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“Requesting ALS backup”

February 25, 2010 Leave a comment

Had a “legit” call the other night. We were already at a nursing home finishing up with another patient when dispatch keys us up and tells us there is a crew upstairs requesting ALS backup. I remember seeing a BLS bus downstairs, and I hoped that it was a different crew, because they should have already transported the patient if he was unstable according to regional protocols. The hospital is 5 minutes away, they were already on scene for 15, and it would take us 5 mins to get upstairs. Oh well I guess.

Upstairs we find chaos. 4 nurses in the room, all standing around watching the BLS crew bagging the patient who is unresponsive. Every time the tech bags, he squeezes a quick breath (with a bag that’s not inflated) and then releases the seal from the mask (as any EMT should know, this is wrong). His stomach is incredibly distended (probably from improper bagging), the crew can’t tell us if he has a pulse when I ask, and he obviously needs suctioning.

I check for a pulse, he has one, good. The monitor is attached. He has a normal rhythm, BP 130/90, pulse ox in the 80’s. My partner tells the nurses (nicer than probably was warranted) to get us a suction unit and sets up his intubation kit. The nurses finally tell us a useful piece of info, that his sugar was 36. Not good.

A nurse comes back with suction, finally, and then leaves.

I check for IV access, my partner drops up glucagon and gives the shot after we see it may take a minute to find a vein. The patient weighs probably 250 lbs, and is on dialysis. We get a line and push dextrose.

My partner tries to tube him. We discover the genius nurse came back and took away the suction (is it really a surprise the patient ended up this way?). I run to get it back. My partner inserts the Mac blade and attempts to pass the tube, no luck. In addition to being obese, he has an incredibly short neck. After instructing the crew to bag him again, properly, his O2 sat comes up into the 90’s.

His sugar is now 106. Another round of dextrose is given. He seems briefly aware of deep painful stimuli, but only for a moment. Last resort, we give narcan. No change. Time to leave.

A member of the BLS crew drives the bus while my partner and I take care of the patient in back. A notification is called into the nearest hospital. The driver heads for the hospital sirens blaring, down a terrible road (not his fault), making it nearly impossible to keep a seal while bagging. Cars ignore our sirens as usual, and he has to get on the PA to tell them to move.

The hospital staff is waiting for us, always nice, especially at this hospital. We give our report, and the doctor attempts to intubate. He is successful, but only after breaking one of the patients teeth with the blade (not entirely uncommon). It’s partially in the right bronchial mainstem, but he does have lung sounds on both sides. He notes that the patient has decerebrate posturing. His hands were awkwardly curled inward, and his eyes were deviated to the left. This is a BAD thing. It typically means some form of brain damage. Not a good day for this patient.

I forgot to mention, the nursing home staff told us the patient had a low sugar earlier, but they gave him glucagon. Why didnt they call EMS the first time he had a low sugar level? Guess it’s on their conciense that they didn’t call earlier, too bad that won’t make up for the harm to the patient.

Categories: EMT