Thursday, July 21

Double V

First of all, update on the firefighter. Not only was she OK, but a friend of mine reports she is still going on calls. REALLY…

V is for Vomit. On a recent call the patient (who has a history of diabetes) was unresponsive even after we got her blood sugar level in the normal range. The patient was in VERY tight quarters, and we were getting her out on a back board. Due to where we were, we had to take the patient down a few stairs, head first (there wasn’t room to turn her around). Who was at the head of the patient? That’s right, DJ. Not one of the four firefighters there. Not our driver or basic EMT. The medic. Oddly enough, the other end of the board was being carried by the Paramedic who came with the rescue truck. Two ALS providers total, both carring the patient while everyone else stands around. Turns out THEY saw what was coming and knew better :-). Part way down the stairs, with the patient on her back and head at my chest level, she projectile vomits. I am COVERED with puke. It is literally dripping off me, soaking ALL of my clothes (I can feel it seeping into my underwear, a sensation I will not soon forget and hope to never experience again). Upon arrival at the hospital, the FIRST words out of the nurse's mouth were “Would you like to borrow a set of scrubs”? I guess she could smell me coming… I’m not taking the head of the board anymore :-).

V is also for V-Tach. Recent patient called 911 complaining of dizziness and a “ticking” in his chest. By the time we get to him, he is feeling much better and is asymptomatic. We are out in the boonies... As I ALS the patient, I glance at the monitor and do a double take - Textbook SVT, and the first time I’ve seen it in the field. When I ask him how he is doing, he says "fine". I go back to work, and suddenly the patient says “Whoah! There it is again”. I look at the monitor and the patient is in V-Tach! Now, I’m sure this is not worrisome to most of my readers, as you likely see this a lot. But for me, this is the first V-Tach I’ve seen in a talking patient, and it gets MY heart rate up as I associate it with a non-perfusing rhythm, code drugs, etc. Somehow I manage to ask the patient to cough and bare down as if he is having a bowel movement (to stimulate his vagus nerve), and the V-Tach breaks. The patient now reports he is feeling fine and asks me what the hell I did. We go through this four more times on the way to the hospital. Given he was asymptomatic in the SVT, and the V-Tach broke with the vagal stimulation, I didn’t do much more for him. It was a good call to experience as I had only seen those rhythmus in testing situations, where they came from simulators.

Hope everyone is enjoying the summer. I am sure I’ll post more frequently when fall returns. Thanks for checking back in and take care.