The day starts off at 4.30 in the morning. Shower. Change. Breakfast. Off to work. Skype with my awesome fiance. Shift starts at 6.00.
At first an hour of office stuff. Nothing interesting, just stuff that has to be done. At 7.00 our first assignment. Patient 65yrs old cannot breathe. We arrive 10 min later. He’s gasping for air. Expiratory stridor. O2 stats at 75%. We give him oxygen and meds. His bronchioles clear up a bit and breathing feels much better already. Listening to his lungs there’s a lot still going on in there. It’s probably an infection combined with COPD (chronic obstructive pulmonary disease). The doc comes too. Gives him more meds. He seems to be stable. O2 back at 95. Stridor almost gone. He’s got an appointment with a pulmonary specialist today anyway. Since his O2 stats don’t drop without oxygen, he’s good to stay at home for another while before going to the specialist. We are off again.Way back to the station. But first, a snack. When my day starts at 4.30 I need a bite at 8.00 or 9.00 😛
Soon after, next call. A 25yrs old woman with chest pain. A symptom of a heart attack. Sirens on, off we go. We arrive. Patient didn’t feel good at work. Went home. Collapsed at home. BP (Blood pressure) is 100/70 now. She hasn’t eaten anything yet. She’s shaking all over and complains about pressure on her chest. We do an ECG as well. I’m not an expert and ECG’s are complex and complicated, but I have learnt to see if there is anything wrong with an ECG. Seems to be normal though. We take her to hospital, where they will take some blood samples and check for things. It seems to be a panic attack, which caused her to collapse and feel that way.
Finally a bit of a break. Time to do some office stuff at the station and to grab some food. We talk about training CPR with the new guys and our experiences with CPR. There are times you have to do CPR more often, sometimes less. It’s nothing you can predict.
Just as if we asked for it the next code comes in. 96yrs old. Collapsed. Not breathing properly. Usually a reanimation code. We get in the car. Ride off. It’s just 3 min away. Arrived at the scene. Lady sitting in her wheel chair. Not responding. Breathing though. Non responsive to me appearing in her sight, nor to me talking to her, nor to me touching her or anything. BP not even measurable. Her pulse is regular but weak. Her ECG seems normal. We put up her feet. She has had diarrhoea in the last couple of days and doesn’t drink much in the first place. Finally we get a BP result. 50/35. Not much. Not much at all. Emergency doc arrives. We give her fluids. Her BP stabilizes slowly. She gains back her consciousness. Probably just dehydration. The doc wants her to go to hospital though. I’m not so much a fan of that, but it’s the docs decision. I know the patient already. Last time she had diarrhoea, it was the same scene. We gave her fluids and she was fine. Transporting a 96 yrs old lady to hospital can be quite stressful on her. But since she’s in the responsibility of the doc we take her. We put her on our stretcher. Off to hospital.
A couple of hours later. No more codes. But then the call to take the 96yrs old back home. What did they do in hospital? Check her blood. Give her another bottle of fluids. Wait a bit. Send her home. Well. What shall I say. But ok. Not my call. The daughters agreed with it too. That’s a bit of the systems fault too. We are lacking regional physicians.
End of the shift. Start of my voluntary night shift with the emergency doc at a different station.
I barely choose a room to sleep in. We get an assignment. We pick up the emergency doc from hospital (he/she usually works in the hospital and goes out if needed). 72yrs old. Collapsed. Normal breathing. Usually a code where someone just fainted for some reason, like dehydration or low BP or whatever and everything is fine after some fluids or something to drink. Not this time though. It is quite a far way for us to drive. We arrive. Patient on the floor. We only hear someone say: No breathing, no pulse. We start CPR. Rhythm analysis. No shock recommended. We see some spikes on the ECG. Fluids with Adrenaline. Endotracheal tube. No pulse though. Just electrical activity. But no muscular one. We try two more rhythm analysis and more adrenaline. We suspect an PEA (Pulseless electric activity, electrical activity intact, muscle contraction not existant). The doc is starting to think of stopping here and talks to the family. We continue our work. Doc comes back in. We check again. She has a pulse. We check her femoral pulse. Yes, I feel one. Ok. All thoughts of stopping gone. Now it’s time to start rounding things up. Get the patient in the car. We pack our stuff. Prepare a bit more. Sedate her a bit. She stabilizes. She falls back into no pulse. We do CPR again. Next analysis. Shes back. We finally get going. We prepare everything downstairs. We bring her down. Into the car. Seatbelts on. Off we go. To hospital. Shes stable for now.
We arrive at hospital. They put her on their monitors. They do an echo. Seems to be a massive pulmonary embolism. Let’s see if she makes it. For now she’s alive.
Prepare the car. Off we go back to the station. Thinking of food and a bed. I mean. Two hours have passed. But no. We get the next call.
58 yrs. Chest pain. Sweating. Oi. Sounds like a heart infarction. It’s again quite far to drive. We ask the colleagues, that are there 5 min later to come towards us. We meet them. We see the patient. ECG shows clear signs (STEMI) of an Myocard infarction. We get the patient into our car. So that the colleagues are free to go off again. We give him Aspirin, Heparin, Clodipogrel, Pain killers and stick the defib-paddles on his chest (just in case). Back to the only hospital close by that can do a PTCA. (Percutaneous transluminal coronary angioplasty is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle). That takes another half hour. No more troubles during the drive. We directly bring him into the PTCA room. Quite an interesting thing. I’ve only been in here once before. All these monitors, doctors, nurses, cannulas, etc. We are off though. We hardly ever see what happens to patients once we bring them in.
Our car is almost empty. We do not have any defib-paddles any more. We used quite some stuff on our two patients now. We could probably see one more patient without needing a refill. But no defib-paddles is a no go for a car with emergency doc. We go back to our station. Half hour drive. Talking of what was good. What wasn’t. What is improvable. Good talking of that. Makes you remember stuff for the next time! Back at the station we refill the car. Now it is 00.30 in the morning. I haven’t even eaten. I’m so hungry. I bought myself some tomato and mozzarella. Midnight snack. Yummy 🙂
Then off to documentation and everything else. 01.00 in the morning. Off to bed.
A solid 5,5 hours of sleep later we get called to a 30 yrs old lady with an epileptic seizure.
A (Breathing) +, B (Awareness) -. (Not to confuse with the ABCDE-Scheme, this is just a short info from our control room [German])
Into the car. Pick up the doc. 8 minutes later we’re at the scene. She’s fine. Still confused from her seizure. She knows about her epilepsy. Forgot to take her pills. We set a cannula. In case she seizes again we have a way to give meds. We take her to hospital. No more incidents.
Documentation. Refill of the car. Hand the pager to the day shift team. Let’s go home. I’m still tired. Off to bed again.