"I don't think so."

I hate difficulty breathing calls. I particuarly hate calls in the nebulous CHF/COPD/Pnemonia area. You get an old person in severe distress, and they are anxious and struggling for breath. They keep gasping that they can't breath. They are big and sweaty and live in old houses with narrow halls and you can't get the stretcher in to them and you are worried they are going to arrest. And its just you and your partner and the patient has poor IV access and all their meds are in pill cases, and you are trying to figure out how to do everything you need to do and in which order, all the while getting them out of the house and on to the hospital while they are fighting you and trying to pull the mask off because despite the 02 they can't breath and they are afraid.

"Just drive," I tell my partner.

Sometimes they arrest on you, sometimes they make it to the hospital where they get tubed, sometimes they get better.

This morning the lady was gray and clammy and had rales and expiratory wheezes. No fever, positive JVD, positive pedal edema, hypertensive, tachycardic, big cardiac history along with CHF and asthma.

I caught a break on the IV, where I got a flash, lost it, but then was able to reposition and advance the IV. I gave her nitro, lasix, and a breathing treatment. I've written before about how sometimes the treatment seems to cause them to flash, and I was worried this time, but she had the asthma history and was wheezing, so I went ahead with it. I didn't see much improvement on the way in, which took us just nine minutes after a 16 minute scene time with a difficult extrication. I did the IV and gave all the meds enroute. They gave her more of everything at the hospital, and when I brought my paperwork back to the room, she looked a whole lot better.

The nurse was telling me how she loves these calls where they look so bad, but get fixed. I tell her I will never get used to them. I just fine it so hard to manage anxious patients who need so much attention, particuarly when some of the meds you give can cause more harm than good. If they have pnemonia, the lasix is bad for them. Sometimes the treatments make them flash, and the nitro can bottom their pressures. It's hard to hear a BP on many of them when they are thrashing about, and you are going lights and sirens, and if they need to be bagged, well, its hard to do when you are by yourself, as is trying to do a nasal tube. You just have to hope the meds you give work or that at least you will get to the hospital before they go out. Don't care for these calls at all.

***

Nursing home for the unresponsive, find a man cool and clammy but alert. Nurse says he arrived last night to rehab from an aortic bypass. They got a pressure of 79/53 when he was out. We lay him down -- they had him sitting in a chair -- and get a pressure of 108/70, which rises to 130/80. His heart rate is steady at 72. he has no pain. Soon, he is warm and dry, good cap refill, steady pulse, mentating well. At the hospital, we use their BP machine to take pressure and heart rate for the triage nurse. The reading is 150/90. We are sent back to one of the room, where I give my report to the nurse as she puts the patient on the monitor and hooks up the machine BP. Then suddenly she leaves the room, and returns with three other staff, all I believe doctors. She asks me to give my report to them. I say, once we got him on our stretcher, we got a good pressure. "And just what is a good pressure to you?" the doctor demands.

"120 130, very stable."

She points, almost accusingly at the BP machine, which reads 60/40.

"I don't think so," I say.

As I leave the room, I hear the doctor order the nurse to take a manual blood pressure. My partner says their next machine reading is 140.

***

A lady turns her ankle running and we take her in. On the way back, I stop at the garage and pick up my car. Good news is it was just the battery. Bad news, I will soon need rear brakes.

***

Lady twists her ankle. Broken or sprained, I don't know. We take her in.

***

Nursing home call for dsypnea. Patient just returned from the hospital has rapid shallow breathing according to the nurse who wants her out of the home and back at the hospital. The patient (with dementia) appears to have "tachysniffles." She is breathing rapidly through her nose, rubbing her nose and poking at the cannula. She doesn't appear to be in any distress. We take her in.

***

Get a call at 5:30, but then are cancelled en route. Thankfully.

I am beat and ready to go home and sleep.