Calls

Two decent calls to start the day:

Call number 1: End Stage Renal Dialysis Patient with decreasing LOC over two weeks, now barely consious with no plapable pulse and irregular respirations. Family has signed DNR papers, but MD hasn't signed them yet. I can't feel a pulse or head a BP either. The monitor gets BP's between 119/70 and 74/40 so who is to say. The monitor shows a bifascicular block at a rate of 108. No IV access. Respirations between 6 and 14, irregular with periods of apnea.

I keep him on a non-rebreather, check his sugar -- its 220, and take him to the hospital. I don't stick him because I can see or feel nothing. I don't try to tube him because even though his doctor hasn't signed his DNR, for all intents and purposes those are his family's wishes, and at the hospital they can call the family and the doctor. If he stops breathing. I'll bag him. I like to be aggresive with the airway, but I also believe in letting people go gently when it is there time( and their family agrees), not showing a steel blade in their throat and pricking them just to make a vain attempt them.

At the hospital, they call IV down, but they have no luck. The doctor is putting in a central line as I am leaving. The patient's still on a non-rebreather. They have a call in to the patient's doctor.

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Call Number 2. Lady recently discharged from nursing home following bout of pneumonia.She lives in a elderly housing complex and the woman there with her I think is a nurse, but she may just be an housing director, who thinks she is a nurse. I don't know. She takes a BP and pulse and calls us because her BP is 80 and her pulse is 80 also, when it normally is 60 she says. The woman appears in no distress, although she says she feels weak. I listen to her lungs -- nice and clear.

Every one has their own routine for doing calls. When I first started I always took a blood pressure and pulse and counted respirations at the patient side. Now I tend to do it in the ambulance unless something in particular merits it. The nurse/Housing director has just told me her vital signs, the woman is in no distress, her skin is warm. I have the woman help me get her into a johnny top, then I take her out to the ambulance.

As we start toward the hospital, I have the EMT riding in the back with me take a blood pressure and do a SAT, while I put in an IV. The pressure is 110/60. The SAT - 97%. I put her on the monitor and whalla -- she is cranking along in a rapid afib at 160. There is no notation in the paperwork of afib. She is on metoporol. She has HTN. No mention of afib. Not on any blood thinners. I ask her if she has ever been told she has afib. She looks very puzzled by the word. I give her some Cardizem and the rate slows right down to the 60-80 range. I hang a drip. She says she feels better. We continue on to the hospital. All stays well.

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Rest of the day -- a medical alarm false alarm no one home, an asthma and an abd pain. They had no one to work the overnight so I am staying until six in the morning. I hope its quiet