tracing is poor -- only lead two comes out, but I can see it's a normal sinus. We get her on the stretcher, and get her out to the ambulance where her blood pressure is 84/50. Her heart rate 60 -- she's on a beta blocker. She is obese with poor IV access. I am lucky to get a 22 in right forearm in a thin superficial vein, but at least it was visible and it runs the Iv fluid well. I reconfirm the blood sugar is high. At least over 600 as my machine reads only HI.

She says her chest hurts so I give her some aspirin and do a 12 lead. I get a nice tracing this time, and have to do a double take. It is not the huge punch you in the face ST elevation, but there is small but noticable elevation in the inferior leads, particuarly Lead II, and AVF. Increasing my concern is the invervse ST in VII and VIII, that combined with the elevation in the inferior leads, suggest an inferiorposterior MI. We go immediately on a priority to the hospital. I patch in with an MI alert on the way. At the hospital, I alert the doctor, and she brings up an old ECG for the patient, and it is clear what we are seeing now is acute. She is on the phone to the cath lab. Shortly after the woman is whisked up there. Still waiting for an update.

A couple lessons. 1) Anything can be an emergency 2) Make sure you get a good initial tracing and look at it, not just glance at it.

But even though I made a small initial mistake, I feel like I rocked the call. I picked up on the MI and I pushed her through the system. I called in an MI alert, told the triage nurse, I thought she was having an MI, when I got in the room, told the nurse to get the doctor because I thought this lady was having an MI, and showed my 12 lead to the MD, and told her why I thought it was an MI, and asked her if she thought the ECG was a ticket to the cath lab.

I much prefer cardiac calls to respiratory because while the cardiac can be just as sick, the patient is usually a little calmer and easier to manage, then someone gasping for breath.

Later did a dsypnea at a nursing home on their psych ward. The patient was SAting at 88 on a cannula, up to 100 on a nonrebreather. I couldn't hear any lung sounds. At first I thought my stethescope was turned off, then I switched it a couple times on and off, but I still wasn't hearing much. I tried my partner's scope and while I couldn't hear much I could at least hear something. Time for a new stethescope. The patient was either in CHF or had pnemonia. When he coughed, it sounded like a washing machine, but when he wasn't coughing like I said, I couldn't hear much. He had a good amount of edema, but he was also extremely lethargic, but not lethargy from huffing and puffing. It was like he was severely overmedicated. He was on about seven psych meds and the nursing home he stays at is more like a halfway house than a true nursing home. Many of the patients are just psychs who come and go. His pupils were constricted, and I thought about giving him some narcan, but as long as he was SATing at 100 and wasn't huffing and puffing too bad, I thought let him sleep. He's another one I need to check back on. The doctor wasn't certain what the deal was with him either, or at least on first impressions.

Also did a long wait and return transfer and another transfer. Got out too late to pick up my prescriptions for my trip to the Domincan Republic, along with the special mosquito reppellent. This morning I went to the Travel Clinic and got three shots -- two in my right arm, one in the left.