Chest Pain

It’s weird how you can walk into a room and in what seems to be less than a second after looking at someone, you know they’re dead, even if only recently dead.

We were expecting a heart attack at most, instead we performed 37 minutes of CPR on a guy bleeding from his mouth and nose. After those 37 minutes, we had done all we could. Unfortunately for this gentleman, CPR, intubation, vasopressin, epinephrine, atropine, sodium bicarbonate and 360 joules of electricity was not enough.

On a side note, firefighters (in general) may not know much about medicine, but they can do DAMN good CPR.

Unlucky

We responded to a call for respiratory distress at a nursing home. We arrive to find a 91-year-old unconcious with labored breathing at 30 breaths per minute. His blood pressure is low at 90/44, and his pulse is a little quick at 90. He is attached to a nasal cannula at 4 lpm, with his mouth gaping open, so the cannula basically does nothing. Okay, I’m annoyed. I tossed him on a non-rebreather mask while I further assessed him.

I soon learn that he has been this way for nearly two hours. The nurse says they called now because he wasn’t getting better. Now, I’m pretty frustrated, but not exactly surprised. This is pretty typical handling of patients in distress by this nursing home’s staff. Oh, and I had to walk outside to get the nurse to even come in the room to give the story.

He was also still attached to his feeding tube, more annoyance. Okay, go out and ask them to remove it. The nurses reply, “you’re taking him to the hospital?” … you must be joking.

My partner and I prepared to the stretcher and I called dispatch to give the receiving hospital a courtesy call that we would be arriving with a patient in severe respiratory distress and are bagging him (using a “ambu bag” connected to 100% oxygen to pump air into his lungs).

I don’t like te hospital we are heading to, but it’s the closest so there’s nothing we can do. I make sure my partner is ready to go as he is bagging our patient in the back and I drive lights/sirens to the hospital.

As we roll in, me pushing the stretcher, partner bagging as we move, the nurse asks us if this is their “notification” after I announce “this is your notification”. Wow. Get our patient on their bed and give the disposition to the doctor. I say “he has a DNR, but no DNI”. Immediately, she looks to the nurse and says “don’t bag him, put him on a mask, he is DNR.” I remind her that he is not DNI and that he is not yet in respiratory arrest and therefore he may be artificially ventilated. She gives me a dirty look and says “in the hospital, DNR means no bagging no intubation”. I have never heard this before and am pretty confident that I have brought respiratory distress DNR patients to other hospitals that were promptly intubated. However, care was transferred and we have no say in their treatment. Attached to the monitor the patients O2 sat was 76% on a mask and he was looking tired.

Want to know who the doctor was tonight? The same one that I wrote about in my post “102”, where a medic and I brought in a DNR respiratory distress patient that died about 5 minutes after the doctor ordered her put on a mask instead of bagging. I feel this woman is playing god and deciding for their patients and the patient’s families that because they are old and have a DNR (no DNI mind you) that they should have little to know treatment. 25 minutes after being brought in, there was still no IV access established, despite his pressure of 90/50 on their monitor. I guarantee there is nothing in his DNR about no fluids. Pathetic, and I loathe the next time I have to take a patient in distress to that hospital and especially to that doctor.

Lazy Nursing Home Nurses

Anyone in EMS knows the stereotype of the lazy and incompetent nurses in nursing homes. The ones that barely look up from their screens when you arrive for a call and motions in the direction of the room. And then you find the patient who is obviously septic and has been that way for over a day. Of course, there are exceptions, and it usually has to do with the quality of the nursing home in general. Today’s nurse was fairly attentive, even pointing out the IV she established in the right hand for us. Too bad it didn’t even work and we had to start our own anyways haha. Oh well, “A” for effort.

Old

Transporting a man born in 1919 back from radiation treatment and I overhear him mumble to himself “I feel soo disabled.” I’m not sure why, but at that moment, that was one of the saddest things I’ve heard one of my patient’s say. I wonder whose decision it was to have this 90-year-old man undergo radiation treatment when apparently he doesn’t feel he has much quality of life as is, not to mention the stage III ulcer he has on his back that causes him 10/10 pain anytime he is moved the least bit.