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Shift Change

I worked the overnight shift recently and had a call that got me thinking about an interesting pattern I’ve observed.

Around 0030 we were assigned a call to one of our local nursing homes known for “legit” calls at night. Why they are known for this will become evident. It came over as “labored breathing”. We take it on an easy lights/sirens run, unfortunately dealing with significant traffic due to it being the weekend. Riding the elevator upstairs I propose to my partner to guess what the answer will be to the obligate “how long have they been like this” question. She guesses 6 hours, my guess was 3 hours; I guess she is more cynical than me. But something made me tell her as the doors opened that my guess was actually “since the shift change”.

We find a nurse who points us in the direction of the room (I can hear the breathing already, not a good sign), and actually accompanies us to the room rather than conveniently disappear. The patient has two pulse oximeters on her fingers, and by my confused look the nurse then explains the first pulse ox showed 40%, so he got the second one to make sure it wasn’t broken. Nice. She’s satting in the 80’s now. He had put her on a non-rebreather mask at high flow, which is impressive considering many times I’ve arrived to find patients like this on a nasal cannula. She is barely alert, breathing is very distressed with sternal retractions and other accessory muscle use, has wheezing in all fields and is febrile. Ok, so, “how long has she been like this?” His answer: “since I came onto my shift around 11:30pm.” Nice. It’s now 0045, I didn’t bother asking why he waited to call us.

Our next call was a little comical. Another nursing home, it came over as “bradycardia”. Turns out the patient was in 3rd-degree heart block, had an altered mental status, along with cool extremeties. Not sure why, but I find heart blocks pretty interesting. The patient didn’t have a pacemaker. The funny part? The patient’s daughter wanted us to take her 30 miles away, when the closest hospital was about 1 mile away, and there are literally over 15 hospitals closer than the one she wanted. Yeah, she ended up at the nearest ER.

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Categories: EMT
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