28 November 2009
It's not what it was dispatched as!!
This is a response to a local managed care facility, dispatched as a person experiencing difficulty breathing.....below is the reason why. The patient was having an AMI covered up by the SVT; not good.
She was an 83yo lady having "difficulty breathing", and she was, w/ upper resp. "grunting", bases=rales...NRB to replace 2L/NC she was on. Pulses= absent perf. and thready carotid...to say the least she was symptomatic.
Due to proximity to ER (-5min) I didn't waste a lot of time w/ I.V. and/or meds because her veins were so depleted. Just to be doing something enroute to the ER I do a quick EKG because she has a history of bradycardia. Turn it on and...THIS!! By this time, we're less than 2mins out and I had no time for Adenosine or time to cardiovert. It was probably for the best that I didn't have time to do either one for this patient, because with this presentation all the squiggly lines might have straightened right out. Pt has a DNR and expires 10min after arrival at ER.
My lesson was this. Regardless of time, I have at my disposal the same initial tools that the ER is going to utilize when I do get there. So as it should be, the ER is brought to the patient for one on one care. The ER may have one MD and four nurses for twenty patients.....I am their best bet.
Take the time to diagnose and begin interventions as soon as you realize something is not as it should be. After all, that is the reason we do this job.