I do love a good medical call. Don’t get me wrong, I don’t wish illness upon people, I just get really excited when I encounter someone suffering from something I can help with. I don’t mind the minor injuries and sickness that comes with not being prepared for your day but there is something about a person with an as yet unknown illness presenting in unique ways we must detect that makes me glad I paid attention in Paramedic School.
To be able to assess, combine a detailed history and list of meds, obtain an ECG and a BP then apply my diagnosis with interventions and reassessments is just…poetry.
But you all know where this is going if Lost Cause is involved.
Male, late 60s, over dressed for the weather, over weight for anything, pale cool and diaphoretic. Dude read the textbook.
I’m onscene early getting an irregular pulse rate, maybe 6:1 early. Chest Pain is a 7, down from a 10 after his nitro tab.
I begin taking a BP as I prep the nitro spray. as soon as I hear a “lub” at 160 I give him a spray.
“What do you need?” I hear from over my shoulder.
Lost Cause. The Paramedic unsure of the use of 12 lead ECG and stead fast in their belief that Paramedics can not diagnose. If Tor Eckman was on this rig they’d be a perfect matched set.
“Symptomatic chest pain with history, first nitro brought pain from 10-7, hypertensive, let’s get him on the monitor.”
“Do you want to goto the hospital today Sir?” Oh hell no. You did not just ask that of the clearly emergent cardiac patient infront of you. Did you?
“No, I think I’ll be OK” the patient says through gritted teeth giving a Levine’s sign visible from the space station.
“ECG please. Prep for a 12 lead and let’s get ready to move.”
Lead II tells me most of what we need to know but the lab will want to see what we found.
12 Lead, after coaching Lost Cause on lead placement, shows infarct in Lead I, II, V2, V3, V4 and V5, ischemia in V1 and V6 and Lead I is somewhere in between the 2.
All criteria are met, everything indicates PCI facility without delay and nitro until I’m out. (you know what I mean)
Lost Cause looks up from the monitor only after the interpretation has printed, “Well, Sir, we can’t,” slowly he turns his head towards me and lets out a small smile, “diagnose you here. We’re not Doctors. Do you want to go to the hospital?”
I stepped in.
“Sir, our assessment has led us to find your heart is under a massive amount of strain and needs immediate relief. We are going to treat your symptoms based on our diagnosis and get you to definitive care without delay.”
He agreed, Lost Cause let out a sigh. The same sigh he had later during a retraining session I’m told.
The next day, on an overtime, I ducked into St Closest and asked in on our patient. 90% occlusions in 2 arteries and he’s been stented. The 2 arteries we saw on the 12 lead which guided our diagnosis, treatment and reassessment.